Having just spent a week on vacation in the beautiful mountains around Vail, Colorado, I was impressed how quickly and completely relaxed I felt once I entered the natural beauty of this area. In fact, my personal experience has been that whenever I am in a natural, non-built environment-forests, mountains, beaches, rivers – I feel calmer, more peaceful and usually quite happy.
So this invites a question – how important is a walk in the woods for our own sanity as humans and for our kids’ development?
Turns out, according to author Richard Louv, that this relaxation response I experienced in the lovely areas of Colorado, is quite common and explained by the fact that humans have an instinctive liking of nature (which is called the biophilia hypothesis) and that a nature-oriented existence is likely hard-wired into our brains. Louv authored the book “The Last Child In The Woods” and coined the term “nature deficit disorder” to describe this phenomena of children spending less time outdoors in natural environments and the resultant behavioral problems in children based on this lack of exposure. Children that spend less time in nature may experience higher rates of Attention Deficit Hyperactivity Disorder (ADHD) and depression. We know for example that lack of sun exposure can contribute to low mood via low vitamin D levels.
Causes for “nature deficit disorder” may include parental fears about kids getting hurt or lost in natural settings, restricted access to natural environments for many kids who live in cities, and the lure of indoor “screen” activities including video games, TV shows and surfing the internet on home computers.
Research studies examining the effects of nature exposure (and lack of it) on human behavior are fascinating. In one study of kids with ADHD, parents described their observation that their kids with ADHD generally exhibited less of the core ADHD symptoms (inattention, impulsivity, and hyperactivity) when in a natural environment than when in a “built” environment.
Although time in nature is not a “magic bullet” that will cure all behavioral challenges, parents should see woods, streams, lakes, and fields around their neighborhoods as a potential type of “therapy” to help keep kids focused, confident, healthy and balanced.
Here are some actions parents can take to prevent nature deficit disorder in their kids
Be a role model. Show your children how much you enjoy outdoor activities in nature
Plan a weekly or monthly surprise outdoor adventure for your family
Limit kids to no more than 2 hours of total “screen time” per day on computer, TV or video game
Take a nightly walk after dinner as a family in a natural area
Get a map of local parks and trails and get out and explore them once or twice a month
How does your family take advantage nature to reduce stress and even manage behavioral challenges?
Imagine that there is a serious illness that caused over 14,000 people in our state to get sick last year. Those who are most vulnerable to this infection are our children, between the ages of 15 and 24. Some people who get it have relatively few symptoms, and some get sick enough to be admitted to the hospital.
It turns out that this is not an imagined scenario, but is a real epidemic. It’s not H1N1 or some other new strain of flu. It’s chlamydia.
Last week, I spent the day at the Minnesota Chlamydia Partnership Summit convened by the Minnesota Department of Health. This was a gathering of professionals and young people who came together to discuss the chlamydia epidemic that is now affecting our state.
People don’t like to talk about chlamydia. It’s a sexually transmitted infection (STI), and as a culture we don’t like to have sincere conversations about sex. Chlamydia is a serious illness that can lead to serious complications such as tubal pregnancy, pelvic inflammatory disease, and infertility in both women and men.
In Minnesota, chlamydia is a problem across the entire state. About 1/3 of infections occur in the city, 1/3 in the suburbs and 1/3 in rural areas. Chlamydia affects young people between the ages of 15 and 24 at significantly higher rates than other age groups.
It’s hard to imagine this many people getting sick and having virtually no attention brought to it, particularly an illness that disproportionately affects young people. Yet, despite the numbers, we see little media attention or public outcry about this disease.
As parents of teens, we need to take chlamydia seriously and include it as part of the conversation when talking with our children. Teens should understand that if they engage in any kind of sexual activity, they are at risk of getting chlamydia. Chlamydia is sneaky – it often has no symptoms until it has already caused damage to the reproductive organs, particularly in women. If young people are already sexually active, they need to be regularly tested for this infection as well as for other STIs. Chlamydia is can be treated with antibiotics, but only if it’s diagnosed.
You can help protect your kids by doing these things:
Talk, talk, and talk. Tell your teens about chlamydia and how it can affect them, as well as talking about sexual decision-making, and other topics related to reproductive health.
Make sure your teen’s doctor feels comfortable talking to your child about sex. Not all doctors do, and this is an important area of teen health.
Educate yourself. It will be easier to talk to your teen if you feel confident in your own knowledge.
Make sure your teen has other adults you know and trust. Sometimes with sensitive issues, teens may not talk with their own parents, but will talk with someone else.
We can make a dent in this epidemic, but it’s going to take all of us – parents, community leaders, religious leaders, doctors and nurses and not least of all the young people themselves.
Emily Scribner-O’Pray is the Community Services Supervisor at Teenage Medical Service. Read more about Emily.
