Introduction

Play is the engagement of activity for enjoyment and recreation rather than for any set purpose. It is an expected, normal process in children. Moreover, play creates opportunities for the development of cognitive skills throughout childhood development. The purposes of play are to provide avenues to think and express emotions, consider alternative ways of viewing a situation, explore new ways of reacting to situations, provide outlets for imagination, and to understand cause-and-effect in relationships.

Play is prosocial and evolves as the child progresses through infancy and childhood. The earliest and most rudimentary indication of play is the social smile, which occurs at about 4 to 6 weeks of age. By 3 months, play progresses to regular smiling and cooing when a baby is face-to-face with a person. Between the ages of 3 to 6 months, infants actively seek interaction with others and begin to play “baby games” like peek-a-boo with their caregivers. At this milestone, children begin using their caregiver for enjoyment in addition to comfort and security. Play at this stage is repetitive and often ranges in intensity according to how the baby responds to the game. 

Play starts “primitively” as sensorimotor play from 1 to 2 years with an exploration of properties and functions of objects. During this age, pretend play is initiated with the imitation of ordinary activities like pretending to eat or imitating caregivers. Between the ages of 1 and 2, imaginative or pretend play replaces sensorimotor play. Pretend play is a direct imitation of ordinary activities. Pretend play extends to symbolic play, which is the use of one object for another. Symbolic play can be a vehicle for relief from reality. By the age of 2, a toddler’s engagement with others will extend to peers their same age, not just their caregivers.

Play takes form in solitary play, parallel play,[1] and social play. Solitary play is a child playing independently with no outside interaction. Playing alongside another child, both intent on similar objects of the play without direct interaction is known as parallel play. If you were to look in on a room full of toddlers, several of them might be at the same playing station, each consumed in their task without actively engaging the children around them. They may enjoy doing the same thing in parallel, but they do not show evidence of sharing the same fantasy. Social play at this stage lacks imagination and is more focused on imitation of each other’s behavior, a shared interest in similar toys, and/or playing simple games like chase.

These peer interactions begin the foundation of prosocial skills with others. As children coordinate their actions in response to another child and share feelings, they become aware that other children have thoughts and feelings. For example, if a child falls from the monkey bars, another child may cry to an adult. The observant child is now aware that the other child is hurting and needs assistance. At this time, peer play involves sharing uninhibited by possessiveness as the child prizes socializing over autonomy. However, as the autonomous self develops between ages 2 to 3, sharing declines. As the toddler develops his sense of self, exhibited by the emergence of possessive pronouns like “I,” “me,” “my,” and “mine,” play with peers often deteriorates swiftly and cannot be sustained due to constant conflict. Before, the goal was to socialize by sharing a toy; now the goal is to possess the toy by competing for it. Although some parents scold or discipline their children for not sharing, this is an important period as a toddler develops an autonomous sense of self. Sharing, if modeled by caregivers, will eventually develop over time.[2]

Play is a symbolic representation of a child’s experience and can be useful to discharge emotional reactions to stressful situations. Play can be used as part of an observable measure of cognitive ability. Language acquisition is still developing and can be a source of internal stress as the child has difficulty communicating frustration. Language lags far behind nonverbal cues of cognitive processes, and thus the cognitive capacities of children are often underestimated.

Between the ages of 3 to 6 years, play provides the opportunity for cognitive skills to develop and increases the child’s mental capacities. For example, a child in this stage can imagine an idea, fantasize about it, then quickly turn it into a scenario which can be acted out with peers. Subsequently, the child can now react and test out different feelings without judgment. The cognitive skills acquired through play help advance academic skills in the early elementary years and are essential to development. 

As is often said, “Play is the work of the preschooler.” Prosocial behavior increases with a focus on interactions with peers of the same age. At this stage, children live to play. Parallel play shifts to cooperative play as children begin interactions based on a shared idea.[3] At this age, a child identifies with children of the same age who can relate and validate their concerns. They now expect a response from their peers, want to be noticed by their peers, and most importantly, seek to be accepted by them. This shift allows for the development of perspective taking, empathy, turn taking, sharing, cooperation, and negotiation.

As the child reaches ages 4 to 5, play leads to real friendships. Children begin to have a preference on whom they want to play with and are more likely to share similar fantasy interests with their preferred peer group. They will spend more time together, have more conflicts (usually about the direction of their fantasy play), and will negotiate solutions to keep the interaction intact and continue playing. Play at this time is more imaginative and complex without being constrained to reality or rule-following. Rule-following develops later in the school-age child. Play takes two routes at this time: either the exploration of reality through role play, e.g., dress-up, or the use of play to master anxiety. For example, a boy may dress as an invincible superhero to compensate for the anxious feelings of a small, young, vulnerable child.

