Playing represents a fundamental activity for children’s growth. Games consisting in manipulating blocks, especially, seems to have an important role in the child’s cognitive development. Many studies have been conducted for investigating the various aspects of playing with blocks, in order to understand its actual effectiveness in relation to different cognitive skills. A first area of research regards the relationship between playing with building blocks and visual-spatial ability; a second one examines the relationship between playing with building blocks and mathematic skills; a third one explores the relationship between building blocks, visual-spatial skills, numerical intelligence in its various components and mental imagery. These studies suggest that playing with blocks represents an important recreational and educational tool with a high capacity to enhance the overall cognitive development and specific skills like the mathematical ones. This narrative review offers an analysis of the existing empirical evidence on playing with building blocks in order to understand its actual effectiveness. In an historical period where electronic devices are gradually replacing the manual games that have always accompanied human development, knowing the state of this kind of research may represent a source of reflection for reconsidering scholastic programs with the aim of a possible return to specific manual playing activities, in order to enhance cognitive functioning and specific school skills.