The role of playgrounds in promoting children's health - a scoping review.

BACKGROUND: Active outdoor play is important for children's health and development, and playgrounds provide good places for play. However, the importance of playground use for health and well-being is unclear. Our scoping review aims to create an overview of all research on playground use and health benefits for children. METHODS: Scopus, Web of Science, SportDiscus, and PsycInfo were searched using two search blocks, focusing on 'playground' and 'children' respectively, for publications from 2000 to November 2023. The primary inclusion criterion was examining the relationship between playground use and positive physical, mental, or social health outcomes. Only papers published in English were reviewed. For each publication, we synthesized and condensed the results, categorizing them by playground setting, reported health outcome, participant age group, study design, methodologies, publication's country, year, and 'stage of evidence'. RESULTS: Data from 247 studies were extracted and nearly 80% of these publications were descriptive or exploratory studies. Fifty-two were intervention studies. Adding playground markings to schoolyards led to increased physical activity. Greening schoolyards had mainly positive effects on social and mental health. In Early Childhood Education and Care, renewing play structures had a positive effect on physical activity in three publications. All Public Open Space interventions we found were different, with mixed effects on health outcomes. CONCLUSIONS: The existing evidence provides good arguments for policy makers, city planners and school-leaders to invest in adding playground markings in schoolyards as this will likely result in more physical activity. The evidence for the health benefits of investing in new play structures indicated that tailoring the playground to local needs is important as 'one size does not fit all' and playgrounds need to be designed as engaging and interesting places for children's play if they are to generate health benefits. Investing in 'greening' playgrounds is likely to result in social and mental health benefits for children, but does not always result in more physical activity. The research field needs more efficacy and effectiveness studies, and in particular replication and scale-up studies to demonstrate which type of playground interventions are successful. PROTOCOL: The review protocol was registered at Open Science Framework ( https://doi.org/10.17605/OSF.IO/UYN2V ).

The association between 2D:4D digit ratio and sex-typed play in children with and without siblings.

The 2D:4D digit ratio is commonly used as a surrogate possibly reflecting prenatal testosterone levels. Indirect evidence comes from studies investigating the association between 2D:4D and human characteristics that likely relate to prenatal testosterone. In children, sex-typed play reveals large sex differences early in development and an influence of prenatal testosterone is likely. Findings on the association between 2D:4D and children's sex-typed play are heterogeneous and other influences on the development of sex-typed play have been suggested, most of all social influences like siblings, their sex and birth order. The current study examined the association between right and left 2D:4D, a proposed surrogate for prenatal testosterone exposure, which was assessed in right and left hands of N = 505 6-month-old children, and sex-typed play behavior, which was evaluated 3.5 years later using the Pre-School Activities Inventory (PSAI), and the influence of siblings. To capture differential effects of siblings' sex and birth order, dummy-coded variables were used reflecting having no siblings as well as older or younger sisters or brothers. Multiple regression models were used to investigate the association between PSAI scores and sex, right and left 2D:4D, being a singleton as well as having an older or younger sister or brother. It was shown that sex and having an older brother were significant predictors for sex-typed play. Effects were further disentangled by conducting separate regression analyses in boys and girls. In boys, a significant association between PSAI scores and having an older brother was revealed, in girls, no significant associations were found. Results are discussed highlighting the non-significant association between 2D:4D and children's sex-typed play, which weakens the applicability of 2D:4D as a surrogate reflecting influences of prenatal T. Further, the importance of social factors like siblings on children's sex-typed play is discussed.

Centring children's lived experiences in understanding the importance of play in hospitals.

BACKGROUND: Children have a right to participate in matters affecting their lives. With increasing regularity, children's perspectives are being sought regarding their health and health care experiences. Though there is evidence that children find play to be one of the 'best' aspects of hospitalisation, studies rarely focus on children's perspectives on play in hospital. METHODS: This qualitative study explored children's lived experiences of play during hospitalisation. Over five months, ethnographic observations were conducted on a paediatric oncology ward as well as interviews with 16 children ages 3-13 years. RESULTS: Using interpretative phenomenological analysis, children's expressions and experiences illuminated three key points: safety and comfort are integral to children feeling able to play in hospital; the value and efficacy of play is decided by children; and that play is a way for patients to be (and be treated as) children first. CONCLUSION: Hospitals can only be child-friendly if children find them friendly. Listening to and integrating children's perspectives in the discourse around the importance of play in hospital is essential for respecting children's rights and delivering person-centred paediatric healthcare.

