We live in a digital world, so children are exposed to screens in many aspects of their lives—from schoolwork to entertainment to social connection. As children’s screen use has increased, researchers, clinicians, parents, and educators have raised growing concerns about attention, focus, and attention deficit hyperactivity disorder (ADHD)-related behaviors, such as inattention or impulsivity (Malesu, 2025). A recent study by Malesu (2025), in which more than 8,000 children from age 9 to early adolescence were followed, adds an important perspective to this conversation and suggests that screen time use does not affect children in the same way. Unlike television or video games, higher social media use was associated with gradual increases in children’s difficulty sustaining attention over the 4 years researchers followed them (Malesu, 2025).

Much of the existing research on screen time has treated all digital activities as equal modes of interaction and has grouped all virtual activities together, from texting and social media to gaming and television viewing. The Malesu (2025) study takes a more detailed approach and uses participants from the Adolescent Brain Cognitive Development (ABCD) Study (2023), which followed more than 11,000 children in the United States from age 8 to early adolescence. In the ABCD (2023) study, Brown and colleagues tracked how much time children typically spent participating in different types of digital activities, including social media, video games, and television or videos (Brown et al., 2023). Then, researchers looked at whether the amount of time children spent on social media, video games, and watching television was linked to changes in their attention and hyperactivity symptoms over several years. These data were derived from parent reports (Malesu, 2025).

Study Findings

The Malesu (2025) study found an important pattern. Children who spent more time on social media showed small but steady increases in attention problems over time (Malesu, 2025). This pattern was not seen with video game usage or television viewing (Malesu, 2025). Malesu also examined the causal flow between social media use and attention problems. The results suggested that children weren’t turning to social media because they were already struggling with attention, but, instead, higher social media use usually occurred first, and increases in attention problems followed (Malesu, 2025).

One possible reason social media stood out, compared to video games and television, may be related to how these platforms are designed. Unlike television or many video games, social media is built around and demands constant interaction. Notifications, messages, and endless scrolling encourage youth to switch their attention quickly and often, which can make staying focused for long periods of time more difficult. Over time, regularly using apps designed to create ongoing engagement may influence how children manage their attention, especially during a stage of brain development when focus and self-control skills are still growing, which occurs during adolescence (Malesu, 2025).

The Malesu study reveals that social media use may have small effects on shaping individual children’s behavior. Social media use, alone, is unlikely to cause major attention problems or lead directly to an ADHD diagnosis (Malesu, 2025). However, when large numbers of children are affected, even if the impact is small for each child, the impact can be cumulative. For example, small increases in attention difficulties across many children could mean more students struggling in school, feeling overwhelmed by tasks that require sustained focus, or experiencing attention challenges that become more noticeable over time (Malesu, 2025).

Takeaways for Parents

For parents, findings from the Malesu (2025) study may offer a more balanced way to think about screen time usage:

• Social media does not cause ADHD. The study suggests that social media use does not directly cause ADHD. In addition, this study put forth that screen use is not inherently harmful.
• Not all screen time usage is the same. Social media use may require different levels of attention than watching television or playing many types of video games.
• Small effects can add up. While the impact on one child may be modest, widespread increases in attention difficulties can build and affect many families and classrooms.
• Timing matters. Limiting social media use during homework time, family time, and before bed may help support a child’s focus and sleep.
• Balance is key. Engaging in healthy sleep, physical activity, and face-to-face interactions and receiving emotional support play important roles in children’s attention abilities and overall well-being.
• Open conversations are powerful. Talking with children about how engaging in social media use makes them feel can be more effective than only implementing rules and restrictions.

As families navigate an increasingly digital world, they need to remain aware of their children’s screen usage activities and set and enforce thoughtful boundaries for digital activity use. Paying attention to how much time children spend on screens and how they use them can help support children’s ability to focus, learn, and thrive.

References

Brown, S. A., Jernigan, T. L., & Dowling, G. J. (2023). The Adolescent Brain Cognitive Development (ABCD) Study. Health Psychology, 42(12), 840–841. https://doi.org/10.1037/hea0001353

Malesu, V. K. (2025, December 11). Screen time and ADHD: Why social media stands out from gaming and TV. News Medical Life Sciences. https://www.news-medical.net/news/20251210/Screen-time-and-ADHD-why-social-media-stands-out-from-gaming-and-TV

Social media can enhance connections and impact relationships and experiences for the individuals who use it. Though many age groups use social media, the Pew Research Center (2024) has found that nearly 9 in 10 teens used at least one form of social media. It was also found that around 60% of teens this age use Snapchat and 59% used Instagram (Pew Research Center, 2023). With these statistics showing frequent usage, parents and caregivers may want to talk with their teens regarding their teens usage and help them learn how to navigate social media in a way that sets them up for success.

Set them up for Success

As a parent, you may be knowledgeable about how your child is using social media, and you may be having open conversations with them about appropriate behaviors regarding social media use. If not, consider engaging in a conversation that could begin by discussing with you child who they are connecting with on their social media platforms—likely their friends and peers. From there, talk with your teen about how they can speak to others with kindness and respect. You may want to ensure your teen understands that those they are communicating with are real people even though they may be physically far away. Remind your teen that they should treat others on social media as they would treat someone in person and as they would like to be treated. Furthermore, be sure your teen realizes that social media works through the use of algorithms, and users are shown, or purposefully connected to, content that correlates with words they use, whom they interact with, and content they engage with.

Connect With Friends

Your teen may be eager to add all of their peers on their social media platforms. However, not all of their peers may be their friends. Talk with your child and discuss who their friends are and what kinds of behaviors they value in their friendships, like respect and honesty. Try using questions like those below to talk about which peers they should add on their social media.
– Whom do you consider a friend?
– What types of activities do they like?
– What common interests do you have?
– Are there behaviors or activities they participate in that you don’t agree with?
– Do you think the type of social media activity they have is positive?
– Are they going to be a positive aspect to your social media presence?

Remind your teen to ask their friends if they are allowed to be added to specific social media platforms before sending invites.

Speak With Kindness

Whether we are talking with others face-to-face or on social media, what we say to people matters. Children may need reminders to speak to others online, or via social media, in a friendly and kind manner just as they would in an in-person situation. Try talking through questions, like the ones outlined below, to help your child consider suitable language as they comment on others’ posts, updates, or shares. You may wish to remind your child that their comments could be seen by many other people and these “others” may not be people they know.
– Would you say this to someone in person?
– Would you want others to see that you have said this?
– How do you think others may feel once they see you have made this statement?
– Would you want something like this said to you?

