Introduction

Child care has become an essential part of everyday life. In 2011, more than half of Canadian parents reported using some type of child care for children aged 4 or younger. These children spend most of their waking hours in childcare, year-round, so it is important that nurturing environments are provided to stimulate child development across all domains. Although receiving little policy attention, evidence suggests that the design of naturalized outdoor environments can contribute substantially and uniquely to health promotion in  early childhood. Because child development facilities are highly regulated, quality must be measurable and created through evidence-based design. Progress is slowly being made in that direction. Design guidelines based on available evidence influence practice. Even so, the 2017 Canadian national report on early childhood education does not mention “outdoor”, “playground”, “natural”, or “nature”, even though the cover shows a child in nature.