The most powerful way children learn isn't only in classrooms or libraries but rather on playgrounds and in playrooms, according to the American Academy of Pediatrics (AAP). In fact, a new AAP report states, "The importance of playful learning for children cannot be overemphasized."

According to the AAP clinical report, released Aug. 20, children's play is not frivolous. Rather, play is brain building, a central part of healthy child development, a key to executive function skills, and a buffer against the negative impacts of stress. Furthermore, play builds the bond between parent and child.

"We're recommending that doctors write a prescription for play, because it's so important," said pediatrician Michael Yogman, MD, FAAP, lead author of the AAP report. "Play with parents and peers is fundamentally important for developing a suite of 21st century skills, including social, emotional, language and cognitive skills, all needed by the next generation in an economically competitive world that requires collaboration and innovation. The benefits of play cannot really be overstated in terms of mitigating stress, improving academic skills and helping to build the safe, stable and nurturing relationships that buffer against toxic stress and build social-emotional resilience."

The AAP will publish "The Power of Play: A Pediatric Role in Enhancing Development in Young Children" in the September 2018 Pediatrics (published online Aug. 20). The report updates a previous clinical report published in 2007. The 2018 version includes new information about the links between play and learning, and research that finds play is an important buffer of toxic stress.

Research has provided numerous examples of the importance of play for healthy child development.

In a study, 3- to 4-year-old children, anxious about entering preschool, were twice as relieved of their stress when allowed to play with teachers or peers for 15 minutes, compared to peers who listened to a teacher reading a story.

Research also found preschool children with disruptive behaviors were less stressed and less disruptive when the teacher played with them regularly one-to-one over the course of a year, compared with peers who had routine interactions.

However, children's playtime has been threatened by societal changes.

From 1981 to 1997, children's playtime decreased by 25%, and 30% of kindergarten children no longer have recess, which has been replaced by academic lessons, according to research published in Advances in Life Course Research.

A national survey of 8,950 preschool children and parents found that only 51% of children went outside to walk or play once a day with a parent.

And surveys have found as many as 94% of parents have safety concerns about outdoor play.

Despite research that links television watching with a sedentary lifestyle and greater risks of obesity, the typical preschooler watches 4.5 hours of television per day, according to media research.

"Media use such as television, video games, smartphone and tablet apps are increasingly distracting children from play. It's concerning when immersion in electronic media takes away time for real play, either outdoors or indoors," said pediatrician Jeffrey Hutchinson, MD, FAAP, a co-author of the report.

"Although active engagement with age-appropriate media can be beneficial for older children, especially if supported by co-watching or co-play with peers or parents, real time social interactions and play are superior to digital media for learning."

The AAP recommends that learning is better fueled by facilitating the child's natural urge to play rather than through external motivations such as test scores, and offers several important tips for parents, pediatrician and educators.

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

Play starts early and continues through a child's development. New parents should observe and respond to the nonverbal behavior of infants during their first few months of life. For example, when a baby smiles at you, smile back. Peak-a-boo is another important game.

Educators, pediatricians and families should advocate for and protect unstructured play and playful learning in preschools and schools because of its numerous benefits.

Teachers should focus on playful rather than didactic learning by letting children take the lead and follow their own curiosity.

Promote recess and physical activity for children every day.

"The next time your child wants to play with you, say yes. It's one of the best parts of being a parent, and one of the best things you can do for your child," Dr. Yogman said. "Play helps children learn language, math, and social skills, and lowers stress. Play is important both for children and their parents since sharing joyful moments together during play can only enhance their relationship."