Children need to understand that when they comment or share an opinion or statement online, those words can be (and are) seen by others whom they may or may not know and who are physically close or distant from them. Though perhaps difficult for teens to comprehend, the comments and statements they make, whether positive or negative, can never be truly retracted or deleted; thus, implications and consequences may never go away. Talk to your teen about practicing empathy and the repercussions of having everyone see what they are saying.

Like What You Like

Social media is designed to show you information and suggestions that you will like and enjoy. By following, sharing, and commenting on social media accounts that are based around your interests, you are gaining access to specific platforms that will adjust and show you more content that is similar. The more you interact with specific content, the more like material you will see.

Talk with your teen and discuss their interests. Perhaps, bring up the influential people within those interests, such as athletes, artists, and influencers. Discuss how those people present themselves and use that information to show your teen the positive and negative perceptions these individuals display. Discuss how your teen views certain actions and determine how your teen may be perceived by others depending on their comments, actions, and reactions. Take the next step and ask your teen if they are pleased with what that perception may be. Try using the following questions to see if the influential people you discussed act in a way that aligns with your and your teen’s views:
– What are they known for?
– How do they treat and talk about others?
– What causes do they advocate for?
– How do people generally view this person?
– Is this person someone whom you and your teen think others should look up to? Why or why not?

These questions can help your teen think about and decide what type of content they want to place on their social media platforms. What values do they want to present? What image do they want to exhibit?

In our digital world, what we say and the actions we take on social media can have implications and consequences (positive and negative) that may follow us for much longer than it takes for us to type out a response or click share. By talking with your teen about their social media presence and what or how they post information, you are helping them learn to effectively use the digital landscape that will likely be part of their entire life.

Additional Resources

Social Media and Teens

Setting Boundaries and Expectations (mini-booster module)

Adolescent Social Media Use

Teens and Social Media Fact Sheet

Teens, Social Media and Technology 2023

References

American Academy of Child & Adolescent Psychiatry. (2018, March). Social media and teens.https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Social-Media-and-Teens-100.aspx

Pew Research Center. (2024, January 4). Teen and social media fact sheet. https://www.pewresearch.org/internet/fact-sheet/teens-and-social-media-fact-sheet/

Pew Research Center. (2023, December 11). Teens, social media and technology 2023. https://www.pewresearch.org/internet/2023/12/11/teens-social-media-and-technology-2023/#how-often-do-teens-visit-online-platforms

The holiday season has arrived! For blended families, this can be a time of additional stress as parents and stepparents attempt to maintain special traditions and create memories with their new or still-adjusting family members. Below are some tips that can help you create a positive holiday experience for everyone in your blended family.

Plan Together—Co-parents, Partners, and Children.

Collaborate with your co-parent to create a schedule that accommodates both sets of parents and offers opportunities for children to spend quality time with everyone. You could share the holiday if your families (i.e., both sets of parents) live in the same area. Co-parents who live in different cities or states may want to establish a time when children can call and talk to the other parent. Discussing specific details at least a week before the drop off or pick up occurs can help ensure all members of all families know what to expect for the holiday. Details could include what time and where the children will be picked up or dropped off and the items they will need to pack or bring along. You may want to involve your children in the decision-making process if appropriate. For example, ask children to suggest activities they would like to participate in with the family or meals they would like to have.

Be Flexible with Scheduling.

Be flexible with schedules. Members of a blended family may have multiple celebrations to attend. Understand that compromises may be necessary. Flexibility often involves finding a middle ground that accommodates the needs and wishes of different family members. In addition, recognize that plans may need to change due to unforeseen circumstances. Having a backup plan or being open to spontaneous adjustments can reduce stress and tension.

Another option may be to consider celebrating holidays on different days or at different times. This can provide added flexibility to accommodate various family commitments. For example, instead of hosting an extended family dinner, you may choose to host a brunch event, so your stepchildren can be in attendance. The memories created are often more significant than the specific date or time of the celebration.

Respect and Embrace Traditions.

Discuss traditions openly with all members of your blended family. Sharing the importance of traditions and understanding each family member’s perspective can create opportunities for compromise during the holidays and can help family members embrace and celebrate the diversity of their blended family. If your blended family comes from different cultural or religious backgrounds, consider celebrating multiple holidays. Using this option creates respect for everyone’s traditions and provides an opportunity for learning and understanding.

Create New Traditions.

Ask everyone to offer their opinion regarding how they would like to celebrate. Gaining insight into what the others in your blended family desire from the holiday season might help you plan, together and individually, for this season and seasons to come. Traditions can be very simple, such as serving special foods, gathering for a movie night, or taking a walk together. New traditions may also emerge organically over time, and they may help create a sense of unity and connection within the new family structure.

Manage Expectations.

Blended families may face challenges during the holidays, and it is important to manage expectations and be adaptable to changes. For example, memories of past holidays may surface, comparisons may be made between then and now, people who are not present may be missed, and resentment toward the new individuals who are now part of the family holiday scene could emerge. Be prepared for the possibility that painful emotions may surface. Notice, name, and validate feelings to help the emotions flow, and offer support and discussion to prevent situations from escalating.

Focus on the Positive.

Focus on the positive aspects of the holiday season as a blended family to help create a joyful and harmonious atmosphere. Encourage a spirit of gratitude and appreciation, and help children (and coparents and partners!) see the holidays as a time for togetherness and creating happy memories.

When plans do not go as intended—you burn the main course and must grab take-out, or you forget to purchase movie tickets before they sell out—acknowledge the disappointment, and move on. Mistakes can make for laughable memories, and, sometimes, the alternative plan may be even more enjoyable than the original one!

Respect Boundaries.

Some individuals may need space or have specific preferences for how they celebrate. Discuss and honor these boundaries. And set your own boundaries if needed. For example, if your stepchildren will not be warmly received at your Aunt Edi’s annual cookie exchange, you may decide to decline that invitation. Boundaries may also include protecting time for your own self-care, such as maintaining a morning run before your cup of coffee. As you nurture yourself, you are also providing a healthy model for your children and stepchildren.

Include Everyone in the Holiday Festivities.

