Environmental Factors Associated With Preschoolers' Outdoor Play and Napping in Childcare Settings: The SUNRISE International Study.
Claudia I Maddren, Gursimran Dhamrait, Ankhmaa Byambaa and 25 others
46% of early childhood centres across 27 countries reported at least one environmental factor (rain, heat, cold) keeping children indoors, and 20% reported factors disrupting naps.
Barriers were more common in low-income and urban settings.
Key findings
146% of ECECs (n = 86) reported at least one environmental factor preventing outdoor play; rain (42%, n = 44), heat (23%, n = 24), and cold (23%, n = 24) were the most common barriers.
220% of ECECs (n = 37) reported at least one environmental factor disrupting naps, with significant differences by region (p < 0.001), income level (p < 0.001), and urban/rural sector (p = 0.001).
3ECECs in low- and middle-income countries more frequently reported barriers to outdoor play than high-income centres. Urban ECECs reported the highest proportions for heat (80%), cold (75%), rain (70%), and noise (67%).
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What it does not show
Cross-sectional convenience sample from a pilot phase; the authors state the findings are not generalisable and should be interpreted with caution. Data collection occurred across different seasons and periods of the year in different countries, making it hard to account for seasonality. Only two countries comprised the low-income group, so those proportions rest on very small numbers. Several cells in the tables contain only 2 or 3 centres, so the percentages (e.g., 100% for space in Africa, 67% for noise in lower-middle-income) are unstable and should not be read as precise estimates. All data are educator-reported perceptions of the previous 3 days, not objective measurements of temperature, noise levels, or air quality. The unit of analysis is the ECEC, not the individual child, so it is not possible to tell whether the same children were affected or whether different children were kept indoors on different days.
Declared interests
The authors declare no conflicts of interest. Funding came from a range of academic scholarships, government health and education ministries (Finland, Singapore), and research grants (NHMRC, WHO European Office, World Cancer Research Fund International, Cancer Australia, and others). No commercial or industry funder is named.
The easy way to misread this
Do not read the 100% or 67% figures in small subgroups as reliable estimates. Several cells contain only 2 or 3 centres, so one additional centre would shift the proportion by 33 percentage points or more. The study is a cross-sectional convenience sample from a pilot phase, and the authors themselves state the findings are not generalisable. It describes what educators perceived over three days, not what objectively limits a child's outdoor time or sleep.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →