Play and the pandemic: a rapid review of the literature and promising steps forward

Kelsey Graber
Kelsey is a PhD student at the Play in Education, Development and Learning (PEDAL) Centre at the University of Cambridge, supervised by Professor Paul Ramchandani and Dr. Christine O’Farrelly. Her research focuses on the intersection of play and children’s health, exploring children’s perspectives on play in health-related contexts such as paediatric hospitalisation and the COVID-19 pandemic. This rapid review was conducted with a team of PEDAL researchers and doctoral students, including: Dr. Elizabeth Byrne, Emily Goodacre, Natalie Kirby, Krishna Kulkarni, Dr. Christine O’Farrelly, and Prof Paul Ramchandani.

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The ongoing coronavirus (COVID-19) pandemic continues to be a health crisis among the global community. Children in virtually all countries have been impacted in terms of movement restrictions, school closures, playground and public park closures, and limited access to social and extended family networks. Though it appears that children are not the most medically at-risk group with regard to COVID-19 (Cruz & Zeichner, 2020), they remain a vulnerable population: large-scale health crises can have hidden, yet potentially profound and long-lasting, impacts on children’s health and education (Ramchandani, 2020). One of the many ways that children’s lives were impacted was a global and unprecedented shift in where, when, how, and with whom play occurs.

There is good reason to take changes to children’s play seriously. Emerging evidence suggests that school closure, home confinement, and social restriction during disease outbreaks could have serious consequences for children’s physical and mental health, highlighting the need for preventative support and early intervention (e.g. Brooks et al., 2020; Guan et al., 2020; Loades et al., 2020). Play may be one of the most essential ways to attend to children’s mental health, development, and learning, as it can be a way of coping with stress, anxiety, and trauma (Chatterjee, 2018) and provides stability, normalcy, and enjoyment (International Play Association, 2017).

Our team from the Play in Education, Development and Learning (PEDAL) Centre at the University of Cambridge sought out existing evidence that could help us understand what effects a global pandemic has on children’s play and what is the role of play in protecting children’s wellbeing amidst restrictive circumstances. We conducted a rapid review in March-April 2020 to synthesise the available literature, identify gaps, and hopefully inform the foundations of policies that affect children during moments of crisis.

What did we do?

We asked the following research questions:

1) How might quarantine and related restricted environments affect play in children and young people?
2) In what ways might play and related activities mitigate the impact of quarantine and restriction on children/young people’s health and education?

The full methodological protocol – including terminology definitions, search syntax, and inclusion criteria – can be found in our manuscript (Graber et al., in press).

As this review was conducted on a short timeline, we limited the databases searched (PsycInfo, ERIC, and PubMed) and abbreviated data extraction and synthesis strategies according to accepted parameters for streamlining traditional review methodologies (Ganann, Ciliska, & Thomas, 2010). Articles were title and abstract screened for eligibility. Where there was uncertainty about whether a paper met inclusion criteria, we discussed the content as a team and reached consensus. All articles selected for inclusion were also screened by at least one other author to ensure adherence to criteria.

What did we find?

Our search yielded 5,897 papers. Twelve met the inclusion criteria, and handsearching provided an additional three papers, totalling 15 studies. Study characteristics were extracted and key themes were identified via narrative synthesis. Detailed information about the breakdown of study methodologies, locations and settings, participants, and types of play engagement can be found in the full manuscript.

We first looked at how restrictive environments affect children’s play, and found some evidence that children’s access to play can be impacted by quarantine or isolation. In such situations, there can be barriers to play – such as unsafe spaces, scarcity of toys, lack of interaction with other children, and lack of time outdoors – and reports indicated that diminished opportunities for play were associated with inactivity and boredom (Kuntz et al., 1996; Mares, Newman, Dudley, & F., 2002; Veronese, Cavazzoni, & Antenucci, 2018). Overall, relatively few studies characterised changes in the nature of children’s play in restrictive environments.

Our second research question considered how play may mitigate negative impacts of restrictive circumstances. Studies alluded to mechanisms through which play might support children during quarantine or isolation (e.g. via coping, social connectivity, self-expression), though these were not explicitly evaluated. Most studies were qualitative, providing insights on perceived benefits of play in restrictive conditions and suggesting a role for play in attenuating negative effects of restrictions; however, further research is needed to test this hypothesis robustly. For example, one study looked at children in hospital isolation and, via drawings depicting play areas, friends, shared spaces, and playful technology, concluded that the children were expressing a desire for more social connectivity (Lambert, Coad, Hicks, & Glacken, 2014[6]). Research has shown that sociability is related to stress resilience in children (Zolkoski & Bullock, 2012), yet we require further study of play itself to understand whether it may serve as a protective factor for children in isolation. We also found that creative and arts-based activities were prominent in studies addressing this second research question, alluding to the notion that play affords opportunities for self-expression, and perhaps a mechanism for coping with restrictive circumstances.

Notably, none of the included studies directly examined the impact of restrictions on play due to infectious disease outbreak. This presented a challenge in generalising the findings to the unique affectations on children’s play in response to widespread health crisis-related restrictions.

Implications and Next Steps

This rapid review is the first to map literature on the impact of restrictions on children’s play experiences and play’s role in mitigating adverse effects of such restrictions. There remain significant gaps in understanding the effects on play and play’s subsequent influence on children’s health outcomes, especially during restrictive conditions due to an infectious disease outbreak.

Since we undertook and completed this rapid review in the Spring of 2020, many individuals (e.g. Moore et al., 2020) and organisations (e.g. EmergingMinds, PlayEngland) have reported on and advocated for the importance of children’s play throughout the pandemic response, and such pushes have resulted in exciting research initiatives. For example, the ESRC recently funded a project, led by Professor John Potter at the UCL Institute of Education, to explore how children have been playing and how games are emerging during the pandemic. Additionally, Dr. Helen Dodd at the University of Reading launched a Pandemic Play Archive project in collaboration with the Museum of English Rural Life in the hopes of exhibiting and preserving children’s unique play experiences that are being shaped by this health crisis.