Ensure that everyone feels included and valued. Stepparents can play a crucial role in fostering a sense of belonging for stepchildren during the holiday season. This can be as simple as making time for children to call Mom on Christmas Eve or attend a special holiday event with Dad. If visiting others, such as extended family, for holiday events ensure that all children are included in activities, like gift exchanges. This will require advance planning to let friends and relatives know to expect additional children at their event, and you may be responsible for providing the extra gifts. No one in your family should be left out.

Be Patient and Understanding.

Recognize that blending families takes time and effort. Offer patience and understanding, especially during the holiday season, as emotions can run high. Manage your own expectations, and realize that you can only control your own behaviors and feelings. Even if others may not be happy to be in your home for the holidays or to be participating in a certain activity, you can still manage your emotions and reactions and be a positive role model. Acknowledge that children may be grieving or they may have a significant mental load as they work through feelings of guilt or anger. Children in your blended family may exhibit irritability or anxiety if they are overstimulated because they have attended or will attend multiple holiday celebrations. Your patience and support can provide a sense of comfort for children with a busy holiday schedule.

Prioritize Quality Time.

Create meaningful experiences and connections during the holidays that can benefit your family for years to come. Consider activities that involve all family members, such as group games, shared meals, and seasonal outings like ice skating or sledding to help your blended family create unique memories and establish new holiday traditions. In the years ahead, children may not remember the gifts they received, but they may remember the time Mom sang holiday karaoke. If gift giving is part of your holiday celebration, go over the children’s wish lists with your co-parent to decide who is going to buy what and set a spending limit.

BONUS TIP: After the holidays have passed, gather feedback so you can consider making adjustments to next year’s celebration. Ask each member of the family to tell you what they enjoyed, what they thought worked well, and what was challenging. Ask them to offer their input about future celebrations. Some family members may want to provide fresh feedback immediately after the holidays, so their thoughts and feelings are validated. Others may wish to wait until closer to the next holiday season to discuss their ideas, so they have time for thought and reflection.

Additional Resources

Coparenting Supplemental Parent-Education Module: https://thrive.psu.edu/modules/supplemental/

Breathe to Thrive: Mindfulness Strategies for You and Your Child: https://thrive.psu.edu/wp-content/uploads/2018/06/Breathe-to-THRIVE.pdf

Moving to Thrive: Physical Activity and Playtime Guide: https://thrive.psu.edu/wp-content/uploads/2018/07/Moving-to-THRIVE.pdf

References

Calleja, D. (2023, September 21). 5 tips for celebrating the holidays with a blended family. Today’s Parent. https://www.todaysparent.com/family/blended-families-celebrating-the-holidays/

Conway, P. (2021, December 18). 8 ways to better navigate the holidays as a blended family. Fast Company. https://www.fastcompany.com/90704686/8-ways-to-better-navigate-the-holidays-as-a-blended-family

Cooking with your preschooler can be a healthy, educational, and fun activity. Involving your child in cooking and other aspects of meal preparation helps them learn about food and nutrition and many life skills, like basic math skills and decision-making. You may be hesitant to bring your child into the kitchen due to some potential hazards; however, as a parent, you can determine what aspects of meal preparation your child is ready to manage under your supervision. When deciding what meal preparation tasks your child can safely complete, consider their developmental level, general abilities, and attention span. By providing age-appropriate tasks, using safe kitchen equipment, and throwing in a pinch of patience, you and your child can transform mealtimes into a joyful and memorable experience.

The benefits of preparing meals with your child:

• Engages the senses. Cooking can be a sensical experience beyond tasting the completed dish. Your child can feel the variety of textures among the vegetables and herbs used in the meal. They can smell the food aroma spread throughout the house. They can hear the food sizzling in the skillet and see the food transform from separate raw ingredients into a delectable meal.
• Builds early math skills. While helping you cook, your child can count the number of items needed for a recipe, identify the steps to complete the process, and get early exposure to measurements and fractions.
• Exposes your child to family culture and traditions. Food is traditionally ingrained in a community’s culture and heritage. Many families tend to pass recipes down through generations to celebrate their heritage and continue traditions. Inviting your child into the kitchen gives them an opportunity to spend time bonding with their parents and other family members while learning about and maintaining family traditions.
• Empowers your child’s voice and choice. Young children are eager to feel in control. When you encourage them to select ingredients or recipes for mealtimes, you can help them build their self-esteem, increase their sense of responsibility, and develop their confidence.
• Encourages your child to explore a variety of foods, flavors, and textures. Meal preparation ensures that your kid has time to explore the foods and ingredients in their own way. You can discuss the differences among the ingredients and even sample a few items to help your child develop a positive perception of the food.
• Increases your child’s likelihood of trying new foods. Cooking with parents can make food fun for children. Your child may be more willing to try foods from different food groups when they have helped prepare them.
• Engages your child’s creativity. Having your child help in the kitchen may give them an opportunity to tap into their artistic side. They may make funny shapes and characters with the ingredients or “paint” oil on the dinner rolls. Additionally, cooking may encourage your child to suggest a new and delicious mix of flavors.
• Teaches them food safety, cooking tricks, and hand hygiene. When your child cooks with you, they can learn important strategies about keeping raw foods separate from cooked foods, cleaning produce before cooking them, and continuing to wash their hands throughout the process to ensure food is safely prepared and served.
• Offers a sense of accomplishment and can boost your child’s confidence. When your child sees the completed dish in front of them, they can gain a sense of pride that they contributed to the meal in some way. Cooking allows them the opportunity to smile and say, “I did that!” and share that excitement with the rest of the family.

Safe ways your preschooler can assist with meal preparation:

• Select a new fruit or vegetable from the market to try at mealtime.
• Pick fresh herbs and vegetables from the garden or market.
• Help you grow your own produce in an outside or inside garden.
• Help you “read” a cookbook by turning the page.
• Wash and dry produce.
• Rinse canned beans.
• Pour ingredients into a measuring cup or spoon at your direction.
• Mix wet ingredients, dry ingredients, or batters.
• Sift dry ingredients.
• Add ingredients to recipes.
• Stuff ingredients into dough, bread bowls, or cored vegetables.
• Squeeze fruits (e.g., lemons, limes, oranges).
• Crumble and sprinkle cheese on top of baked dishes and salads.
• Brush butter or oil onto veggies or bread.
• Tear lettuce and toss salads.
• Add toppings to pizzas.
• Dip foods and set them on a platter.
• Mash potatoes with a potato masher.
• Beat egg yolks for scrambled eggs.
• Roll, knead, and shape dough.
• Cut dough with a cookie cutter.
• Place cookies on a cookie sheet.
• Spread icing over baked goods.
• Set the timer.
• Add dirty pans and unbreakable dishes to the sink or dishwasher.
• Wipe the countertop clean.
• Fill cups with ice and/or a beverage.
• Help set the dishes and utensils on the table.
• Remove unbreakable dishes and utensils from the dinner table.
• Help clean the unbreakable dishes and silverware by rinsing them.