In a recent article in JAMA by Robert H. Brook and Roy T. Young, April 21, 2010, Volume 303(15):1535-1536, the authors write a commentary entitled, “The Primary Care Physician and Healthcare Reform”. With changes coming from healthcare reform leading to more and more people being covered, the need for primary care physicians is actually increasing. Unfortunately the number of primary care physicians is decreasing. There are two main reasons for this:
the scope of practice is being constricted for primary care physicians with their ability to do less and less procedures (think of less OB and procedures) and less and less in hospital care, (think of hospitalists), as well and more importantly
the differential between what they get paid and what specialists get paid. The gap is substantial.
The median salary in large multi-specialty groups for primary care physicians is around $200,000. The median dermatologist salary is $351,000. Given this type of pay differential and the narrowed scope of practice, why should bright, hard-working, debt-ridden or even altruistic medical students choose primary care versus specialty.
In 2010 only 54.5% of 4,999 residency spots in internal medicine were filled, 44.8% in family medicine and in pediatrics 70.5%. In comparison at least 90% of physicians in neurosurgery, orthopedic surgery, and dermatology were filled by U.S. medical school graduates. Young clinicians are simply not willing to forfeit lifetime earnings of over $3 million.
To many of these students the authors state the primary care physician has become like the water boy on a football team, making sure that the really important members of the medical team do their work. Our dilemma is we don’t have great solutions. There could be no change and we could just let the inevitable decrease continue.
An alternative approach is to convince 50% of the students entering U.S. medical schools in 2010 to choose primary care as their professional career path. But, to do this we’ve go to change those other two variables. They need a different set of clinical responsibilities and skills, we should make them leaders in efforts to avoid preventable hospitalizations for patients with chronic diseases, eliminate inappropriate or equivocal surgery, radiological procedures, and help individuals die with the least pain and without expense for vast amounts of money.
Secondly we’ve got to come up with a way that they get paid more in comparison to specialists. Without these changes there is little hope of producing a healthcare system that provides high quality, affordable care to the U.S. population.
One thing these authors didn’t discuss is the use of advance practice nurses. Perhaps the future is that primary care physicians who want to stay in the field truly have to create systems where they work with advance practice nurses and becomes a conductor of a symphony of advance practice nurses in primary care.
I’d love to hear your thoughts on this.
Phil Kibort, MD, is Children’s vice president of medical affairs and chief medical officer. Read his bio here.
The reality of having a child with chronic health care needs is that clinic appointments are a frequent event. One year I counted them all and from January to July we had 60 appointments alone.
I had to figure out how to make the best out of our appointment time.
For example, to get us in the right mindset, my son and I have a fun routine on the way to the clinic of listening to a tune by Elmo that goes “You have to be patient to be a patient.” This helps us both, but there are some other things that we could do as well.
So I’ve compiled a short list of tips that have helped me, and will hopefully help you get the most out of your next clinic visit with your child.
These ideas come from a lot of personal experience doing things the wrong way, leaving me frustrated, wondering what the doctor said, trying to recall when I am suppose to come back for a follow-up, and remembering that good question I wanted to ask heading home well after my visit, etc … you get the idea.
Why are you there? This is important because it may determine how much time you have with the doctor. If it is a physical or well child check up you have about 15 minutes. If a sick child visit probably less time.
How do we use this short amount of time wisely? Bring a list of questions and the first one should be the most pressing issue you have. This I learned after having a terrible time getting out the door, running late stuck in traffic, can’t find parking, or need a quick diaper change in the back seat, and then completely forgetting every question I had when the doctor arrives.
Take notes if possible or ask the doctor to write things down, draw pictures, or what ever you prefer. Same list of troubles as #2 above happen when leaving and inevitably you cannot remember anything you talked about. You can also ask them to mail you a copy of the office visit notes. If you learn better visually tell the clinician that. If you don’t, save them the trouble of having to be a brilliant physician and an artist.
Don’t forget prescriptions. If you need refills this is done more easily in person then tracking them down over the phone.
Bring help. If you are able, have someone with you to care for your child while you are talking with the doctor. This can be very helpful.
Get to know how the clinic operates. Surprises are not fun during after-hour emergencies. Educate yourself on what the after-hours procedures are, and what happens if your child ends up hospitalized or in the emergency department, or if your primary doctor is on vacation? I have learned that “call us if you need anything” is not as easy as it sounds.
As I also have said before, having your own personal health record is a great way to keep everything organized. I prefer an online version with the Children’s Medical Organizer, that I can then print out if needed.
Please add to this list. What tips have you learned coming to clinic appointments?
Melissa Winger is a Children’s of Minnesota employee and long-time member (and former chair) of Children’s Family Advisory Council. Read more about Melissa in her first post to the Kids’ Health blog.
As a kid I always got excited about thunderstorms and tornadoes. I would run outside to see them when possible. However, for many kids, severe weather is a source of significant anxiety.
