Outdoor risky play and health-related outcomes in children aged 3–12 years: A mixed-methods systematic review
Rachel Ramsden, Alethea G. Jerebine, Gemma Brailey, Ellen Beate Hansen Sandseter, Hebah Hussaina, Avril Johnstone, Bryony Longdon, G. J. Melendez-Torres, Rachel Nesbit, Mariana Brussoni, Helen F. DoddBackground
Outdoor risky play and its relationship with children’s health, development and well-being have garnered significant attention in recent years.
Objective
This systematic review synthesised existing evidence on associations between children’s outdoor risky play and health outcomes.
Methods
A systematic search of five electronic databases (SportDiscus, MEDLINE, PsychInfo, ERIC, and CINAHL) was initially conducted in December 2023 and updated three times (April 2024, March 2025, May 2026) during the review development. Studies were eligible if they examined outdoor risky play in children aged 3–12 years and assessed a health outcome. Studies that did not use empirical data or did not have an accessible full-text were excluded. Five reviewers independently screened all articles and two separate reviewers resolved discrepancies. Quantitative narrative synthesis and qualitative framework synthesis were completed, and a mixed-methods synthesis occurred using a Pillar Integration Process.
Results
A total of 74 studies met the eligibility criteria for inclusion (48 quantitative; 19 qualitative; 7 mixed-methods). Six health domains (physical health, mental health and well-being, aggression, social, cognitive, and risk competence and injury) and four risky play exposures were identified: general risky play (n = 13 studies); environments that support risky play (n = 21); independent mobility (n = 19); and rough-and-tumble play (n = 21). General risky play and risky play supportive environments were positively associated with health outcomes across physical, mental health and well-being, social, cognitive, and risk competence domains. Independent mobility was positively associated with physical activity, with insufficient evidence to determine associations for other domains. Evidence for rough-and-tumble play was inconsistent across all domains, except for a negative association with aggression (i.e., increased aggression). The overall quality of evidence was low-to-moderate.
Conclusion
Outdoor risky play shows promising associations with children's health outcomes. The low number of studies in some health domains and need for higher quality evidence preclude firm conclusions and provide direction for further research in this field.
Registration
International Prospective Register of Systematic Reviews (PROSPERO) (No. CRD42023488023).