Additional Resources

For ideas on how to make cooking with your child engaging and fun, including child-friendly recipes, try the following resources:

Download the Cooking to Thrive resource at https://thrive.psu.edu/resources/cooking-to-thrive/ to learn about healthy eating habits and recipes you can try with your family.

Find tips and resources to help your child develop healthy eating habits with MyPlate at https://www.myplate.gov/life-stages/preschoolers.

The USDA Kids in the Kitchen website at https://www.nutrition.gov/topics/nutrition-life-stage/children/kids-kitchen hosts a directory for recipes and resources on food safety and resources for families like yours.

References

Fernando, N. (2020, November 17). 5 great reasons to cook with your kids. Healthychildren.org. https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Cooking-With-Your-Children.aspx#:~:text=Teach%20kids%20the%20importance%20of,safe%20and%20age%2Dappropriate%20tasks.

Garden-Robinson, J., & Smith, T. (2021, August). Now you’re cookin’: Meals with help from kids! North Dakota State University Extension. https://www.ndsu.edu/agriculture/extension/publications/now-youre-cookin-meals-help-kids

Gavin, M. L. (2021, November). Cooking with preschoolers. Nemours KidsHealth. https://kidshealth.org/en/parents/cooking-preschool.html

Healthychildren.org. (2018, April 26). 10 tips for parents of picky eaters.https://www.healthychildren.org/English/ages-stages/toddler/nutrition/Pages/Picky-Eaters.aspx

Malan, C., Bevan, S., & Savoie-Roskos, M. R. (2022, September). The benefits of including kids in the kitchen. Utah State University Extension. https://extension.usu.edu/healthwellness/research/benefits-of-including-kids-in-the-kitchen

National Heart, Lung, and Blood Institute. (n.d.). Chefs in training: Getting children involved in the kitchen.https://healthyeating.nhlbi.nih.gov/chefTraining.aspx?linkId=3

University of Illinois Extension. (n.d.). Cooking with children.https://extension.illinois.edu/sites/default/files/cooking_with_children.pdf

News articles that warn Americans of the dangers of climate change are not new; however, you may have recently noticed an increase in air-quality alerts and, perhaps, poorer air quality in your backyard. This situation is, in large part, due to smoke and fine particle matter from Canadian wildfires that are traveling hundreds of miles into the continental United States. Protecting your family’s health from air pollution is important at any time, but, with the increase in air-quality alerts, you may be particularly interested in addressing this concern and reducing your family’s risks.

Understand the types of air pollution.

The Clean Air Act regulates major air pollutants in the United States. Below are descriptions of two major sources of air pollution:

• Particle pollution is a combination of solid and liquid droplets in the air, such as dust, dirt, smoke, pollen, mold spores, and soot. Particle pollution can be especially high when you are near busy traffic areas, when smoke is present (e.g., camp fires, wildfires), and when the weather is calm, and the air is stagnant (e.g., hot, humid day versus a windy, rainy, or snowy day). Particle pollution often has a seasonal pattern based on location (e.g., more wood stove use in cooler weather months in the mountains).
• Ground-level ozone pollution forms in sunlight from sources like vehicles, power plants, and industrial facilities (e.g., areas of fracking; large-scale animal operations) and can be found in products that are not environmentally friendly (i.e., paints or solvents). This type of air pollution intensifies with heat, so it is especially concerning in the afternoon and in the early evening on hot, sunny days. Therefore, it is best to plan your family’s outdoor activities when it is cool outside or in the morning when air quality is better.

National air-quality standards are set by the Environmental Protection Agency. In addition to particle pollution and ground-level ozone pollution, the following chemicals are major pollutants that can impact air quality:

• Carbon monoxide is a poisonous gas that is colorless and odorless. It results from the incomplete burning of natural gas or products that contain carbon (e.g., wood, oil, coal, kerosene, propane). This gas can be produced within or around homes from sources such as gas water heaters, vehicle exhaust, faulty heating sources, and charcoal grills (Penn Medicine, 2021).
• Sulfur dioxide is a naturally occurring gas that consists of sulfur and oxygen. It causes acid rain. This gas results from burning fossil fuels like coal (United States Environmental Protection Agency, 2008).
• Nitrogen dioxide is a respiratory irritant that precedes ozone formation. The main source of it is combustion sources like vehicles, power plants, and industrial engines (United States Environmental Protection Agency, 2010).

Monitor air quality as air pollution is more problematic for children.

Children are at greater risk of incurring health complications due to air pollution. Monitoring your child’s environment for poor air quality is critical for the following reasons:

• Children tend to be shorter than adults and are closer to the ground; therefore, they are more likely to breathe pollution particles that have settled.
• Children are more likely than adults to spend time outdoors engaging in physical activity (e.g., play, school recess).
• Children’s respiratory rates are faster than adults. So, they breathe in more air in comparison to their body weight than adults do.
• Children’s bodies and their organs are still developing. This means that they are sensitive to environmental toxins. Air pollution can reduce lung-function development and affect the growth and development of the brain and central nervous system, which controls activities like learning, emotion, self-control, problem-solving, and memory (American Academy of Pediatrics, 2021; Brumberg et al., 2021; Mahnke et al., 2023).

Remember, children, especially infants and toddlers, are unable to monitor their exposure to air pollution and modify their environment on their own. You play an important role in protecting them!

Check your local Air Quality Index regularly.

One of the simplest ways to be vigilant is to assess your local air quality. The official United States Air Quality Index (AQI) is a color-coded index, which is designed to inform individuals whether their local outdoor air quality is healthy or unhealthy. The highest ratings have a value over 151 and are coded red (unhealthy), purple (very unhealthy), and hazardous (maroon).

AirNow, is a website supported by the United States Environmental Protection Agency and its partners. This website allows users to enter a zip code, city, or state to immediately receive an Air Quality Index report for their local air quality. Users can also access a variety of other information on the website, including forecast air-quality reports, health activity guides, and interactive air-quality maps for more than 500 cities across the United States.

