Emerging evidence suggests that childhood physical, cognitive, and social and emotional health and wellbeing is worsening across low and high-income counties (1, 2). Globally, an estimated 41 million infants and young children (0-5 years) are living with overweight or obesity (1) and 10-20% of children and adolescents experience mental disorders (2). In Scotland, a similar pattern is evident with 22.4% of children living with overweight or obesity when starting primary school (3). As children mature into adolescence and adulthood, these negative health outcomes continue and exacerbate related conditions, including type 2 diabetes, cardiovascular disease, cancer and chronic depression (1, 2). Excess weight and poor mental health are also likely to affect behaviour in childhood and key cognitive outcomes important for educational attainment (4, 5). These negative health outcomes are influenced by complex and interrelated political, environmental, social and individual factors. These have caused children to live increasingly sedentary lifestyles dominated by screen use and low levels of physical activity which begin to decline around the age children start primary school (6, 7).
Providing young children with opportunities outdoors, particularly in nature, could potentially offer an effective strategy for enhancing children's physical, cognitive, and social and emotional wellbeing (8, 9). When children are outdoors, they engage in higher levels of physical activity (10-12); important for improving overweight and obesity, bone and skeletal health, motor skills, and cognitive development (13, 14). Experiences in nature, which can include trees, vegetation, grass, hills, water, sand and other elements may provide additional affordances beyond the benefits of the outdoors alone (15, 16). These natural elements allow children to diversify their play, develop their motor skills and engage in physical activity through climbing and navigating varied surfaces (17, 18). Two separate systematic reviews have suggested that exposure to nature improves emotional wellbeing, overall mental health, resilience, self-esteem and reduced stress in children and adolescents aged 0-18 years (8, 9). There is less evidence on the effect of nature on learning and cognitive outcomes (8).
Key evidence missing that this review addresses:
Evidence primarily exists in older children and adolescents and looks beyond just educational settings. This means that it is not known what specific benefits nature-based early learning and childcare (ELC) provide children and the mechanisms by which potential benefits may occur. To our knowledge, no high-quality evidence synthesis exists that looks at the effect of nature-based ELC on young children's (2-7 years) health, wellbeing and development.
The early years are an important time to intervene as children are rapidly developing across a range of physical, cognitive, and social and emotional outcomes (19). Furthermore, the majority of children aged 3-5 years attend ELC (98%; n= 96,375) in Scotland in 2019 highlighting that educational settings offer a potentially cost-effective and sustainable solution to ensuring that children are provided with opportunities to improve health outcomes (14).
Currently, the Scottish Government is committed to increasing free ELC entitlement for all 3- and 4-year olds (and eligible 2-year-olds) from 600 hours to 1140 hours (20). To achieve this progressive policy, the ELC Directorate has made a substantial investment in the workforce, infrastructure and new, innovative models of delivery. Scotland has looked to Norway, Denmark and Finland to explore increasing full day outdoor nature-based ELC, indoor/outdoor and satellite settings. These models aim to promote high-quality, accessible, and affordable nature-based experiences for young children attending ELC and enhance their health, wellbeing and development (21). This has seen Scotland become the UK and a global leader in promoting nature-based experiences in early years education.
With increased nature-based provision in ELC, it is important to understand what the possible benefits and harms are to children's health, wellbeing and development and the process by which they occur. Therefore, the ELC Directorate has commissioned researchers at the MRC/CSO Social and Public Health Sciences, University of Glasgow to conduct a novel and timely systematic review to look at the existing global evidence on nature-based ELC on children's physical, cognitive, social, emotional and environmental development. This will inform future policy, planning, and practice recommendations for their ELC as outdoor, nature-based provision increases. The relevance and timeliness of this report have also increased with the emerging interest of outdoor education on limiting the spread of COVID-19.
Review aim and research questions
The aim of this systematic review is to synthesise existing global literature to answer the following research questions:
1. To what extent does attending nature-based ELC influence children's physical, cognitive, social, emotional and environmental outcomes?
2. What are children's, parent's and/ or practitioner's perceptions of nature-based ELC on children's physical, cognitive, social, emotional and environmental outcomes?
3. What are the potential mechanisms by which nature-based ELC improve children's physical, cognitive, social, emotional and environmental outcomes?
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