Play partner preferences among groups of unfamiliar juvenile male rats.

Like many mammals, as juveniles, rats engage in play fighting, which in the laboratory is typically studied in dyads, and consequently, it is the researcher who determines a rat's play partner. In real-life conditions, a rat would have many partners with whom to play. In a previous study, we found that rats do prefer to play with some individuals more than others, and surprisingly, when given the choice, unfamiliar partners are preferred to familiar ones. In this study, we assessed partner choice when all the available partners are strangers. Eight groups of six unfamiliar juvenile male rats were observed for 10 min play trials. One of the six in each group was selected as the 'focal' rat and his play towards, and received by, the others were scored. Social networks revealed that five of the eight groups formed preferences, with preferred partners also engaging in more play with the focal rat. The mechanism by which these preferences were formed remains to be determined, but it seems that there are individual differences, potentially in the amount and style of play, that allow an individual to select the most suitable partner from a group of strangers.

Mobile Media Content Exposure and Toddlers' Responses to Attention Prompts and Behavioral Requests.

Importance: With personalized touch-screen tablets, young children can choose content and engage in play-like activities. However, tablets may also reduce shared engagement as the action of viewing or touching the screen is often not visible to nearby adults. This may impact communicative gazing and pointing, which is critical to the formation of shared awareness and in turn supports language development. Objective: To assess the association of tablet media content with toddlers' responses to joint attention prompts and behavioral requests. Design, Setting, and Participants: This cohort study took place at a behavioral research laboratory and included toddlers who were aged 18 to 32 months with neurotypical development who were recruited from a volunteer and community sample. Toddlers engaged with a real toy or 3 different types of tablet content (ie, viewing video of toy play, playing with a digital toy, or playing a commercial game) while an experimenter delivered joint attention prompts. Data were acquired from June 2021 November XX 2022, and data analysis occurred from January 2023 to May 2024. Main Outcomes and Measures: Main outcomes included child response to joint attention (number of prompts with joint attention response per number of prompts delivered) and child response to behavioral request (ie, the prompt on which the child responded to the behavioral request). Measures included crossed random effects, Wald tests, and likelihood ratio tests. Results: In this study, 63 toddlers were enrolled, and data from 62 were included (31 female [49%]; mean [SD] age, 26.1 [3.4] months; median [IQR] age, 25.0 [18.6-32.6] months). When toddlers were playing a commercial game on a tablet, they responded to fewer joint attention prompts (crossed random effects model, -0.15; 95% CI, -0.24 to -0.06 prompts) and male toddlers took longer to acknowledge a behavioral request (interaction of content and sex, -0.75; 95% CI, -1.36 to -0.17). The negative impact of the tablet game was larger as child age increased (τ = -2.30; 95% CI, -0.05 to 0; P = .03). Greater media use at home was associated with decreased responding to joint attention prompts during the tablet game (ρ = -0.47; P < .001), while better language skills were associated with more joint attention during play with a real toy (ρ = 0.31; P = .02). Conclusions and Relevance: In this cohort study, a touch-screen tablet game was associated with decreased joint attention among toddlers and they were less likely to respond to a behavioral request. In a laboratory setting, it was difficult for toddlers to engage in social-communicative interactions with adults when using a tablet media device.

Guides or guidelines for interacting and playing with medical complex children: a qualitative documentary research.

OBJECTIVES: to identify content on play and interaction with children with special health care needs recommended in clinical guidelines; analyze play and interaction activities applicable to children with special health care needs and complex care requirements. METHOD: qualitative documentary research based on guides, protocols, or guidelines on playing and interacting with children with special and living with complex care. Search terms in English (guidelines, playing OR play, complex needs, OR chronic disease) and in Portuguese ( guia, brincar ou brincadeiras, condições crônicas ) on the first ten pages of_Google Search ® . Thematic analysis was applied to the information extracted from the documents. RESULTS: a total of nine documents with similar content were grouped into units of analysis, keeping only the interacting and playing activities applicable to children with special health care needs and living with complex care requirements, namely stimulation of potential, stimulation of adult-child interaction, and stimulation of the senses (touch, sight, and hearing), to be carried out by health professionals and family caregivers in the different care contexts. CONCLUSION: interaction and play are potential promoters of adult-child interaction, with application in the stimulating and life-delivering complex care for children.