Stay apprised of circumstances that may impact your air quality! If you are concerned, check the Air Quality Index for your community before taking your child outdoors to engage in physical activity. This will empower you to take precautions as needed to protect your family’s health.

Recognize and prepare to guard against the dangers of air pollution.

Air pollution is a potential threat to all children’s health. It has been associated with respiratory infections, asthma, preterm births, low birth weight, infant mortality, abnormal lung development, neurodevelopmental disorders (i.e., growth and development of the brain and/or central nervous system), cognitive effects and IQ loss, autism, pediatric cancers, obesity, and risks for other chronic diseases later in adult life (e.g., diabetes, cardiovascular disease, pulmonary disease; American Academy of Pediatrics, 2021; Brumberg et al., 2021; Mahnke et al., 2023).

Some populations are at increased risk from air-pollution exposure. Older adults and individuals with health conditions, such as heart or lung disease, are at greater risk when air quality is poor. For these individuals, the impacts of breathing polluted air can include hospitalization or death (AirNow, n.d.). In children with chronic health conditions such as asthma, allergies, or other chronic diseases, air pollution has been shown to worsen health conditions (Mahnke et al., 2023). Children living in poverty and children of marginalized races/ethnicities are more likely to reside in areas in which United States air-quality standards are not met and where they experience elevated exposures to hazardous air pollutants that are known to cause health conditions like cancers (Brumberg et al, 2021; Mahnke et al., 2023). Residents who live in geographic areas that are affected by environmental factors like extreme or prolonged heat, droughts, or wildfires can encounter increased risks; air pollution can present in these communities as smog, dust, smoke, and elevated ozone and carbon dioxide (Mahnke et al., 2023).

During times of poor air quality, any individual can experience symptoms like the following:

• Undergoing eye, nose, or throat irritation;
• Coughing or experiencing increased phlegm production; or
• Having difficulty breathing (e.g., chest tightness, shortness of breath).

Children may have more trouble breathing than other individuals when the air quality is poor, especially when smoke or ash is present. Respiratory hazards, like mold, nuisance dust (e.g., pollen or dust from sanding wood), and wildfire smoke, can be reduced through the use of a respirator or mask by adults and children 2 years old or older. For information on the function and fit of different types of respirators and masks, review information provided by the National Institute for Occupational Safety and Health (NIOSH).

Take small actions to make a big difference in the air we breathe!

Breathing is essential to life, and everyone can do their part to reduce air pollution. Natural experiments, like traffic restrictions during the 1996 and 2008 Olympics and curtailment of commercial flights during the COVID-19 pandemic’s state-of-emergency restrictions, have demonstrated that air-quality improvements are possible and can have positive impacts on community health (Brumberg et al., 2021; Friedman et al., 2001; Mueller et al., 2022; Wang et al., 2009). Below are some steps you can take to reduce the negative health impacts that poor air quality can cause, so the air your child breathes is safe and helps them grow healthy!

• When air quality conditions are poor, remain indoors and keep windows closed. Limit vigorous outdoor activity.
• If possible, choose a home and child care or school that are not located close to heavy traffic or sources of pollution (e.g., dry cleaning store, airports).
• Plant trees and add plants to your outdoor green space to help filter the air. Mulch or compost leaves and yard waste instead of burning them.
• Reduce carbon emissions with a cleaner commute—walk, cycle, carpool, or use public transportation.
• Some emerging data suggest that vitamins C, D, and E might mitigate the oxidative effects of air pollution (Brumberg et al, 2021). Feed your child(ren) healthy meals that include quality proteins and fruits and vegetables (e.g., citrus fruits, dark leafy greens, seafood, eggs, mushrooms, asparagus, almonds). [Caution: Avoid feeding your child any foods that are known allergens for them.]
• Purchase a portable carbon dioxide detector to monitor problems with air circulation in your home or travel sites. Elevated carbon dioxide levels can cause drowsiness, headaches, poor concentration, dizziness, increased heart rate or blood pressure, and nausea. At the highest levels, oxygen deprivation can result and lead to convulsions, coma, and death.
• Consider upgrading your heating/cooling source to a heat pump or ductless heat pump, or use electric heat for more efficiency and to reduce carbon emissions. Use high-efficiency particulate absorbing (HEPA) air filters in your heating, ventilation, and air conditioning (HVAC) system.
• Purchase zero-emission vehicles, and combine trips for errands to avoid multiple ignition starts and idling. Keep your vehicle’s tires inflated to the recommended pressure, and try to avoid spillage when fueling. Ensure your gas cap is tightened after fueling.
• Keep all vehicles’ (e.g., car, boat) engines maintained to prevent smoking.
• Turn off lights and other devices (e.g., televisions, computers) when not in use.
• Properly use environmentally safe household and garden products (e.g., cleaners, paints), and seal them well to prevent evaporation. Look for products marked as low-volatile organic compounds (i.e., low-VOC).
• When buying appliances and equipment, purchase items with Energy Star labels as they will conserve energy.
• Set your air conditioner at a higher temperature in the summer, and set your heating source at a lower temperature in the winter.
• Reduce fireplace and wood stove use. Use gas logs instead of wood if possible. If you must burn wood, visit the Burn Wise Program for clean strategies. Limit the use of candles.
• Avoid smoking tobacco products or exposing your child to second hand tobacco smoke from others.
• Advocate for renewable energy; reduced reliance on coal, gas, and oil; and regulations on industrial emissions.

Additional Resources

AirNow – U.S. Air Quality Index

https://www.airnow.gov/

AirNow hosts an air-quality website, which is supported through a partnership of the United States Environmental Protection Agency; National Oceanic and Atmospheric Administration; National Park Service; National Aeronautics and Space Administration; Centers for Disease Control and Prevention; and tribal, state, and local air-quality agencies. The partners and others from across the country send their monitoring data to AirNow for local Air Quality Indexes to be displayed for users. In addition, the Department of State provides data from United States Embassies and Consulates to help inform military personnel and other citizens overseas of air quality outside the United States. In addition, the United States Forest Service contributes fire and smoke data.

Climate Kids – Air

https://climatekids.nasa.gov/menu/air/

The National Aeronautics and Space Administration hosts the Climate Kids website for children, and it includes information on air pollution. Climate change is explained using games, activities, and videos. Your child can learn about earth and ocean scientists and environmental topics like the weather, the atmosphere, water, energy sources, animals, and plants.

