Caring Environment, Creative Play, Healthy Food – PediaCast 321

Show Notes

Join Dr Mike in the PediaCast Studio for details on the Ohio AAP’s Good4Growth Program. Melanie Farkas, Dr Robert Murray and Dr Jessica Foster stop by to tell us how the program emphasizes a caring environment for kids, encourages creative play and physical activity, and models healthy choices surrounding meals and snacks. The program also aims to transform the way health supervision check-ups are conducted. Tune-in to learn how!

Good4Growth Program
Supportive, Caring, Nurturing Environments
Creative Play & Physical Activity
Healthy Meals and Snacks
Transforming the Health Supervision Check-Up!

Melanie Farkas
Director of Communications and Immunization Programs
Ohio Chapter of the American Academy of Pediatrics

Dr Robert Murray
President-Elect of the Ohio AAP
Professor of Human Nutrition
The Ohio State University

Dr Jessica Foster
Physician Administrator
Bureau for Children with Developmental and Special Health Needs
Ohio Department of Health

American Academy of Pediatrics – Ohio Chapter
Good4Growth Program Page
Healthy Children, Healthy Weights – Parents Page


Announcer 1: This is PediaCast.


Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello everyone, and welcome once again to PediaCast. It's a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It is Episode 321 for June 17th, 2015. We're calling this one, "Caring Environment, Creative Play, and Healthy Food".

I want to welcome everyone to the program.

So judging by the title, you'd think that today's show covers News Parents Can Use or maybe Answers to Listeners' Questions, but that's not the case. In fact, we have a nuts and bolts interview edition of PediaCast lined up for you this week. 

So what's the topic at hand? What topic ties together supportive, caring, nurturing environment for kids, creative play and physical activity and healthy choices surrounding meals and snacks? That's a good question, and I have an equally good answer.

Today, we're talking about the Good4Growth Program for the Ohio Chapter of the American Academy of Pediatrics. I also have to tell you, I'm really excited about this program. Now, I know, I get excited about a lot of thing on PediaCast, and I frequently tell you this is going to be a good one or I say make sure you share this one with your family, friends and co-workers. I always mean it when I say that. I really am excited to share information with you. But today, I'm doubly excited and here's why. 

You know, we've been meeting together, you and I on this podcast since July 2006, one year shy of a decade. And from that very first show, really, every show since the beginning, we've closed the program with a simple phrase, and most of you can probably repeat it without even thinking about it — "Stay safe, stay healthy and stay involve with your kids." 


Right from the get-go it seemed to me that the parent-child relationship was key, and we didn't stop with the tagline when promoting the importance of staying involved with your children. Really, throughout the series, we've shared ideas on how to do that, share a good place to start as turning off screens and eating family meals together. 

We've talked about that many times on PediaCast. We've covered research which supports it. We've also talked about fun and creative ways to spend time with your kids. We've covered spending time outdoors, family outing for every season and game nights. We've asked our guests to share their family favorites, and I have had countless emails from all of you with ways that your family spends quality time together.

As it turns out, we were onto something because additional research is telling us that the parent-child bond, and the bond that child has with other caregivers, it's an important thing, and that quality time we've talked about that conserve and strengthen the bond. 

We'll talk more about what research is telling us, but to give you a sneak peak, when you provide a caring supportive nurturing environment for a child, you're really in a better position to act and speak into that child's life to encourage creative play and physical activity and to help them eat healthier meals and choose healthier snacks, things that really matter. 

So today, we'll tie all that together and we'll go several steps further and give you specific ideas for implementing the concepts behind Good4Growth in your families, in homes, even in your pediatric practice if you happen to be one of the many healthcare providers in the audience today. 

And speaking of pediatric practice, the Good4Growth Program, really I think seeks to turn the health supervision visit, also known as the well-child check. Good4Growth seeks to turn those visits on their head with a complete paradigm shift in how they're conducted, especially in the early years of a child's life.

I don't want to give away too much. We have lots to cover, and want to step through in a way that doesn't leave out important details. Suffice it to say, it's an important show and we have some great guest lined up to help me with the topic. 

Melanie Farkas is with us today. She's Director of Communications and Immunization Programs for the Ohio Chapter of the American Academy of Pediatrics. 


And, by the way, I know many of you aren't in Ohio, so why should you care about an Ohio program? Well, because you don't need to be in Ohio to benefit from it. We'll share how easy it is for families everywhere to access the resources of Good4Growth.

We also have Dr. Robert Murray in the studio. He is president-elect in the Ohio AAP and professor of Human Nutrition at the Ohio State University. 

Jessica Foster is a developmental pediatrician and Physician Administrator for the Ohio Department of Health's Bureau for Children with Developmental and Special Health Needs. 

We'll do formal introductions after the break. First, I do want to remind you, PediaCast is your show. If there's a topic that you'd like us to talk about, if you have a question for me, give me a holler. Head over to, click on the Contact link. 

You can also call 347-404-KIDS. That's 347-404-5437 and leave your message that way.

Also, I want to remind you, the information presented in every episode of this program is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you do have a concern about your child's health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at

All right, let's take a quick break. I'll be back, we'll get our guests settled into the studio and we'll talk about Good4Growth right after this.



