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American Academy of Pediatrics Suggests “Prescriptions for Play” for Children Ages Two Years and Younger

October 8, 2018

In August 2018, the American Academy of Pediatrics (AAP) published a paper that includes a “prescription for play” for children ages 2 years and younger.

For those who are unsure what “play” might be, AAP offers the following general definition:

The definition of play is elusive. However, there is a growing consensus that it is an activity that is intrinsically motivated, entails active engagement, and results in joyful discovery. Play is voluntary and often has no extrinsic goals; it is fun and often spontaneous. Children are often seen actively engaged in and passionately engrossed in play; this builds executive functioning skills and contributes to school readiness (bored children will not learn well). Play often creates an imaginative private reality, contains elements of make believe, and is nonliteral.

The paper, entitled, “The Power of Play: A Pediatric Role in Enhancing Development in Young Children,” actually includes the suggestion for pediatricians to defend play by formally prescribing it as part of the child’s wellness visit:

Just as pediatricians support Reach Out and Read, encourage playful learning for parents and infants by writing a “prescription for play” at every well-child visit in the first 2 years of life.

Below is a summary of the takeaways from the paper, which is not restricted to children two years and younger, including confronting “more digital distractions,” and “facilitating the child’s intrinsic motivation through play rather than extrinsic motivations, such as test scores”:


  • Cultural shifts, including less parent engagement because of parents working full-time, fewer safe places to play, and more digital distractions, have limited the opportunities for children to play. These factors may negatively affect school readiness, children’s healthy adjustment, and the development of important executive functioning skills;

  • Play is intrinsically motivated and leads to active engagement and joyful discovery. Although free play and recess need to remain integral aspects of a child’s day, the essential components of play can also be learned and adopted by parents, teachers, and other caregivers to promote healthy child development and enhance learning;

  • The optimal educational model for learning is for the teacher to engage the student in activities that promote skills within that child’s zone of proximal development, which is best accomplished through dialogue and guidance, not via drills and passive rote learning. There is a current debate, particularly about preschool curricula, between an emphasis on content and attempts to build skills by introducing seat work earlier versus seeking to encourage active engagement in learning through play. With our understanding of early brain development, we suggest that learning is better fueled by facilitating the child’s intrinsic motivation through play rather than extrinsic motivations, such as test scores;

  • An alternative model for learning is for teachers to develop a safe, stable, and nurturing relationship with the child to decrease stress, increase motivation, and ensure receptivity to activities that promote skills within each child’s zone of proximal development. The emphasis in this preventive and developmental model is to promote resilience in the presence of adversity by enhancing executive functioning skills with free play and guided play;

  • Play provides ample opportunities for adults to scaffold the foundational motor, social–emotional, language, executive functioning, math, and self-regulation skills needed to be successful in an increasingly complex and collaborative world. Play helps to build the skills required for our changing world; and

  • Play provides a singular opportunity to build the executive functioning that underlies adaptive behaviors at home; improve language and math skills in school; build the safe, stable, and nurturing relationships that buffer against toxic stress; and build social–emotional resilience.

In its suggestion that pediatricians write formal prescriptions for play for children under two years, the AAP clearly believes that the role of play in the development of the youngest children needs defending.

I am surprised that the AAP limits its suggestion for the prescription to two-year-olds; the threats to healthy development, including unhealthy exposure of children to digital devices and the test-centric school culture forcing small children into age-inappropriate inactivity in the name of academic achievement demonstrate the need to defend play in the lives of older children, as well.

I wonder how elementary schools would handle parents showing up with formal, medical prescriptions for children to have one or two hours of unstructured play time each day.

Regularly-scheduled, unstructured play for young children used to be a given; it was called “recess.” But that was before the survival of districts, schools, and teachers came to depend upon ever-rising test scores.

For school leaders defending recess for elementary students, I commend you.

For students in less fortunate school environments: Perhaps a prescription for play might prove useful.



Want to read about the history of charter schools and vouchers?

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Schneider is a southern Louisiana native, career teacher, trained researcher, and author of two other books: A Chronicle of Echoes: Who’s Who In the Implosion of American Public Education and Common Core Dilemma: Who Owns Our Schools?. You should buy these books. They’re great. No, really.

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From → Early Childhood

  1. Laura H. Chapman permalink

    Sad that a prescription for play needs to be considered. Even so I agree that the two-year old marker should be revised. I love the idea of kids showing up with a prescription for play-time..recess. I wonder if any state ESSA plan put recess into the accountability scheme,especially for elementary school, with PE and health combined in the upper grades.

  2. Jill Reifschneider permalink

    Right on. Thank you.

  3. “I wonder how elementary schools would handle parents showing up with formal, medical prescriptions for children to have one or two hours of unstructured play time each day.”

    More likely than not they’d toss it in the trash can. Adminimals do as adminimals do!

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