References

AirNow. (n.d.). Older adults and air quality. https://www.airnow.gov/air-quality-and-health/older-adults

AirNow. (n.d.). What you can do. https://www.airnow.gov/education/what-you-can-do/

American Academy of Pediatrics. (2021, May 13). AAP highlights impact of air pollution on children’s health. Healthchildren.org. https://www.healthychildren.org/English/news/Pages/Air-Pollution-Childrens-Health.aspx

Brumberg, H. L., Karr, C. J., Boyle, A., Ahdoot, S., Balk, S. J., Bernstein, A. S., Byron, L. G., Landrigan, P. J., Marcus, S. M., Nerlinger, A. L., Pacheco, S. E., Woolf, A. D., Zajac, L., Baum, C. R., Campbell, C. C., Sample, J. A., Spanier, A. J., & Trasande, L. (2021). Ambient air pollution: Health hazards to children. Pediatrics, 147(6), 1-13.https://doi.org/10.1542/peds.2021-051484

Centers for Disease Control and Prevention. (2023, May 16). Community respirators and masks. National Institute for Occupational Safety and Health. https://www.cdc.gov/niosh/topics/publicppe/community-ppe.html#anchor_514697

Centers for Disease Control and Prevention. (2023, June 12). Wildfire smoke and children. Air Quality. https://www.cdc.gov/air/wildfire-smoke/children.htm

Friedman, M. S., Powell, K. E., Hutwagner, L., Graham, L. M., & Teague, W. G. (2001). Impact of changes in transportation and commuting behaviors during the 1996 summer Olympic games in Atlanta on air quality and childhood asthma. JAMA, 285(7), 897– 905. https://doi.org/10.1001/jama.285.7.897

Mahnke, S., Rai, P., & Friedman, E. (2023, July 6). How climate change, heat, & air pollution affect kid’s health.Healthychildren.org. https://www.healthychildren.org/English/safety-prevention/all-around/Pages/how-climate-change-heat-and-air-pollution-affect-kids-health.aspx

Mueller, S. C., Hudda, N., Levy, J. I., Durant, J. L., Patil, P., Lee, N. F., Weiss, I., Tatro, T., Duhl, T., & Lane, K. (2022). Changes in ultrafine particle concentrations near a major airport following reduced transportation activity during the COVID-19 pandemic. Environmental Science and Technology Letters, 9(9), 706-711. https://doi.org/10.1021/acs.estlett.2c00322

Penn Medicine. (2021, February 12). What is carbon monoxide poisoning? https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/carbon-monoxide-poisoning

Pennsylvania State University. (2023, July 17). Wildfire smoke: Campus communities should monitor conditions, follow guidelines. https://www.psu.edu/news/campus-life/story/wildfire-smoke-campus-communities-should-monitor-conditions-follow-guidelines/

United States Environmental Protection Agency. (2023, June 26). What is particle pollution? https://www.epa.gov/pmcourse/what-particle-pollution

United States Environmental Protection Agency. (2010, April 14). Nitrogen dioxide. In United States Environmental Protection Agency vocabulary catalog: Air permitting terms. Retrieved July 18, 2023, from https://sor.epa.gov/sor_internet/registry/termreg/searchandretrieve/glossariesandkeywordlists/search.do?details=&glossaryName=Air%20Permitting%20Terms

United States Environmental Protection Agency. (2008, August 14). Sulfur dioxide. In United States Environmental Protection Agency vocabulary catalog: Acid rain glossary. Retrieved July 18, 2023, from https://sor.epa.gov/sor_internet/registry/termreg/searchandretrieve/glossariesandkeywordlists/search.do?details=&glossaryName=Acid%20Rain%20Glossary#formTop

United States Environmental Protection Agency, Centers for Disease Control and Prevention, & School Flag Program. (2014). Air quality and outdoor activity guidance for schools (EPA-456/F-14-003). AirNow. https://panthers.app.cloud.gov/sites/default/files/2021-03/school-outdoor%20activity%20guidance.pdf

Wang, Y., Hao, J., McElroy, M. B., Munger, J. W., Ma, H., Chen, D., & Nielsen, C. P. (2009). Ozone air quality during the 2008 Beijing Olympics: Effectiveness of emission restrictions. Atmospheric Chemistry and Physics, 9(14), 5237-5251. https://doi.org/10.5194/acp-9-5237-2009

Wisconsin Department of Health Services. (2023, March 29). Carbon Dioxide – Learn what you need to know about carbon dioxide. https://www.dhs.wisconsin.gov/chemical/carbondioxide.htm

Anyone can feel stress – adults and children. A combination of prior life experiences and other factors, like personality traits and genetics, influence how individuals perceive and respond to stress in their daily lives. Positive stress can motivate and help individuals focus their energy in ways that can improve their performance, help them problem solve, or encourage them to reach a goal or desire (e.g., learning to care for a new infant, preparing to graduate from high school). Negative stress can create mental, emotional, or physical distress, and it falls on a continuum that ranges from tolerable to toxic to traumatic.

Stress is the body’s normal response to change and challenges, and many of the stressors individuals experience daily are manageable and promote growth and well-being. For example, a kindergartner may have a meltdown and become frustrated as they try to tie their shoes, or a young a child may experience anxiety about visiting the doctor. For adults, examples of stress can include feeling overwhelmed when balancing work demands and child care or, perhaps, when dealing with sibling arguments among children. When individuals receive support, they can better navigate stress in ways that could build new skills, strengths, and connections to resources.

Stress, positive and negative, can activate the body’s flight-or-fight response systems. However, when a person experiences negative stress, their body reacts to a perceived threat, and feelings of helplessness, fear, and powerlessness may arise. Consider a time when you were previously in a stressful situation; you may have noticed physical reactions like your heart pounding, your breathing growing faster, your muscles clenching, or sweat dripping from your brow. These physical reactions occur because the brain processes the situation and stressful emotions and, then, sends signals to activate your body’s autonomic nervous system. This system has two parts: the sympathetic and the parasympathetic nervous systems. In response to a perceived threat, the sympathetic nervous system sharpens your senses, like your eye sight and hearing, and it provides the body with increased blood flow, more oxygen for alertness, and energy to respond. The parasympathetic nervous system, conversely, calms the body after a threat has passed.

