The potential of natural play in hospital grounds

Children thrive and their minds and bodies develop best when they have access to a natural, inclusive outdoor play space. Engaging with such an environment builds confidence, improves well-being and aids the development of motor skills, balance and co-ordination.  

Although many hospitals have outdoor areas surrounding the building which are often underused and undervalued, rarely are these spaces used to their full potential. So, what could be done to improve these areas to offer children the benefits of access to natural play environments?

To reach the full potential of an outdoor environment there are many design features that can be incorporated into hospital grounds without requiring a redesign of the entire space. Such developments would have a huge impact on the health and wellbeing of the children in (and visiting) the hospital – and making such changes need not cost the earth.


Active play enhances proprioceptive and vestibular development and also encourages the use of fine and gross motor skills. A well-designed active play area will promote suitable challenges such as climbing, balance, co-ordination, swinging, bouncing and spinning. This activity can be encouraged by providing balance beams (that can be set on the ground, or at low level with fixed rails) and by adding natural logs at a higher level with grab posts. These can be accompanied by a complex range of balance opportunities with no supports at all. Such structures can then be used for physiotherapy as well as play.


Various natural resources and plants can be used to create leafy dens and hiding areas. Shady outdoor play tunnels can also be made from willow or hazel trees which provide suitable areas for children that cannot be exposed to the sun for too long. Planting trees, shrubs and flowers will bring seasonal play objects such as leaves, petals, conkers and acorns which offer a range of activities that are often underprovided in play spaces. Open areas of grass can be developed by transforming them into wildlife meadows. By adding long grass with a mown pathway children can walk through these areas, which should be fully accessible so that children in wheelchairs can join, if they choose to, their friends at ground level to explore flowers and mini-beasts.


Sensory environments can help to provide children with a wonderful opportunity to engage with natural stimulation or escape to calmer places. These spaces can also offer nurses and play practitioners an alternative space to calm or stimulate children. Careful design can help to provide children who are hypo and hyper sensitive and good microclimate amelioration can help to make the outdoor environment comfortable for all. Consider a variety of plants that simulate all five of the senses.

Adding a surface with the right texture and topography will enhance the play and physiotherapy potential of an environment. It is, of course, essential to comply with the DDA (Disability Discrimination Act), but by going beyond compliance it is possible to explore additional routes to provide different textures and topographies and deliver a wider range of play scenarios.

Walking up slopes, crawling through planted areas, climbing steps, stepping from log to log or balancing on wobbly bridges are both fun and key in rehabilitation. Ideally these areas would be created as close to the physiotherapy department as possible for easy access.  


With a little imagination and attention to detail, seating can serve various purposes and offer children, visitors and staff a better, more comfortable place to rest. Details such as back rests, arms (to push up from) and choice of location can have a huge effect. Incidental seating such a boulders, logs or walls also provide impromptu seating and can offer different textures and alternative play surfaces.

Whilst most children use their imagination in play scenarios some find it harder to improvise or pretend. Creativity and imagination can be supported through the provision of a wide range of materials. Leaves, twigs, branches, flowers, sand, water, logs and stones all offer a wide range of opportunities to help children of all abilities to share, interact and play together.


Learning through Landscapes’ new publication, Naturally Inclusive is the result of two years of extensive research into natural and inclusive play in partnership with the London Borough of Camden. The new book comes with a training guide and DVD and offers more examples of how inclusivity can be designed into various play environments. Naturally Inclusive is available from April and can be purchased from Learning through Landscapes website: