A new study published in BMC Psychiatry sheds compelling light on a critical, yet underexplored, domain of early childhood development: the relationship between outdoor activity in infancy and subsequent anxiety symptoms among preschool-aged children. As modern lifestyles increasingly confine children indoors, the implications of diminished outdoor time for mental health are becoming an urgent public health concern. This large-scale cross-sectional investigation focused on a cohort of nearly seventy thousand preschoolers from the Longhua District in Shenzhen, China, and utilized robust psychometric measures to quantify anxiety symptoms in relation to early outdoor activity patterns.
The researchers aimed to address a pronounced gap in existing literature regarding whether the frequency and duration of outdoor activity during the vital developmental windows of 0–1 year and 1–3 years have a measurable impact on anxiety outcomes at preschool age. Their methodological approach was comprehensive, employing the Chinese version of the Spence Preschool Anxiety Scale (SPAS), which captures multidimensional anxiety symptoms, thereby offering nuanced insights beyond general emotional wellbeing. Parent-completed questionnaires served as the primary data source for tracking outdoor activity variables, enabling a detailed examination of behaviors occurring in early infancy.
One of the study’s most striking findings is the dose-dependent association between outdoor activity and anxiety risk. Infants aged 0–1 years who spent less than one outing per week outdoors were found to have more than double the odds (odds ratio = 2.55) of screening positive for anxiety symptoms compared to those who ventured outside at least seven times weekly. This suggests that even during infancy—a period often underestimated in terms of active outdoor engagement—regular exposure to outdoor environments plays a vital protective role against the emergence of anxiety symptoms later in early childhood.
Further, the duration of outdoor sessions showed a similarly profound effect. Infants exposed to under 30 minutes per outdoor session had a 62% increased likelihood of anxiety symptoms relative to peers with outdoor sessions lasting 120 minutes or more. This temporal threshold highlights the importance of not only frequent but also sufficiently prolonged exposure to natural surroundings for fostering psychological resilience. It invites a reevaluation of current caregiving practices that may undervalue the quality and length of outdoor playtime during these foundational years.
The trends observed in the 1–3 years age group were even more pronounced. Preschoolers who had fewer than one weekly outdoor session between ages one and three had a threefold increased risk (OR=3.10) of exhibiting anxiety symptoms. The correlation between shorter outdoor durations (<30 minutes) and anxiety was similarly robust, with a doubling of risk (OR=2.07) compared to children enjoying longer outdoor periods. These data underscore the sustained importance of outdoor activity beyond infancy and suggest a cumulative protective effect as children grow.
The study’s results provide a clarion call for parents, educators, and policymakers to reevaluate the role of the outdoors in early childhood development strategies. As urbanization and digital devices continue to dominate children’s lives globally, practical interventions promoting routine and meaningful outdoor experiences could serve as cost-effective, non-pharmacological preventative measures for childhood anxiety disorders. The clear statistical associations found in this research stress the need for early and continuous promotion of outdoor activity to support mental health in young children.
Mechanistically, the benefits of outdoor activity on anxiety symptoms may be multifaceted. Exposure to natural environments is known to enhance sensory integration, stimulate physical activity, and facilitate social interactions—all critical factors in emotional regulation and anxiety prevention. Moreover, outdoor play often provides children with opportunities for autonomous exploration and stress reduction through unstructured, imaginative activities. While the current study did not explore biological pathways, these psychosocial mechanisms offer plausible explanations for the observed protective effects.
It is important to note that the researchers employed a cross-sectional design, which limits causal inference. Nonetheless, the analyses controlled for various family sociodemographic variables, strengthening the validity of the associations. The massive sample size further enhances the reliability of the findings and serves as a solid foundation for future longitudinal studies that can more definitively unravel causality. Such research could elucidate whether interventions to increase outdoor activity can directly reduce the incidence or severity of anxiety symptoms in vulnerable populations.
This investigation also contributes significantly to the ongoing discourse on mental health prevention in early childhood, an area often overshadowed by adolescent and adult psychiatry. Anxiety disorders are among the most prevalent forms of psychopathology originating in childhood, frequently persisting into adulthood with substantial societal costs. Identifying modifiable early life risk factors such as outdoor activity frequency and duration opens promising avenues for early intervention and public health policy shifts.
The findings encourage a holistic approach within pediatric healthcare and childcare services, emphasizing environmental and lifestyle factors alongside traditional therapeutic strategies. Incorporating recommendations for outdoor activity into pediatric check-ups, parental education, and early childhood program curricula could have far-reaching impacts on mental health trajectories. Additionally, designing urban and community spaces that facilitate safe, accessible outdoor playthings for families with young children becomes a key infrastructural priority.
The cultural context of this study’s population—preschoolers in Shenzhen, a major Chinese metropolis—adds further relevance given rapid urbanization trends and shifting family dynamics in East Asia. However, the universality of nature’s benefits suggests that these findings likely extend beyond this region, warranting cross-cultural replication. The utilization of a validated anxiety scale ensures comparability, and the methodology sets a benchmark for future epidemiological studies investigating early environmental influences on childhood mental health.
In summary, this landmark study firmly establishes a significant inverse relationship between early childhood outdoor activity and anxiety symptoms in preschoolers. Both the frequency and duration of outdoor exposure during infancy and toddlerhood are important predictive factors for emotional wellbeing as children enter preschool. These insights demand urgent consideration from caregivers and health professionals alike, foregrounding outdoor activity as not only a recreational pursuit but a vital mental health intervention.
Looking ahead, integrating these findings into public health frameworks could revolutionize early prevention efforts for anxiety disorders. Increased interdisciplinary research bridging psychology, pediatrics, urban planning, and environmental sciences will be essential to translate these epidemiological insights into effective interventions. As our understanding deepens, fostering a generation of children who grow up in connection with nature may prove a foundational strategy for mitigating the global burden of anxiety and mental illness.
Subject of Research: The association between early childhood outdoor activity (frequency and duration) and anxiety symptoms in preschool-aged children.
Article Title: Association between early childhood outdoor activity and anxiety symptoms in preschoolers
Article References:
Wu, JB., Zhang, Y., Yang, Y. et al. Association between early childhood outdoor activity and anxiety symptoms in preschoolers. BMC Psychiatry 25, 388 (2025). https://doi.org/10.1186/s12888-025-06831-2
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