P0052 - Nature Contact and Children's Health: A Systematic Review

Background: Daily outdoor play for children has been encouraged by the American Academy of Pediatrics, which has long recognized the importance of play for promoting children’s health and social-emotional development. The COVID-19 related school closures and activity restrictions have highlighted potential inequities in opportunities for children to play outdoors. There is increasing evidence, of varying quality, that outdoor environments containing elements of nature may offer benefits for children’s health that come specifically from the nature contact experienced. However, one barrier to increasing support for nature contact from the health care community has been the lack of systematically and rigorously reviewed accessible evidence on this topic.

Objective: Our goal was to conduct a systematic review to evaluate and aggregate the evidence regarding the impacts of nature contact on children’s health and well-being.

Methods: We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. The database search was conducted using PubMed, CINAHL, PsychInfo, ERIC, Scopus, and Web of Science in June, 2018. In all searches, the first element included nature terms (exposure occurring birth to 18 years) and the second element included child health outcome terms (physical, mental, and cognitive/learning outcomes). Studies that focused only on outdoor time or play, without nature elements, were excluded. Two reviewers evaluated each study and reached consensus for: 1) review inclusion; 2) determination of nature exposure category; and 3) quality assessment using the Mixed Methods Appraisal Tool (MMAT). The MMAT is a reliable and valid quality assessment metric; a summary score ≥ 80% was considered high quality.

Results: Of the 8756 studies initially identified, 163 were included in the review. Most studies included were observational (n=159) and examined the presence of natural environments (green space) around residential or school locations (n=89). Our quality assessment suggested that several high quality studies were present within each nature exposure category. We categorized studies into one of the following types of nature exposure: green space/park proximity to home (n=74, 83% high quality), green space activity (n=27, 37% high quality), green space/park proximity to school (n=14, 93% high quality), wilderness exposure (n=11, 9% high quality), gardening (n=6; 25% high quality), greening intervention (n=5, 40% high quality), outdoor classroom (n=5, 0% high quality), and nature walks (n=2, 0% high quality), and other (n=19, 27% high quality). Studies focused on a range of outcomes including physical health (n=111, 68%), mental health (n=36; 22%), and cognitive/learning outcomes (n=16, 10%).

Conclusions: Our systematic review summarizes literature available regarding the impact of nature exposure on health outcomes in children, with an emphasis on high quality studies. Ultimately, we seek to make this evidence accessible to pediatricians to base clinical recommendations, develop health-promoting programs and policies, and guide future research.