Play as Occupation: The State of Our Science and a Research Agenda for the Profession.

Occupational therapists view play through a unique lens. Considering play as a human occupation, and one to which all people have a right, places occupational therapists among a special group of professionals championing play. This State of the Science article seeks to increase awareness regarding the occupational therapy profession's contributions and to situate those contributions within the larger body of literature on play while also promoting further study of play as an occupation.

'Finding the play' - exploring with occupational therapists practice possibilities in the context of Irish schoolyards.

BACKGROUND: Research has identified diverse constraints to the adoption of school-based occupational therapy approaches and a lack of attention to addressing the barriers to children's play opportunities. Critical contextualised research is advocated to inform practice possibilities. AIMS/OBJECTIVES: This inquiry aimed to explore with occupational therapists their existing practices in Irish schoolyards to generate practice possibilities concerned with play, as an issue of occupational justice. MATERIALS AND METHODS: Using the theory of practice architectures, six occupational therapists from diverse sites of practice participated in the first phase of a critical action research process using dialogical focus group and occupational mapping methods. RESULTS: Three themes were generated (1) Existing practices as situated (2) (Re)mattering play and practices as occupations and (3) Practice possibilities - 'Finding the play' between responsiveness and responsibilities. A further interrelated dimension was how the research methods provided mechanisms of raising consciousness. CONCLUSIONS, AND SIGNIFICANCE: Alongside constructing knowledges on existing practices in an Irish context, this inquiry contributes to understandings of practices as socially embedded generative processes of 'finding the play', highlighting ethical responsibilities to make visible inequities reproduced in habitual practices and engage in relationships of solidarity to (re)construct alternative shared practices.

A 10-week play-based after-school program to improve coordinative abilities and physical fitness capabilities among adolescents: a randomized trial.

The average levels of physical activity in children are below the ideal, which may influence children's health and motor competence levels. Therefore, this study aimed to assess the impact of a 10-week play-based after-school program on 50 twelve-year-old students' anthropometric characteristics (body height and body weight), coordinative abilities (flamingo balance test and T-test agility), and physical fitness (sit and reach, 20-m sprint test, SLJ, CMJ, and handgrip). After baseline assessments, the students were randomly divided into two groups: one participating in a play-based after-school program (experimental group) and the other attending regular PE classes (control group). No differences were noted between the sexes. Analysis revealed baseline differences between groups in body weight, agility T-test, and right-handgrip, with no significant sex differences. Following the intervention, the experimental group demonstrated improvements in the 20-m sprint test (F(1,46) = 11.03, p < 0.01), flamingo balance test (F(1,46) = 9.16, p = 0.004), SLJ (F(1,46) = 5.30, p = 0.03), agility T-test (F(1,46) = 28.30, p < 0.01), and right-handgrip (F(1,46) = 6.59, p < 0.01). In summary, the results suggested that a 10-week play-based after-school program enhances coordinative abilities and physical fitness in 12-year-old children. This underscores the potential advantages of integrating play-based physical activities into schools to promote holistic health and fitness in children.

Ideational Praxis, Play, and Playfulness: A Cross-Sectional Study of Autistic Children.

IMPORTANCE: Assessment of praxis skills is an essential aspect of understanding autistic children's development of play and playfulness. OBJECTIVE: To assess the relationship and influence of ideational praxis skills on play skills and playfulness among autistic children. DESIGN: A cross-sectional study. SETTINGS: Homes, schools, and early care centers across Spain. PARTICIPANTS: Children ages 4 yr 6 mo to 6 yr 11 mo (45 typically developing [TP] and 45 with autism spectrum disorder [ASD]). OUTCOMES AND MEASURES: Student's t tests were used to compare means between the two groups. Pearson's correlation and multiple linear regression were used to determine possible effects of ideational skills on play and playfulness. RESULTS: Scores for the TP group were significantly higher than those of the ASD group on all play dimensions-space management, t(88) = 4.58; material management, t(88) = 5.86; pretense-symbolism, t(88) = 8.12; and participation, t(88) = 7.31-and on the Test of Playfulness (ToP), t(88) = 10.18, and Test of Ideational Praxis (TIP), t(88) = 4.38 (all ps < .001). Multiple linear regression revealed a statistically significant effect of TIP dimensions-space management, F(3, 41) = 4.83, p < .042; material management, F(3.41) = 8.49. p < .001; pretense-symbolism, F(3, 41) = 5.66. p < .002; and participation, F(3.41) = 7.81. p < .001-and on the ToP, F(3, 41) = 5.96. p < .002. CONCLUSIONS AND RELEVANCE: Ideational praxis skills combined with diagnostic information significantly predicted play skills and playfulness, highlighting the influence of ideation on play. Plain-Language Summary: This article provides data supporting the influence of ideational praxis skills on the play skills and playfulness of autistic children. Understanding how ideational praxis skills affect the ability to recognize and act on object affordances might promote greater possibilities for play interactions among autistic children.