An old adage encourages individuals to free themselves of stress by “shaking it off.” For manageable, every day stress, this proverb can be true! Kinetic strategies, which involve movement or motion, can provide channels for preventing and reducing stress reactions in the body. Physical activities, like running, practicing tai chi, lifting weights, or engaging in balancing and stretching movements, can have the following effects on the mind and body:

• Mood can improve when endorphins, which are hormones that are stimulated through exercise,  are released in the body. These chemicals can relieve pain and increase a sense of well-being.
• Physical tension caused by muscle contraction, such as stiffening and clenching, can be released.
• A sense of relaxation can be experienced as stored energy or tension is released as this allows muscles to return to their normal resting state.
• Unhelpful mental and emotional processes can be interrupted. For example, rumination – dwelling on a situation or the continuous looping of repetitive, negative thoughts – can be diminished.

When parents and caregivers engage in physical activity, they are role modeling healthy habits and a way to teach emotional coping strategies to their children. You can help your child develop and maintain a sense of mental and emotional balance by encouraging your child to participate in regular physical activity and movement like yoga poses and walks in nature. Positive and negative stressors can cause powerful, or big, emotions in a child. For example, a child can become overstimulated at a birthday party or a child whose active duty parent is deployed may feel anxiety or anger and may lash out at a younger sibling. Physical dysregulation can decrease your child’s ability to reason, control impulses, and problem solve. When a child is dysregulated in this way, they become more vulnerable to overreacting to additional emotional triggers like feeling hungry, tired, or frustrated with a task or when instructed to transition from an activity.

If an everyday occurrence has caused your child to become distraught, allow them time to calm down and name and accept their emotions. Then, you can help them release the intense emotions and physical tension by engaging with them in movement. You can help them to “shake it off” with activities like jumping or dancing, or you can guide them in settling down and gently caring for themself with activities like simple stretches and deep breathing  (e.g., blow bubbles or pretend to blow out candles on a cake).

You can also make physical activity a relaxing, fun part of your family’s’ regular routines. For example, have an impromptu dance party while putting toys away or sweeping the kitchen floor. Physical activity provides an opportunity for family members to connect, promotes physical health and mental well-being, and helps individuals build coping skills for a lifetime! You can incorporate physical activity into every day moments. For example, use household chores as opportunities to encourage movement: vacuuming, putting away laundry, or playing fetch with a pet. Any movement can help the body release stored tension. To support your efforts, see resource guides on the Thrive website, like Breathe to Thrive and Moving to Thrive.

Resource Suggestion: The book, Good Night Yoga – a Pose-by-Pose Bedtime Story by Mariam Gates, provides illustrated examples of simple yoga poses that children and parents/caregivers can try together. Doing these poses may help your child build their understanding that physical activity can be a relaxation and emotional coping strategy. This book highlights how movements like bending like a crescent moon, arching like a cat, rooting like a tree, and sparkling like a star can be fun and calming.

Try These Movement Activities Together to Release Stress:

(Activities adapted from the website Save the Children.)

Go Slow Like a Turtle!

• Move like a turtle maneuvering across the beach.
• Drip, drop! It is starting to rain. Curl up and hide under your shell.
• Here comes the sun! Come out of your shell, and continue your relaxing walk towards the ocean’s waves.

Lounge like a Lazy Cat!

• Curl up in a little ball on the floor like a sleeping cat.
• Wake up with a big yawn and a slow meow.
• Slowly rise up onto your hands and knees.
• Arch your back.
• Slowly stretch out your arms and legs.
• Relax and lie down again like a lazy cat.

Float like a Feather and Freeze like a Statue!

• Spread your arms and float through the air like a feather.
• Now, freeze and stand still like a statue.
• Slowly start to move and float like a feather again.
• End in a relaxed state after floating like a feather.

Additional Resources:

InsightTimer: This online source and app provide a collection of more than 30,000 guided meditations and recordings for children.

American Psychological Association: How to help children and teens manage their stress

Children’s Hospital of Orange County (CHOC): 7 stress relief techniques for kids

Nemours KidsHealth: Childhood stress: How parents can help

Office of Disease Prevention and Health Promotion: Move your way

References:

Harvard Health Publishing, Harvard Medical School. (2020, July 6). Understanding the stress response.https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response

Miller, C. (2023, January 26). How to help children calm down: Techniques for helping kids regulate their emotions and avoid explosive behavior. Child Mind Institute. https://childmind.org/article/how-to-help-children-calm-down/

Save the Children. (2023). Relaxation activities to do at home with kids. https://www.savethechildren.org/us/charity-stories/easy-at-home-relaxation-activities-to-help-calm-kids

Play is generally defined as activity engaged in for enjoyment, pleasure, or recreation, but, for an infant or toddler, play is an integral part of promoting healthy development! Children learn through play, and play provides sensory, physical, cognitive, and emotional experiences that help build connections in their brains.

Play Promotes Skill Development

Your child is constantly watching you and the world around them and absorbing your actions and those of others. You can purposefully model interactions and teach through your interactions, and playing with your child makes doing so fun! You can use strategies during play interactions with your child to encourage and support skill development in several areas, such as the following:

• Teach your child communication skills by helping them learn new words and calmly express feelings through words, gestures, and facial expressions.
• Focus on literacy skills and academic readiness through activities like counting, shape identification, and singing the alphabet song.
• Incorporate motor-skill development by playing games that include hand-eye coordination, like catching a ball, or grasping and moving objects.
• Find ways to model and teach social-emotional skills like sharing, waiting patiently for one’s turn, and managing frustration.
• Provide opportunities for your child to make choices and work on developing their problem-solving skills.
• Explore your child’s curiosity and creativity through activities like imaginative storytelling.

Play Strengthens Attachment and Attunement

Play also provides an opportunity for you to demonstrate to your child aspects that are important for healthy attachment such unconditional love; safety; that they are heard, seen, and valued; and that they will be comforted and supported when needed (Brown & Elliott, 2016).

Consider this example. A parent and toddler are enjoying putting together a simple puzzle of animal-shaped pieces; while fitting the pieces into the puzzle, they are giggling as they make silly animal sounds. When the child becomes frustrated by not being able to fit a piece, the parent patiently reassures the child with gentle words and a loving touch. In this simple example, the loving interaction with this parent comforted the child and built skills for emotional regulation.

In addition, play gives you opportunities to share your culture and values. By doing this, you can help build your child’s sense of belonging while also molding pro-social beliefs (e.g., respect for diversity, compassion, honesty).