Summer is severe weather season in Minnesota and if you live here you know we’ve had our share lately of intense thunderstorms, hail, high winds, and even tornadoes. Studies show that fear of personal harm associated with severe weather is quite common in kids grades 2 through 12 and it makes the top-20 list of things kids worry about (other top stresses for kids include public speaking, terrorist attacks, drowning, monsters/ghosts, and loss of a parent).
Kids can learn to manage weather related fears (and other fears). Self-care skills can help build their confidence in coping more positively around feelings of anxiety before or during extreme weather (watch Tim Culbert, MD, on WCCO working with a patient and family on these self-care skills).
aromatherapy (smelling relaxing scented oils like lavender and orange)
acupressure
Parents can also model a calm, self-controlled style when inclement weather strikes (this is a good self-care skills exercise to practice and model at home as a family unit).
If kids anxiety related to storms and tornadoes interferes substantially with day-to-day life (for example they won’t go outside – even in good weather), then they should see a pediatrician or child psychologist for further evaluation.
Here are some tips and resources I find useful in helping kids cope with anxiety around severe weather:
Having A Plan
Have a Weather Worries Toolkit stashed in the basement or wherever you go for severe weather
Include a board game that you can play, some scented candles, music CDs that are relaxing and some comfy blankets and pillows
Finding The Calm Within The Storm – Things to Do
Acknowledge Your Child’s Fear. Do not criticize, ignore, or belittle these feelings. Talk about it openly and give a name/words to what it is they are most afraid about.
Have a Plan and Rehearse It. It is best to practice skills when things are calm and controlled. Practice several times, then you will all be ready when severe weather occurs. With practice kids develop mastery and confidence. Parents should practice with younger kids and also model these techniques.
Limit Media Exposure. Television and radio media will sometimes cover inclement weather intensely. It is best to limit children’s exposure to this.
Get The Facts. Research the facts about severe weather and understand the reality of it and the conditions for it. Knowledge is power and will often reduce fears.
A recent Star Tribune article tells us that four out of five teens surveyed had no meaningful relationships with adults outside their immediate families. This is concerning, because one thing we know that helps teens grow up to be healthy and happy is connecting with at least one positive adult.
In years past, this happened more naturally because teens were often engaged in the adult world through work, apprenticeships, etc. Today, teens spend most of their time with other teens. A few lucky teens may have a coach or a neighbor who “clicks” with them and provides mentorship, but many teens go without these important adult guides. Teens are at an age where it’s their developmental task to find their place in the world, and part of that process is connecting with adults outside of their families.
Sometimes teens seem disinterested in the world of adults. My experience, however, is that teens are often really craving adult attention, especially if it isn’t based on enforcing rules and discipline. One of the great things about connecting with a teen that isn’t your own child is that it isn’t your job to provide discipline. You get to be the supportive, caring, nonjudgmental adult.
As parents, we also need to encourage our teens to reach out to other positive adults. When my daughter turned 13, we asked those important adults in her life to write her a letter, saying whatever they wanted to communicate on the occasion of her official entry into adolescence. We made a scrapbook of all of those supportive notes and gave it to her as a birthday gift. Knowing that the teen years can be tough, and that she might not always want to come to her parents for help, we wanted her to have a reminder that she has many adults in her corner, rooting for her.
My experience working with teens is that they enrich my life as much as I could hope to enrich theirs. It’s always worth it to take the risk and reach out to young people. As Garrison Keillor said: “Nothing you do for children is ever wasted. They seem not to notice us, hovering, averting our eyes, and they seldom offer thanks, but what we do for them is never wasted.”
Emily Scribner-O’Pray is the Community Services Supervisor at Teenage Medical Service. Read more about Emily.
Fourth of July is typically a time of family gatherings and fun-filled outdoor activities to celebrate our nation’s freedom. But for many, celebration can quickly turn to sadness when a child is injured. Hospital emergency departments see an increase in preventable injuries to children over the Fourth of July.
Fireworks are a leading cause of injury during this holiday, and children account for one half of all firework-related injuries.
Why do parents who would normally guard their child from a three-hundred-degree oven hand them a one-thousand-degree sparkler? Is it because parents are so distracted by the beauty of the sparkles that they forget it’s still fire?
Sparklers are responsible for the vast majority of legal firework-related injuries. Parents, you can reduce the risk of injury by following some very basic safety tips:
Do not allow children under the age of 12 to use sparklers without very close adult supervision
Do not allow children to wave a sparkler
Do not allow children to run while holding a sparkler
Never light more than one sparkler at a time
Drop spent sparklers directly into a bucket of water
I know, it wouldn’t be a Fourth of July celebration without the sights, sounds, and smells of fireworks. But to get the most enjoyment out of this traditional activity, please be safe and protect your children from firework-related injuries.
