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Commentary: No better time for kids to be outdoors than during a pandemic

Parents worry about their children being susceptible to COVID-19 because they are not vaccinated, but getting dirty outdoors is the best balm to build up immunity, says a paediatric specialist.

Commentary: No better time for kids to be outdoors than during a pandemic

Parents are worried about COVID-19 infecting their children but outdoor play boosts immunity too. (Photo: iStockphoto)

SINGAPORE: The prolonged COVID-19 pandemic has caused much fear and anxiety for parents.

They have had to struggle with keeping their children masked, getting them to perform hand hygiene to protect them from infection while hearing about COVID-19 clusters forming in various sectors including schools and enrichment centres.

Children below 12 years of age are also not yet eligible for the COVID-19 vaccines and thus many parents have opted to keep their children at home even on weekends, but are struggling to keep them meaningfully occupied.

During the gradual reopening phases, some families have found creative ways to beat cabin fever by exploring new, or lesser known, outdoor locations in Singapore, such as animal farms or the zoo, going on hikes in nature parks or exercising outdoors.

Getting dirty playing in the mud or sand and going outdoors in a pandemic may at first seem counterintuitive given the prevailing emphasis on hygiene and safe distancing, but this may in fact have unexpected benefits.

Spending time in open, uncrowded and well-ventilated spaces reduces the risk of COVID-19 transmission.

It also allows children to expend their pent-up energies in healthy ways, such as running, cycling, and swimming which improves cardiovascular health and fitness, while learning more about nature, the plants and animals around us and the importance of conserving our environment.


Studies have also shown that spending time outdoors changes the balance of healthy and harmful bacteria in our bodies, which may boost our immunity, reduce risk of developing diseases like allergies and infections, as well as improve our mental health.

The “hygiene hypothesis” suggests that the increase in allergic diseases in recent years is linked to an overemphasis on cleanliness and hygiene, which has changed the bacteria in our surroundings and removed beneficial bacteria which might have been important for development of a healthy immune system.

Another theory, called the “old friends” hypothesis, suggests that some microbes, which have been in existence since ancient times, evolved alongside the human immune system. They live in peaceful cohabitation with us in the gut, skin, or respiratory tract and have been crucial partners to help us develop a robust immune system.

Thus, the current heightened emphasis on hygiene may disrupt this fine balance that has been established between humans and microbes over millennia, leading to poor or defective immune responses and potentially increasing the risks of developing other non-infectious diseases in time to come.

A large study in the US found that Amish children brought up in traditional farming environments had a lower rate of asthma and displayed good immune system responses protecting against allergic diseases, compared to children brought up in modernised urban farming environments. This suggests that exposure to rural environments and bacteria in early life could be protective against allergies.

Children who played more often also displayed less stress according to research. (Photo: iStockphoto/Alex Liew)

A recent study also showed that increased outdoor nature-related activities increased the amount of beneficial gut microbiota in pre-school children. These children also displayed less stress compared to others who spent less time outdoors.  

In addition, sunlight exposure increases Vitamin D levels which are crucial for the development of a robust immune system.

The benefits of outdoor time go beyond the immune system. Studies around the world are now showing that increased online learning and screen time during the COVID-19 pandemic are causing rates of myopia in children to climb rapidly.

Nine-year-old children in Singapore are not spending enough time outdoors, even though more outdoor time and outdoor light exposure may protect against developing short-sightedness (myopia), a study of the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) birth cohort, a major collaborative research effort involving the National University Health System, KK Women’s and Children’s Hospital, A*STAR’s Singapore Institute for Clinical Sciences and international researchers, found.

More outdoor physical activities also reduce sedentary behaviour and lower obesity rates and the associated complications of heart disease, diabetes and stroke.

People who spend more time outdoors also report better health, feel happier and have lower stress levels. This is particularly pertinent as the prolonged pandemic has taken a toll on the mental health of not just adults but also adolescents and children who have had to adjust to home-based learning and curtailment of social activities.

Parents, educators and healthcare providers should work in partnership to protect our children’s physical and psychological health as the long-term impact of this pandemic may not be apparent for years to come.

If you are planning to spend time outdoors as a family, do remember to adhere to prevailing guidelines on group sizes. Even if there is a restriction of two persons, this could be a great opportunity for parents to plan one-on-one outings with a child in turns, which gives each child quality time with a parent.

Dr Elizabeth Tham is Head and Consultant, Division of Paediatric Allergy, Immunology andRheumatology, Department of Paediatrics, Khoo Teck Puat – National University Children’s Medical Institute, National University Hospital.

Source: CNA/cr