Furthermore, play creates opportunities to observe what your child is experiencing and expressing. It allows you to increase your attunement to your child, which means you can better recognize, understand, and engage with their inner thoughts and feelings. Parents and caregivers can learn so much about their children during play when they make an effort to notice! You can learn the following about your child if you purposely observe your child and their behaviors during play:

• personality traits (e.g., sensitive, persistent, cautious, agreeable, optimistic)
• temperament (e.g., activity/energy level, reactivity, adaptability)
• interests (e.g., trains, dinosaurs)
• likes and dislikes (e.g., song or book preferences, what frustrates the child)
• signals and emotional cues (e.g., rubs eyes when tired)
• preferred ways to be calmed and soothed (e.g., rocked, hugged)

Engage in Different Types of Play

There are different types of play, and each type provides interaction opportunities for connection, communications, affection, modeling, and teaching. For example, during constructive play, a child constructs, shapes, or builds something (e.g., using building blocks), and this type of play builds fine motor and problem-solving skills. Other types of play build social skills such as cooperative play (e.g., building sandcastles together) and competitive play (e.g., playing a board game). Imagination is sparked with dramatic or fantasy play (e.g., child acts out situations and roles with a puppet) or symbolic play (e.g., using a cardboard box as a house, drinking water from a play tea set). Some play is cognitively focused like language play (e.g., rhyming words), while other play is physical and builds gross- or fine-motor skills like functional play (e.g., using a toy vacuum) or physical play (e.g., throwing a ball).

Be Purposeful in Playful Interactions

It may take some practice to become comfortable with playing as play can be unstructured, repetitive, and even messy! Sometimes, parents or caregivers might select an activity with the intent of teaching their child, such as playing a game in which they match shapes. Other times, parents and caregivers can let their child take the lead! Their child will be learning verbal and social skills as the parent or caregiver follows along – talking with the child but not giving directives. Below are sample play and interaction activities you can try:

• Get on your child’s level, and engage in floor play (e.g., put together a floor puzzle, stack blocks)
• Read books together
• Play simple games (e.g., what sounds do animals make, guess items in a bag by touch)
• Sing silly songs
• Facilitate exploration (e.g., find different types of fruit at the grocery store)
• Play with tactile toys and expressive materials (e.g., water, sand, paint, playdough)
• Make helping a game (e.g., match colored socks)
• Find enrichment in your environment (e.g., go to the library, take a nature walk)
• Be playful in simple daily activities (e.g., sing a song while dressing)
• Set up a child-friendly cabinet with items (e.g., plastic bowls and spoons), and engage your child in stacking, banging, and shaking the items
• Play imitation games (e.g., gesture rhymes like Head, Shoulders, Knees, and Toes)
• Fill an album with photos of family and friends, and play a game to find specific people
• Use a mirror to explore facial features and expressions (e.g., Where is your nose?)
• Be physically active (e.g., playground, swimming pool, indoor obstacle course)
• Count, sort, or match items (e.g., count the number of toy cars)

Communicate with Care During Play

How parents and caregivers interact during play is as important as the activities they chose to play. During play, your words and actions can communicate to your child that they are loved, valued, and supported, and you can teach them new vocabulary, how to make decisions, and how to socialize with others (e.g., taking turns). With each interaction, you build their skills and self-esteem! Try these strategies:

• Give loving and nurturing touches during activities (e.g., rub your child’s back)
• Name objects and their characteristics (e.g., colors, textures, tastes)
• Use gestures (e.g., point to an item) to help a child connect names with objects
• Provide explanations for actions (e.g., The doll is hungry, so I am going to feed her with this bottle.)
• Comment on what a child is doing (e.g., You picked a bright yellow crayon for coloring.)
• Ask open-ended questions (e.g., Where will you park the car?)
• Expand on a child’s vocabulary with descriptive words (e.g., building words like “over” and “under”)
• Offer praise for effort (e.g., You worked so hard to build that tall block tower!)
• Use constructive language (e.g., please do this vs. don’t do that)
• Avoid criticism, blame, and shame

When to Stop Playing

Play boosts children’s healthy development and can be part of meeting recommended physical activity requirements. Although infants need about 30 minutes a day of “tummy time” or interactive play and toddlers need about 3 hours total of physical activity each day (American Academy of Pediatrics, 2020), you should monitor your child’s energy and attention levels during play as children can grow tired of interacting or may need time to process and reflect on their learning. The following are some signs that a young child may need some rest from the stimulation of play:

• Crying or making fussy sounds
• Rubbing or closing eyes
• Arching back
• Turning away
• Clenching fists and/or waving arms and kicking
• Throwing tantrums
• Refusing to continue or fulfill simple requests
• Struggling to use words to convey feelings

Infants and toddlers grow quickly. Cherish this time of playful fun! Through play, you are helping your child to understand how to interact, that they have an impact on objects and other people, and to be a creative problem solver. While having fun, you are laying a foundation for your child’s future relationships, learning, and success!

Additional Resources

Zero to Three

American Academy of Pediatrics

National Association for the Education of Young Children

Empowered Parents

Genius of Play

References

American Academy of Pediatrics. (2020, August 5). Making physical activity a way of life: AAP policy explained. healthychildren.org. https://www.healthychildren.org/English/healthy-living/fitness/Pages/Making-Fitness-a-Way-of-Life

Brown, D. P., & Elliott, D. S. (2016). Attachment disturbances in adults: Treatment for comprehensive repair. W.W. Norton.

Ginsberg, K. R., Committee on Communications, & the Committee on Psychosocial Aspects of Child and Family Health. (2007). The importance of play in promoting healthy child development and maintaining strong parent-child bonds. Pediatrics, 119(1), 182-191. https://publications.aap.org/pediatrics/article/119/1/182/70699/The-Importance-of-Play-in-Promoting-Healthy-Child

Milteer, R. M., Ginsburg, K. R., Council on Communications and Media Committee on Psychosocial Aspects of Child and Family Health, Mulligan, D. A., Ameenuddin, N., Brown, A., Christakis, D. A., Cross, C., Falik, H. L., Hill, D. L., Hogan, M. J., Levine, A. E., O’Keeffe, G. S., & Swanson, W. S. (2012). The importance of play in promoting healthy child development and maintaining strong parent-child bond: Focus on children in poverty. Pediatrics, 129(1), e204-e213. https://doi.org/10.1542/peds.2011-2953