The Occupation of Play.

The articles for the Special Section on Play highlight the complexity of play and the many ways occupational therapy practitioners study and promote play with children, families, and adults across individual, school, family, political, and cross-cultural settings. The authors of the articles in this issue view the importance of play across the lifespan and through multiple research lenses, including play preference, environmental supports for and barriers to play, the skills required to succeed in play, and the extent to which play is self-determined. The guest editors offer suggestions for how to enhance occupational therapy's voice in the study and promotion of play as a primary lifelong occupation.

The Bead Maze Hand Function Test for Children.

IMPORTANCE: There is a need for a pediatric hand function test that can be used to objectively assess movement quality. We have developed a toy-based test, the Bead Maze Hand Function (BMHF) test, to quantify how well a child performs an activity. This is achieved by assessing the control of forces applied while drawing a bead over wires of different complexity. OBJECTIVE: To study the psychometric properties of the BMHF test and understand the influence of age and task complexity on test measures. DESIGN: A cross-sectional, observational study performed in a single visit. SETTING: Clinical research laboratory. PARTICIPANTS: Twenty-three participants (ages 4-15 yr) were recruited locally. They were typically developing children with no illness or conditions that affected their movement. Interventions/Assessments: Participants performed the BMHF test and the Box and Block test with both hands. OUTCOMES AND MEASURES: Total force and completion time were examined according to age and task complexity using a linear mixed-effects model. We calculated intraclass correlation coefficients to measure interrater reliability of the method and estimated concurrent validity using the Box and Block test. RESULTS: Total force and completion time decreased with age and depended on task complexity. The total force was more sensitive to task complexity. The Box and Block score was associated with BMHF completion time but not with total force. We found excellent interrater reliability. CONCLUSIONS AND RELEVANCE: A familiar toy equipped with hidden sensors provides a sensitive tool to assess a child's typical hand function. Plain-Language Summary: We developed the Bead Maze Hand Function (BMHF) test to determine how well a child performs an activity with their hands. The BMHF test is a toy equipped with hidden sensors. Twenty-three typically developing children with no illnesses or conditions that affected their hand movement participated in the study. We asked the children to perform the BMHF test with both hands. Our study found that occupational therapists can reliably use the BMHF test to assess a child's hand function.

Does a high threshold of sensory responsiveness affect the development of pretend play in children on the autism spectrum?

BACKGROUND: Among the current avenues of research into the origins and development of the autism spectrum, those concerning atypical levels of sensory responsiveness are gaining increasing relevance. Researchers note the relationship of sensory responsiveness in children on the autism spectrum to their motor, cognitive and social development. Current research reports combines the responsiveness to sensory stimuli also with the development of pretend play. Aim of this study was to verify the relationship between the level of development of pretend play and the level of sensory responsiveness in children on the autism spectrum. METHODS: A study was conducted in a group of 63 children with a diagnosis of autism spectrum aged from 3 years and 7 months to 9 years and 3 months using: Pretend Play subscale from the Theory of Mind Mechanism Scale and Sensory Experiences Questionnaire version 2.1. RESULTS: The results revealed that elevated sensory hyporesponsiveness predicted low pretend play skills in the group of participating children. CONCLUSION: The study verified the contribution of the level of sensory hyporesponsiveness to explaining the atypical development of pretend play in children on the autism spectrum.

Juvenile social play predicts adult reproductive success in male bottlenose dolphins.

