Characterization of play, sleep, and behavior in preschool-aged children


  • Raquel Lopes Bragança Department of Pediatrics, Centro Materno Pediátrico, Centro Hospitalar e Universitário João
  • Margarida Pinto Unidade de Saúde Familiar da Prelada, Agrupamento de Centros de Saúde Porto Ocidental
  • Mayara Nogueira Department of Pediatrics, Centro Materno Pediátrico, Centro Hospitalar e Universitário João
  • Margarida Ferreira Department of Pediatrics, Centro Materno Pediátrico, Centro Hospitalar e Universitário João
  • Bárbara Mota Department of Pediatrics, Centro Materno Pediátrico, Centro Hospitalar e Universitário João
  • Lara Lourenço Department of Pediatrics, Centro Materno Pediátrico, Centro Hospitalar e Universitário João
  • Fátima Pinto



behavior, children, development, Pediatrics, play, sleep


Introduction: Playing is a fundamental activity of childhood. The primary goal of this study was to characterize the playing habits of Portuguese children aged between three and five years old. The secondary goals were to investigate children’s sleeping habits, audiovisual media exposure, and behavior, as well as caregivers´ perception of these.

Material and methods: Observational study based on the application of an online questionnaire to parents and caregivers about children’s sociodemographic features, playing habits, exposure to screens, sleep, and behavior.

Results: A total of 240 questionnaires were retrieved, 58.3% (n=140) of which regarding male children. Overall, 93.9% (n=225) of children attended or had previously attended kindergarten, 56.9% (n=137) practiced at least one extracurricular activity, 64.4% (n=155) played outdoors in most days, and 80.9% (n=194) played with their peers. Most caregivers (68.3%, n=164) daily played with their children, but 95% (n=228) would like to do it more often. Free play was preferred among children (64%, n=154). Most children (77.4%, n=186) had contacted with audiovisual media before the age of 18 months. Most caregivers (89.6%, n=215) considered that their children slept well, with 27.4% (n=66) acknowledging that they threw frequent tantrums and 21.3% (n=51) that they were impulsive or aggressive. Most caregivers recognized the importance of playing for children. Regarding sleep habits and behavior, lower focus in quiet activities (odds ratio [OR] 4.638, 95% confidence interval [CI] 1.902-11.314) and more regular tantrums (OR 2.317, 95% CI 1.022-5.250) were independent predictors of sleeping problems.

Conclusion: Free playing, frequent outdoor playing, and playing with other children stood out as protective factors of children’s physical and mental health. However, inadequate screen exposure and schedule overload with structured activities represent concerns that should be addressed in Pediatric appointments. Family-centered playful learning should be encouraged.


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Author Biography

Fátima Pinto

Posthumous work


Milteer RM, Ginsburg KR; Council On Communications And Media; Committee On Psychosocial Aspects Of Child And Family Health. The Importance of play in promoting healthy child development and maintaining strong parent-child bond: focus on children in poverty. Pediatrics. 2012;129(1):e204-13.

Póvoas M, Castro T, Mateus AM, Costa M, Escária A, Miranda C. O brincar da criança em idade pré-escolar. Acta Pediatr Port. 2013;44(3):108-12.

Hirsh-Pasek K, Golinkoff RM, Berk L, Singer DG. A Mandate for Playful Learning in Preschool. New York, NY: Oxford University Press; 2009.1ªedição. pp. 17-42.

Bodrova E, Germeroth C, Leong DJ. Play and self-regulation: lessons from Vygotsky. Am J Play. 2013;6(1):111-23.

Walker CM, Gopnik A. Pretense and possibility–a theoretical proposal about the effects of pretend play on development: comment on Lillard et al. (2013). Psychol Bull. 2013;139(1):40-4.

Pellis S, Pellis V. In The Playful Brain: Venturing to the Limits of Neuroscience. Oxford, United Kingdom: Oneworld; 2009. 1ªed. pp. 62-90; 161 -6.

Lewis V, Boucher J, Lupton L, Watson S. Relationships between symbolic play, functional play, verbal and non-verbal ability in young children. Int J Lang Commun Disord. 2000;35(1):117-27.

Galinsky E. In: Mind in the Making: the seven essential life skills every child needs. 1st ed. New York: Harper Collins; Harperstudio. 2010. pp. 43-4.