All right, we have trio guests in our studio today to tell us about and help us understand the underlying concepts and goals of the Good4Growth Program. 

First up, Melanie Farkas is Director of Communications and Immunization Programs at the Ohio Chapter of the American Academy of Pediatrics. She coordinates and oversees all communications for the chapter, manages the maximizing Office-based Immunization Program and the Teen Immunization Education Sessions Program, and she coordinates the Practice of Pediatrics Pillar and the Pediatric Care Council. 

Melanie is a graduate of Central Michigan University and a former journalist. She and her husband live in the Columbus suburb of Dublin, along with — she describes them — the two most adorable children in Central Ohio, which might be true if it weren't for my two children, although they're 18 and 20 and probably wouldn't appreciate being called adorable anymore.

Melanie Farkas: I'll show you pictures. You'll believe me.

Dr. Mike Patrick: I do. I do. I trust you. Well, thanks for stopping by today. Really appreciate it.

Melanie Farkas: Thank you for having us.

Dr. Mike Patrick: Absolutely. 

We also have President-elect of the Ohio Chapter of the American Academy of Pediatrics with us in the studio, Dr. Robert Murray. Dr. Murray joined the faculty of the Department of Pediatrics at the Ohio State University College of Medicine back in 1985 as a member of the Division of Gastroenterology and Nutrition at Nationwide Children's Hospital here in Columbus. He spent 20 years in clinical practice before serving as Pediatric Medical Director at Abbott Nutrition. Following that, he returned to clinical practice in the Center for Healthy Weight and Nutrition in Nationwide Children's where he focused on medical and surgical weight management. And since 2011, he's been a professor of Human Nutrition in the Department of Human Sciences at Ohio State.

Dr. Murray has been a member of the American Academy of Pediatrics for 25 years and served as past president of the Central Ohio Pediatric Society. At the state level, Dr. Murray has been chair of the Ohio Chapter's Home and School Health Committee for ten years. At the national level, he served on the AAP's Council on School Health also for ten years including four years as chair, and he currently serves on the AAP's Council Management Committee. 

It's an honor to have Dr. Murray in the studio, so let's extend a warm welcome to him as well. Thanks for joining us today.


Dr. Robert Murray: Thank you for inviting me.

Dr. Mike Patrick: Really appreciate it. 

So I had mentioned to you when you came in that you were a GI attending when I was a resident here back in the 90's. It's been a long time, but it's great seeing you again.

Dr. Robert Murray: Yeah. Good to see you.

And then, Dr. Jessica Foster is also with us today. Dr. Foster currently serves as Medical Director for Ohio's Title V Program on children and youth with special health care needs and she's a Physician Administrator in the Office of the Medical Director at the Ohio Department of Health.

Dr. Foster is a board-certified Developmental-Behavioral Pediatrician completing her fellowship training in the Masters of Public Health at the University of Kansas. Prior to her current position, Dr. Foster was a Clinical Assistant Professor of Pediatrics at Nationwide Children's Hospital in the Ohio State University where she served as a member of the LEND Faculty at the Nisonger Center. LEND, you may be wondering, stands for the Interdisciplinary Leadership Education in Neurodevelopmental and Related Disabilities Training Program. So let's extend a warm PediaCast welcome to Dr. Jessica Foster. Thanks for stopping by.

Dr. Jessica Foster: Thank you. Very glad to be here today.

Dr. Mike Patrick: Great. Really appreciate all of you coming.

Melanie, let's start with you, I want you to give just a brief overview of what is the Good4Growth Program and who's sponsoring it?

Melanie Farkas: Sure. Good4Growth is really a groundbreaking program. It's a partnership between the Ohio Chapter, American Academy of Pediatrics and the Cardinal Health Foundation. 

There's three large pieces of it, but it's all promoting that parent-child relationship through the three key areas which are healthy food, creative play and caring environment. 

Dr. Mike Patrick: Great. And you guys are focusing on making this practical, right? I mean really having tools and tips to help parents because it's one thing that we sort of talk about, these kind of ideas, but really put some practical tools into parent's hands and caregivers and providers. That's really the goal here, right?


Melanie Farkas: Sure. And one of the three pieces is our website,, and we're launching a challenge here coming up in August. And that has very easy tips on helping parents make that connection and bond with their child and using those three key areas — healthy food, creative play and caring environment — to connect with their child on a daily basis. So we're really excited.

Dr. Mike Patrick: Yeah, absolutely. We talked about physical activity and play frequently and you hear about it in the news, and parents see research that supports that. We know kids need to be more active, and we know kids need to eat better. We all need to eat better. But I love that you guys include that caring environment piece of it. 

Dr. Foster, why is caring, supportive, nurturing environment important for kids?

Dr. Jessica Foster: So a nurturing environment is really what sets the foundation to allow that opportunity for kids to be able to engage in creative play and to be able to be a part of those wonderful nurturing relationships. Without that safe stable nurturing environment, kids really are not able to have that comfort level and be able to truly engage in the most meaningful way possible.

