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There is some evidence that physical activity and nature contact is associated with positive impact on health; however, the research in young children is sparse. The aim of this study was to determine the association between of city park use, residential surrounding greenness level and preschool children health.This nested case-control study included 1,489 4–6 years children residents of Kaunas city, Lithuania. Responses to the questionnaires completed by the parents were used to identify children’s health. We assigned individual exposure to greenness levels as GIS assessed the average of satellite-derived Normalised Difference Vegetation Index (NDVI) within a 100 m buffer of each participant address. Using multivariate logistic regression analysis, we estimated the associations of residential greenness in 100 m buffers by median and time spent in nearest city park (more than 5 h/week vs less than 5 h/week) with children health outcome as adjusted odds ratios (aOR) with 95% confidence intervals (CI).Poor health was reported in 14.0% of children aged 4 to 6 years. Preschool children who spent shorter than 5 h/week in city park had statistically significant by 48% higher risk (OR 1.48 95% CI: 1.10–2.02) of poor health than those who spent longer than 5 hours per week. With reference to the group of higher level of residential greenness exposure (NDVI >median and time spent in city park >5 h/week), lower level of greenness exposure and shorter time spent in city park were associated with statistically significant higher adjusted odds ratios for poor health in 4–6 year-old children (aOR 2.35; 95% CI: 1.45 to 3.81).The findings of this study suggest a beneficial impact of use of city parks on poor health amongst 4–6 year-old children and demonstrate the important role that increased residential greenness can play a beneficial role in reducing the risk of young children’s poor health.