As you prepare for this holiday I’d like to know what are some precautions you take to keep your kids safe?
Kristi Moline is the Injury Prevention Manager for Trauma Services at Children’s Hospitals and Clinics of Minnesota.
Long days, staying up late, sleeping in, lots of free time… For many teens summer is a welcome break from the busy schedule of the school year. For their parents, however, it can be a stressful time of trying to figure out how to ensure that kids get the relaxation that they deserve while still staying safe.
There are the physical safety concerns – bike helmets, sunscreen, and water safety. Additionally, with all that free time comes worry about what kids are doing. Unsupervised teens are more likely to drink or get high, engage in sexual activity or engage in violence. And yet it’s neither realistic nor desirable for teens to be monitored every minute of the day.
So what’s a parent to do? Research shows that something called “Parent-child connectedness” is an important protective factor in keeping teens out of trouble.
In simple terms, when parents and teens feel close to each other, they have connectedness. When you are connected to your teen, you might experience the following things:
You and your teen spend time together doing things you each enjoy
You can talk freely and openly
You are affectionate and warm, laugh together and enjoy each other
You trust each other
You respect and support one another
You share similar values and respect your differences
You feel positive about the family relationship
Family arguments and conflicts are at a low level
Both you and your teen feel satisfied with your relationship
OK, great. But how does a parent create this, especially during the rocky teenage years? While you can’t control how your teen acts, you do have control over how you respond to and act towards your teen. Here are some tips for helping you stay connected:
1) Remember that teens need to have some independence. It’s their job in this stage of life to seek it out. Keep this in mind when their behavior is driving you crazy. Encourage independence when it’s reasonable and safe to do so.
2) Admit to yourself when you have overreacted. Admit it to your teen too. This will help build trust with your teen – a key component to parent-child connectedness. Often, if a parent apologizes or admits a mistake, it opens up a real conversation with their teen. Don’t forget to forgive yourself too – raising teens is hard work!
3) Build a support network. It is easier to deal with frustrating behavior from your teen if you have support from friends, family, clergy or other professionals.
4) Find out why your teen is acting in a certain way. Teens want parents to understand their point of view. Listen more than you talk.
5) Pick your battles. Let your teenagers make some of their own choices, and allow them some privacy. Sometimes people learn best when they make mistakes and experience the consequences first hand.
6) Help your teen to gain the skills they will need to live independently. This can be challenging, but is important. Teens feel better when they are contributing to the household in a meaningful way too!
7) Make sure your teen knows you’re on their side. Think about how your responses to your teen’s behavior will affect the closeness that you share. When teens feel connected to their parents, the messages and modeling that parents offer are more likely to “stick.” Staying connected to your teen is more important than being right.
Parenting teens can be hard work. But parents who are strongly connected to their teens get more satisfaction out of these years, and their teens do better both during the unstructured days of summer and throughout the year.
What do you do to stay connected to your teens? Share your own tips in the comments below.
Emily Scribner-O’Pray is the Community Services Supervisor at Teenage Medical Service. Read more about Emily.
Laura Gilchrist, a clinical research scientist with Children’s Hospitals and Clinics of Minnesota, discusses the hematology/oncology research she does to help our patients.
Recently, Children’s held its quarterly Champions for Children’s breakfast. This wonderful event is one of the hospital’s many ways of saying thank you to our employees. Staff throughout the organization nominate other employees for going beyond the call of duty in delivering extraordinary care to children, their families, or one another. What I love about this event is that it is all about “pure goodness.”
An event like Champions for Children’s reminds me why I came to work in a children’s hospital and why the vast majority of us work here.
Whether it is stated directly or not, the people who work at Children’s do understand its mission of championing the special healthcare needs of children. These amazing stories convey to us that we come to work to find worth, to give, to be compassionate and to help others. To put a smile on a face, warmth in others’ hearts and the relief of pain and suffering. I am never more proud of the organization than at this breakfast whether it’s the nurses, social workers and chaplains, people in materials management, IT, admitting or other areas — they all are amazing, and committed to our patients and families.
And so while we must be thankful for our good health, for the jobs we have, and realize that we may go through ups and downs, the number one reason we do what we do is because of the goodness in our hearts.
Phil Kibort, MD, is Children’s vice president of medical affairs and chief medical officer. Read his bio here.
Imagine that there is a serious illness that caused over 14,000 people in our state to get sick last year. Those who are most vulnerable to this infection are our children, between the ages of 15 and 24. Some people who get it have relatively few symptoms, and some get sick enough to be admitted to the hospital.
Recently, Children’s held its quarterly Champions for Children’s breakfast. This wonderful event is one of the hospital’s many ways of saying thank you to our employees. Staff throughout the organization nominate other employees for going beyond the call of duty in delivering extraordinary care to children, their families, or one another. What I love about this event is that it is all about “pure goodness.”