The middle childhood timeframe begins around age 6 and extends until age 12, or when a child begins puberty. Same-sex peer friendships are predominant during this time. Fantasy play is less prominent as the child shifts to more organized or ritualized play via games and sports.[4] Fantasy is still prevalent, but not outwardly enacted. Before this stage, a child would have acted out a fantasy while simultaneously offering a narration, aloud, for others to hear. This combination of observable fantasy decreases significantly or disappears. Internal fantasy increases and mimed play in peer groups can be observed. If adults are present, children will keep their fantasies private. Fantasy at this age occurs alone or with very close peers who accept them and are therefore less likely to cast negative judgments on their ideas.

The work of middle childhood lies in the mastery of school work, intellectual competence, and physical skills. Play now becomes a break from the demands of reality. Recess is the paramount example of switching gears from reality to fantasy play. To further illustrate this point, parents often allow their children time to play and decompress from the demands of the day before starting their homework. During play, the child may imagine the self in more competent roles or as a grown up. The child begins to use systematic and logical thinking and doesn’t have to rely on imaginative thinking to understand the world and his role in it. Peer play evolves into games involving structure, rules, and competition. As the child ages, even spontaneous play develops into games requiring planning and strategy.

As a child enters puberty, fantasy play is largely abandoned as social interactions are based on reality. Organized play can continue in the form of sports. Play that is novel to this century is play via video gaming. Video games are marketed to all age groups and can take place in a variety of settings. They can be individual, cooperative, or competitive. Video gaming is an alternate form of fantasy play where the player is virtually transported through vast video game environments and must accomplish tasks to proceed.[5]

Issues of Concern

The aforementioned age groups and corresponding play patterns are approximations of normal development for childhood play. Whenever there is a deviance from the established pattern, there is potential for concern regarding development, the home environment, or the individual mental welfare of the child.[6][7][8][9][8]

The infant-caregiver dyad defines an infant's world. Concerns appear when poor interactions between the two are common. In the context of play, be aware of play that borders on abuse, or when expectations of the caregiver exceed the infant’s developmental ability. Unsafe play and ignoring the baby at times when the baby is in danger or in need of feedback should alarm anyone observing. Other red flags may suggest underlying organic brain issues such as developmental delays in achieving milestones, a minimal response to the parent’s stimulation, or withdrawn and detached affective responses.

During toddlerhood, a child’s play and behavior may be reflective of stress and trauma. While children at this age are expected to have tantrums and go through “the terrible twos,” there is a fine line for normal and abnormal behavior that could indicate a more severe underlying problem. For example, a toddler having uncontrollable tantrums, screaming, yelling, or becoming dangerously aggressive is abnormal. Behavior that becomes disorganized, out of control or dangerous should raise alarms. This may be evidence of social and or communication impairments. They may also have difficulty reading social cues and empathizing with peers. Play that remains primitive and isolative and not representational is also a deviation from normal behavior. The beginning of language delay will first appear at this stage and, again, can be observed in a child’s play.

Among preschoolers, be mindful if a child has difficulty establishing peer relationships or is overly reliant and clingy to caretakers. Other developmental issues include limited vocabulary and understanding of language evidenced by an inability to play with peers of the same age or follow the directions of the teacher. Play may cross the boundary between fantasy and aggression. Note repetitive themes that lack creativity and variety or contain frequent fearful themes. This may be evidence of abuse or neglect occurring at home. Difficulties in play also may indicate the beginnings of mental illness manifesting itself such as a developmental delay, ADHD, or an anxiety disorder.

During school age, problems often appear as aggression or impulsivity. Poor peer relationships will result when a child is unable to play cooperatively with others. Bullying or being bullied, social withdrawal, social immaturity, rejection by peers, or a variety of other issues may cause a child to struggle with peer relationships. Mental illness may further manifest itself in many forms, including generalized anxiety, separation anxiety with or without school refusal, depression, a learning disability, or oppositional defiant disorder.

Aberrant play can be the first symptom of an underlying problem in a child, and close observation and evaluation should follow to ensure adequate development of the child.

Clinical Significance

Trained professionals can use play therapy as a tool. Play therapy was formalized in the 20th century and has continued to prove useful as a way to evaluate and treat young children. The Association for Play Therapy defines play therapy as a process where trained play therapists use play to help their patients prevent or resolve psychological and social difficulties to achieve growth and continue to develop. Children who have experienced adverse or traumatic events may not be able to express those ideas or feelings directly. Play therapy between a child and a therapist allows a child to express complex thoughts, feelings, and behaviors, develop problem-solving skills, and address difficult problems, then modify those behaviors in a psychologically safe space.[10]

Other Issues

Play is essential to development. Learning, creativity, imagination, problem-solving, and socializing are just some of the life skills that are learned and mastered through play. When playtime is limited or eliminated, learning can be impaired. Instead of thinking of play and learning as 2 distinct activities, they should be considered synergistically. With enough time in normal childhood play, each child prepares for adulthood.