Sand Play and 0- to 8-Year-Old Children's Physical, Cognitive and Socioemotional Outcomes: A Mixed-Methods Systematic Review.

Background: Sand play (SP) is a global phenomenon that may be linked to children's health outcomes, but limited evidence exists. The purpose was to synthesize evidence on the association between SP and 0- to 8-year-old children's physical, cognitive and socioemotional outcomes.

Methods: CINAHL, Academic Search Premier, PsycINFO, SPORTDiscus with Full Text, ERIC, Medline, Scopus and Google Scholar were searched. Studies were eligible if 0- to 8-year-old children's outcomes were reported while attending SP. Synthesis was performed using effect direction (quantitative), thematic (qualitative), narrative and results-based convergent synthesis incorporating the risk of bias and confidence in the evidence assessments. Studies were grouped by SP exposure context as education, leisure and rehabilitation.

Results: The effect direction (Nstudies = 17; Nchildren = 677), thematic (Nstudies = 8; Nchildren = 131) and narrative (Nstudies = 8; Nchildren = 11 784) syntheses included 28 studies published in 1993-2023 (Ntotal = 12 646; Mchildage = 3-6 years; Mgirls 41%; Methnicity Asian 3%, African American/Black/Hispanic 8%, European American/White/Non-Hispanic 56%, Multi-ethnic 36%). Based on very low to moderate confidence in the evidence, findings indicated inconsistent associations between educational, rehabilitational and leisure SP and children's physical, cognitive and socioemotional outcomes. There was inconsistent evidence on the occurrence of SP by children's gender and age.

Conclusion: SP may enhance some childhood outcomes. However, high-quality controlled designs describing the exposure to SP are needed to inform the effectiveness of SP on children's health and development.