In considering the implications of this review of the existing literature, the PEDAL Centre initiated a new study that puts both play and children’s voices at the forefront of the research. The Play in the Pandemic study, which I lead, focuses in on children’s own perspectives and experiences of playing during the pandemic and ways, if any, in which play is different. This work stems from principles of participatory qualitative research: children aged 3-10 were virtually interviewed and considered experts of their own experiences, especially regarding play – one of the most fundamental aspects of childhood.

As the pandemic endures, we can likely expect continued shifts in children’s play experiences, and new aspects within the content of their play that reflect the unprecedented, health-related circumstances surrounding them. Uncertain times can emerge as interesting moments of reflection and exploration – there is promising work being undertaken regarding children’s play during this health crisis that will enhance our collective understanding of the value of play, its meaningfulness to children’s health and wellbeing, and how play might help to support children coping with crisis.

Disclosure of interests

The PEDAL Centre receives philanthropic funding from the LEGO Foundation. The funder played no part in the direction or execution of this research.

Our full rapid review

Graber, K.M., Byrne, E.M., Goodacre, E.J., Kirby, N., Kulkarni, K., O’Farrelly, C. & Ramchandani, P.G. (in press). A rapid review of the impact of quarantine and restricted environments on children’s play and the role of play in children’s health. Child Care Health Dev.

 Link to the pre-print on the Open Science Framework 

Further reading 

  • News article on ESRC-funded UCL/University of Sheffield project: https://www.ucl.ac.uk/ioe/news/2020/oct/project-launches-examining-how-covid-19-pandemic-impacts-childrens-play
  • Pandemic Play: Capturing children’s experiences for future generations (Collaboration between University of Reading and MERL): https://merl.reading.ac.uk/merl-collections/research-projects/pandemic-play/

References

Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet, 395(10227), 912-920. doi:10.1016/S0140-6736(20)30460-8

Chatterjee, S. (2018). Children’s Coping, Adaptation and Resilience through Play in Situations of Crisis. Children, Youth and Environments, 28(2), 119-145.

Cruz, A. T., & Zeichner, S. L. (2020). COVID-19 in children: initial characterization of the pediatric disease. Pediatrics, 145(6).

Ganann, R., Ciliska, D., & Thomas, H. (2010). Expediting systematic reviews: methods and implications of rapid reviews. Implementation Science, 5, 10-19. doi:Artn 56

10.1186/1748-5908-5-56

Guan, H., Okely, A. D., Aguilar-Farias, N., del Pozo Cruz, B., Draper, C. E., El Hamdouchi, A., . . . Kontsevaya, A. (2020). Promoting healthy movement behaviours among children during the COVID-19 pandemic. The Lancet Child & Adolescent Health.

International Play Association. (2017). Access to Play for Children in Situations of Crisis. Retrieved from http://ipaworld.org/wp-content/uploads/2017/07/IPA-A4-ACCESS-TO-PLAY-IN-SITUATIONS-OF-CRISIS-TOOLKIT-LR.pdf

Kuntz, N., Adams, J. A., Zahr, L., Killen, R., Cameron, K., & Wasson, H. (1996). Therapeutic play and bone marrow transplantation. J Pediatr Nurs, 11(6), 359-367. doi:10.1016/S0882-5963(96)80080-7

Lambert, V., Coad, J., Hicks, P., & Glacken, M. (2014). Social spaces for young children in hospital. Child: Care, Health and Development, 40(2), 195-204. doi:10.1111/cch.12016

Loades, M. E., Chatburn, E., Higson-Sweeney, N., Reynolds, S., Shafran, R., Brigden, A., . . . Crawley, E. (2020). Rapid Review: The impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19. Retrieved from osf.io/p8q3d

Mares, S., Newman, L., Dudley, M., & F., G. (2002). Seeking Refuge, Losing Hope: Parents and Children in Immigration Detention. Australasian Psychiatry, 10(2), 91-96.

Moore, S. A., Faulkner, G., Rhodes, R. E., Brussoni, M., Chulak-Bozzer, T., Ferguson, L. J., . . . Vanderloo, L. M. (2020). Impact of the COVID-19 virus outbreak on movement and play behaviours of Canadian children and youth: a national survey. International Journal of Behavioral Nutrition and Physical Activity, 17(1), 1-11.

Ramchandani, P. (2020, 8 April). Covid-19: We can ward off some of the negative impacts on children. NewScientist(3277). Retrieved from https://institutions.newscientist.com/article/mg24532773-000-covid-19-we-can-ward-off-some-of-the-negative-impacts-on-children/

Veronese, G., Cavazzoni, F., & Antenucci, S. (2018). Narrating hope and resistance: A critical analysis of sources of agency among Palestinian children living under military violence. Child Care Health Dev, 44(6), 863-870. doi:10.1111/cch.12608

Zolkoski, S. M., & Bullock, L. M. (2012). Resilience in children and youth: A review. Children and Youth Services Review, 34(12), 2295-2303. doi:10.1016/j.childyouth.2012.08.009

Discussion

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Dear Kelsey

Very interesting and worthwhile project – I’m delighted to see the PEDAL Centre contributing to this important current issue regarding children’s mental health. I don’t know if you came across a review I did of older research studies in this area, but, if not, you might find something of interest in this. It has been very well received in the paediatric community:

Whitebread, D. (2017). Free Play and Children’s Mental Health. The Lancet Child & Adolescent Health, 1, November, 167-9.

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