For over a century, the evolution of animal play has sparked scientific curiosity. The prevalence of social play in juvenile mammals suggests that play is a beneficial behavior, potentially contributing to individual fitness. Yet evidence from wild animals supporting the long-hypothesized link between juvenile social play, adult behavior, and fitness remains limited. In Western Australia, adult male bottlenose dolphins (Tursiops aduncus) form multilevel alliances that are crucial for their reproductive success. A key adult mating behavior involves allied males using joint action to herd individual females. Juveniles of both sexes invest significant time in play that resembles adult herding-taking turns in mature male (actor) and female (receiver) roles. Using a 32-y dataset of individual-level association patterns, paternity success, and behavioral observations, we show that juvenile males with stronger social bonds are significantly more likely to engage in joint action when play-herding in actor roles. Juvenile males also monopolized the actor role and produced an adult male herding vocalization ("pops") when playing with females. Notably, males who spent more time playing in the actor role as juveniles achieved more paternities as adults. These findings not only reveal that play behavior provides male dolphins with mating skill practice years before they sexually mature but also demonstrate in a wild animal population that juvenile social play predicts adult reproductive success.

Implementation of Learn to Play Therapy for Children in Special Schools.

IMPORTANCE: Play is the primary occupation in childhood and fundamental to occupational therapy practice. OBJECTIVE: To evaluate a play intervention in special school settings. DESIGN: Pre- and postinvolvement of a 7-mo play program. SETTING: Four special schools in Victoria, Australia, for children with IQs < 70. PARTICIPANTS: Thirty-eight children with diagnoses including intellectual disability, autism, and global developmental delay, 7 teachers, 2 speech pathologists, and 2 occupational therapists. INTERVENTION: Learn to Play Therapy for 1 hr per week over a 7-mo period. OUTCOMES AND MEASURES: Pre-post outcome measures included children's pretend play skills, language, social skills, emotional regulation, and academic competence. RESULTS: Mean age of 38 children (15 girls and 23 boys) at baseline was 5 yr 7 mo (SD = 0.46 yr). Results showed significant changes in children's pretend play (p = .03), ability to recall sentences (p = .02), social skills (p = .022), and academic competence (p = .012). Learn to Play had a large effect on children's narrative skills (d = 2.72). At follow-up, object substitution at baseline influenced expressive language (p < .001), narrative mean language utterance (MLU; p = .015), social skills (p < .001), and academic competence (p < .001); elaborate play at baseline plus time influenced social skills (p < .001); and elaborate play at baseline influenced narrative MLU (p =. 016), sentence recall (p = .009), and academic competence (p = .001). CONCLUSIONS AND RELEVANCE: Embedding pretend play within practice positively influenced children's language, narrative, social, and academic skills. Plain-Language Summary: This study adds to the limited research on play-based therapy programs in special school settings for children with an IQ of less than 70. Children participated in Learn to Play Therapy, during which an occupational therapist, who has observed and assessed the child's play and understands the child's play abilities, played beside the child. Learn to Play Therapy is a child-centered therapy that is used to increase a child's ability to self-initiate and enjoy pretend play. The positive impacts of supporting the children's pretend play ability were highlighted by increases in their pretend play, language, social skills, academic competence, and narrative language after participating in Learn to Play Therapy in their special schools.

Efficacy of a Remote Play-Based Intervention for Children With Prader-Willi Syndrome.

The current study examines the efficacy of an 8-week pretend play intervention targeting social-cognitive abilities in children with Prader-Willi syndrome (PWS), ages 6-9. PWS is a rare disorder associated with various social, emotional, and cognitive challenges linked to pretend play impairments, and for which interventions are sparse. Nineteen children were quasi-randomized to receive the intervention or be part of a waitlist control group. Participants who received the intervention (n = 10) demonstrated significant improvements in various components of pretend play, most notably in organization of play, which may generalize to broader social-cognitive gains. These findings provide evidence of the intervention's efficacy in enhancing pretend play skills and related social-cognitive abilities during this critical period of development for children with PWS.

Setting the Stage for Play: Exploring the Relationship Between Play Type and Positive Caregiving Strategies During Therapeutic Playgroup.