Yogman M, Garner A, Hutchinson J, Hirsh-Pasek K, Golinkoff RM; Committee on Psychosocial Aspects of Child and Family Health; Council on Communications and Media. The power of play: a Pediatric Role in Enhancing Development in Young Children. Pediatrics. 2018;142(3).pii:e20182058.

Conselho Nacional de Educação. “A EDUCAÇÃO DAS CRIANÇAS DOS 0 AOS 12 ANOS”. Lisboa: Conselho Nacional de Educação; 2008 Available at:; acedido a 06/06/19

High PC; Committee on Early Childhood, Adoption, and Dependent Care and Council on School Health. Pediatrics. 2008;121(4).

Walker SP, Chang SM, Vera-Hernández M, Grantham-McGregor S. Early childhood stimulation benefits adult competence and reduces violent behavior. Pediatrics. 2011;127(5):849-57.

Golinkoff RM, Hirsh-Pasek K. Becoming Brilliant: What Science Tells us About Raising Successful Children. 1st ed. Washington, DC: American Psychological Association (APA); 2016.pp. 34-48.

Lubans DR, Morgan PJ, Cliff DP, Barnett LM, Okely AD. Fundamental movement skills in children and adolescents: review of associated health benefits. Sports Med. 2010;40(12):1019-35. Review.

Hirsh-Pasek K, Golinkoff RM, Eyer D. Einstein Never Used Flash Cards: How Our Children Really Learn—and Why They Need to Play More and Memorize Less. Pleasant Valley, NY: Rodale; 2003. pp. 205-43.

Sobel DM, Sommerville JA. The importance of discovery in children’s causal learning from interventions. Front Psychol. 2010;1:176.

Gruber MJ, Gelman BD, Ranganath C. States of curiosity modulate hippocampus-dependent learning via the dopaminergic circuit. Neuron. 2014;84(2):486-96.

Child Trends. Neighborhood safety [Internet]. Bethesda; 2019 [cited 2019 Jul 10]. Available from: https://www.childtrends. org/indicators/neighborhood-safety/.

Louv R. In: Last Child in the Woods: Saving Our Children From Nature-Deficit Disorder. Chapel Hill, NC: Algonquin Books; 2008. p.99-114.

Barry E. In British playgrounds, bringing in risk to build resilience [Internet]. New York Times 2018 [cited 2019 Jul 7]. Available at: risk.html.

Pellegrini AD, Smith PK. Physical activity play: the nature and function of a neglected aspect of playing. Child Dev.1998;69(3):577-98. Review.

Lieber R. Think Seriously About Spending for Play. 2016;(January 2):B1 [Internet]. New York Times 2018 [cited 2019 Jul 7]. Available at:

Brussoni M, Gibbons R, Gray C, Ishikawa T, Sandseter EB, Bienenstock A, et al. What is the Relationship between Risky Outdoor Play and Health in Children? A Systematic Review. Int J Environ Res Public Health. 2015;12(6):6423-54. Review.

American Academy of Pediatrics (AAP). American Academy of Pediatrics Announces New Recommendations for Children’s Media Use [Internet]. AAP; 2016 [cited 2019 Feb 1]. Available at:

World Health Organization. (‎2019)‎. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. World Health Organization.

Entidade Reguladora para a Comunicação Social (ERC). CRESCENDO ENTRE ECRÃS: Usos de meios eletrónicos por crianças (3-8 Anos) [Internet]. Lisboa: ERC; 2017 [citado 2020 Jan 28]. Available at:

Council on communications and media. Media and Young Minds. Pediatrics. 2016 Nov;138(5):e20162591. doi: 10.1542/peds.2016-2591. PMID: 27940793.

Sociedade Portuguesa de Pediatria – Secção de Pediatria Social. Recomendações SPS-SPP: Prática da sesta da criança nas creches e infantários, públicos ou privados. Published online in June 2017.URL: [03.02.2021].

Bhargava S. Diagnosis and Management of Common Sleep Problems in Children. Pediatrics in Review. 2011,32(3)91-99. DOI:

Gouveia R. As birras na criança. Rev Port Clín Geral. 2009;25(6):702-5.




How to Cite

Bragança RL, Pinto M, Nogueira M, Ferreira M, Mota B, Lourenço L, Pinto F. Characterization of play, sleep, and behavior in preschool-aged children. REVNEC [Internet]. 2022Apr.4 [cited 2024Jun.18];31(1):16-24. Available from:



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