IMPORTANCE: Although play and positive caregiving strategies have been associated with child well-being, little is known about the relationship between play type and strategies used by caregivers in early childhood. OBJECTIVE: To investigate whether a relationship exists between play type and positive caregiving strategies. DESIGN: Exploratory correlational nonexperimental design. SETTING: Early childhood center. PARTICIPANTS: A convenience sample that included 60 observations of 14 caregivers during a therapeutic playgroup with 14 children with and without disabilities ages 15 mo to 3 yr (4 fathers, 3 mothers, 1 nanny, and 6 female early childhood teachers; age range = 30-39 yr). The caregivers were Black (n = 1; 7.1%), Hispanic (n = 5; 35.7%), and White (n = 8; 57.1%). OUTCOMES AND MEASURES: Positive caregiving strategies were scored using the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes. RESULTS: Results revealed no significant correlations between play type and positive caregiving strategy. There was a positive, significant correlation between caregiving strategies (affection, responsiveness, encouragement, teaching, and total; rpbs = .767-.970, n = 58, p = .001). The play type and caregiver type variables did not predict total positive caregiving strategies, F(2, 57) = 2.147, p = .126. One variable, caregiver type, added statistical significance to the prediction (p = .045). CONCLUSIONS AND RELEVANCE: The findings show no relationship between play type and positive caregiving strategy. Consideration of the types of caregivers participating in a therapeutic playgroup and their roles and use of positive strategies during play is worthy of further investigation. Plain-Language Summary: This study explored how parent and teacher caregivers supported children (both with and without disabilities) during a therapeutic playgroup at an early childhood center. Therapeutic playgroups are a special type of group play in which a trained professional helps guide play activities to support participation. The researchers wanted to see whether there was a connection between the type of play the children engaged in and how the adult caregivers interacted with them. The surprising finding was that there was no link between play type and how caregivers interacted. However, the caregivers often used positive strategies with the children, regardless of the play activity. Interestingly, type of caregiver (parent, teacher) seemed to make a slight difference in how they interacted with the children during playtime. Overall, this study suggests that more research is needed to understand how the types of play activities and objects might influence caregiver interactions during group play.

Joystick-Operated Ride-On Toy Navigation Training for Children With Hemiplegic Cerebral Palsy: A Pilot Study.

IMPORTANCE: Children with hemiplegic cerebral palsy (HCP) require intensive task-oriented training to make meaningful gains in affected upper extremity (UE) motor function. OBJECTIVE: To evaluate the acceptability and utility of single joystick-operated ride-on toy (ROT) navigation training incorporated into a modified constraint-induced movement therapy (CIMT) camp for children with HCP. DESIGN: Single group pretest-posttest design. SETTING: Three-wk structured CIMT camp. PARTICIPANTS: Eleven children with HCP between ages 3 and 14 yr. INTERVENTION: Children received group-based CIMT for 6 hr/day, 5 days/wk, for 3 wk. As part of camp activities, children also received ROT navigation training for 20 to 30 min/day, 5 days/wk, for 3 wk. OUTCOMES AND MEASURES: We assessed children's acceptance of ROT training by monitoring adherence and evaluating child engagement (affect and attention) during training sessions. The effects of ROT training combined with other camp activities on children's affected UE motor function were also assessed with the standardized Quality of Upper Extremity Skills Test (QUEST) and training-specific measures of ROT maneuvering accuracy. RESULTS: Children demonstrated high levels of training adherence, positive affect, and task-appropriate attention across weeks. Positive engagement during ROT sessions was correlated with independent navigation. We also found medium- to large-sized improvements in QUEST scores and toy-maneuvering capabilities after the combined program. CONCLUSIONS AND RELEVANCE: Our pilot data support the use of joystick-operated ROTs as child-friendly therapy adjuncts that can be incorporated into intensive UE training programs to improve adherence and motivation in therapy programs, boost treatment dosing, and promote affected UE motor function in children with HCP. Plain-Language Summary: This pilot study offers promising evidence that supports the use of modified single joystick-operated ride-on toys (ROTs) for children with hemiplegic cerebral palsy (HCP). The study used ROTs as one of several interventions that were part of a constraint-induced movement therapy (CIMT) camp program for children with HCP. The ROTs boosted children's motivation, their engagement with and adherence to training, and their practice in using their affected upper extremity (UE) for goal-directed activities in their natural settings. ROTs are accessible, age-appropriate, and easy-to-use devices for both occupational therapy clinicians and families to encourage children to use their affected UEs by challenging their perceptual, motor-planning, problem-solving, and movement-control skills in an enjoyable and engaging way. ROTs can be used within and outside conventional rehabilitation settings.

Reviewing the current state of legacy POP-brominated flame retardants in plastic childcare products and toys: a scoping review protocol.

BACKGROUND: Due to their adverse environmental and health impacts, brominated flame retardants (BFRs) are listed in Annex A of the Stockholm Convention for global elimination of production and use. Their health impacts include endocrine disruption, cancer, reproductive effects, and neurobehavioral and developmental disorders in children. Emerging literature suggests that legacy POP-BFRs are increasingly found in consumer products, including those used for and by children. The presence of legacy POP-BFRs in children's products is a big concern. Children are more vulnerable to chemical exposure risks than adults because their bodies are still developing and fragile. The rising problem is contributed to by the global push towards a circular economy that encourages responsible production and consumption by practising the recycling of waste materials. Waste materials such as electronic and electrical equipment plastics often contain POP-BFRs. POP-BFRs in waste materials are transferred into new products through recycling. The recycled products have become a potential source of exposure to legacy POP-BFRs for vulnerable populations, particularly children. Our scoping review aims to map and summarise the emerging literature. This information is needed to inform evidence-based policies to protect children from toxic exposures. METHODS: Our scoping review will follow a methodological framework proposed by Arksey and O'Malley. Peer-reviewed and grey literature on the topic will be retrieved from electronic databases and other relevant sites. Two reviewers will screen titles and abstracts, followed by a full-text review of studies for eligibility based on the established inclusion and exclusion criteria. Data will be extracted, and findings will be mapped in a table according to study settings, types of children's products tested, and concentration of legacy POP-BFRs in contaminated products. A map chart will be created to display how contaminated products are spread globally. DISCUSSION: Because of their unique vulnerabilities, children continue to suffer disproportionate exposures to toxic chemicals compared to adults. Information on potential exposures, particularly for children, is crucial to make evidence-based policies. We intend to map and summarise the emerging literature on legacy POP-BFRs in children's products. Findings will be disseminated to relevant stakeholders through publishing in a peer-reviewed scientific journal and policy briefs. SYSTEMATIC REVIEW REGISTRATION: The protocol is registered with the Open Science Framework ( https://doi.org/10.17605/OSF.IO/7KDE5 ).

Examining associations between physical activity context and children meeting daily physical activity guidelines: the role of outdoor play, sports, and other organized activities.

Background: Less than one-quarter of US children meet physical activity (PA) guidelines. Understanding the context in which PA occurs and how these contexts may play a role in meeting PA guidelines is an essential step toward developing effective behavioral interventions. The purpose of this study was to examine associations between PA context (sports participation, participation in other organized physical activities, active travel to school, and outdoor play) and the number of days children met PA guidelines in a representative sample of children living in Texas. Methods: We analyzed cross-sectional data from a statewide sample of fourth-grade children in Texas who completed the 2019-2020 Texas School Physical Activity and Nutrition (Texas SPAN) survey. The Texas SPAN survey was designed to monitor the statewide prevalence of overweight/obesity among school children and assess habitual self-reported obesity-related behaviors, including diet and PA. Weighted Poisson regression models were employed to examine the associations between PA contexts (sports participation, participation in other organized physical activities, active travel to school, and outdoor play) and the number of days children met PA guidelines, adjusting for sex, race/ethnicity, overweight/obesity, urban-rural status, and economic disadvantage. Results: A total of 16.7% of fourth-grade children met physical activity guidelines every day during the week (mean age = 9.4 ± 0.6 years; female = 48.7, 51.8% Hispanic, mean days meeting PA guideline = 3.6 ± 2.3 days). One in ten (11.2%) children did not meet daily PA guidelines on any day of the week, and 72.1% met them between 1 and 6 days. Participating in sports (b = 0.22, 95%CI:0.14, 0.30), any other organized physical activities (b=0.13, 95%CI:0.017, 0.19), and playing outdoors 1-3 days (b = 0.25, 95%CI:0.04, 0.46) and 4-7 days in the past week (b = 0.77, 95%CI:0.57, 0.97) was significantly and positively associated with the number of days children met PA guidelines. Conclusion: Participating in sports, participating in other organized physical activities, and playing outdoors may beneficially influence the number of days children meet PA guidelines. PA programs should consider these contextual factors and investigate how to promote organized activities and outdoor play effectively and appropriately among children.