Dr. Mike Patrick: There have been some studies that look into the relationship of kids who are in supportive nurturing environments and how they do physically. So there are some studies that show they're less likely to get sick. They do better in school. They're more likely to get along with friends, less likely to use drugs and alcohol. So it really does seem like the environment the child is in is very important.

Dr. Jessica Foster: Absolutely, it is. It is foundational to healthy growth and development and social and emotional outcomes as well.

Dr. Mike Patrick: So what constitutes is supportive, nurturing environment? How can caregivers be sure that they're providing that for their child?


Dr. Jessica Foster: So number one, the environment has to be safe before you think about anything else. Safety is more important than the things and the toys that are present.

Number two, that environment has to be filled with those nurturing caring relationships. The child needs to know that the adults that are there are consistent, and they're going to respond to their needs based upon what that child needs. And you've got to have that foundation. And then you can begin to build that developmentally appropriate, exciting environment that allows for creative physical interaction with all of the wonderful things around them.

Dr. Mike Patrick: Yeah, absolutely. It seems to me that the child really has to feel loved like they're accepted, like they belong. It seems like these are great ideas, but when the shoes hit the street, how do you do that?

Dr. Jessica Foster: So a lot of that is how literally the parent or the caregiver interacts in that back and forth way with that child. So when that child approaches a parent, the parent responds in an accepting way. The parent is able to play that sort of volleying game back and forth — maybe with words or communication, maybe with a toy or a game — and encourages that interaction.

Dr. Mike Patrick: We're all so busy in our lives that it seems like you almost have to be intentional about making time to interact with whatever child is in your sphere of influence, whether you're the parent or the caregiver. But when we have so many competing things that we're thinking about and technology and our phones, you really need to set that stuff down and focus on the child who you're responsible for.


Dr. Jessica Foster: That's absolutely right. And remember that just a few minutes of your time and attention can help to develop that relationship. So, you don't necessarily have to set aside that solid hour for that intensive play, but instead it really is about being responsive in those minutes that children approach you throughout the day.

Dr. Robert Murray: One of the great pediatricians of our lifetime, T. Berry Brazelton, used to call that the magic of everyday moments. What I like about that is that when you're serving a meal, that's your opportunity. You have to carve out anything. When you're doing bath time, when your child is playing on the floor, it's something that you incorporate into your day. You watch them and you interact with them at every opportunity. I think it is a magical thing. It doesn't require parents to be practically really busy parents. It doesn't require them to schedule separate time. 

Dr. Mike Patrick: And I would think that the more you practice that, the more natural and easy that it becomes, too.

Dr. Robert Murray: With that conversation that just can talk about, that sort of and volley, that back and forth, that really is what opens that up. Because the child will come to the parent or the parent can come to the child in those little magical moments and that conversation never ends. It goes all day, and that's really the connectivity.

Dr. Mike Patrick: Let's look at the next focus of the program and that is creative play. Why is creative play important?

Dr. Jessica Foster: So creative play builds brains. That's why creative play is important.

Dr. Mike Patrick: Wow.

Dr. Jessica Foster: And creative play really requires engagement of every one of the child's senses and abilities. So when children can be physically active and engage in whatever the moment is, they learn from those successful activities. They learn from things that surprise them when it goes differently than they thought. And through all of that opportunity, children are literally building neuronal connections in their brain. It's really amazing.


Dr. Mike Patrick: So it's not just a fun thing. It really translates into neurodevelopment?

Dr. Jessica Foster: Absolutely, just like we teach you. You need to go out and run or walk 30 or 40 minutes a day to keep that heart healthy. Creative play is how children build brains.

Dr. Mike Patrick: How can parents facilitate creative play without necessarily directing it because at some point it doesn't really become creative anymore? It just becomes what the parents tell and the kid do. How do you walk that line and help kids to learn to play creatively?

Dr. Jessica Foster: It's a great question. So first, it goes back to that foundation that we've already talked about. So you have to have that safe environment. You have to have a developmentally appropriate environment to allow that child to feel safe and able to engage in that play. 

You need to have appropriate developmental expectations for your child. Have some sort of understanding of what the abilities of that 18-month old should be, so that say that child is really working on mastering throwing. Well, your kid will most probably going to want to throw everything they encounter at that age. 


Dr. Jessica Foster: And so you want to set it up in a way that you can allow that type of wonderful playing behavior without having to constantly reprimand and redirect them.

Dr. Mike Patrick: Because, really, you sort of set them up in failure if you don't have that environment that they need in order to be creative with the things that they're interested in doing.

Dr. Jessica Foster: Absolutely, and you set yourself up for frustration as a parent as well.

Dr. Mike Patrick: And then you can see then how creative play and more physical activity can morph together so you get the added benefit of really moving your muscles in addition to the brain development.


Dr. Jessica Foster: Absolutely, and the research tells us that when you're physically engaged, you'll learn better. There's just no doubt about that. 

Dr. Mike Patrick: From the group here, what are some ideas that you have on creative play in your own homes and things that you would advise parents? Just some things that maybe others haven't thought of.

Dr. Robert Murray: Well, certainly when you look at parents and play, the parent really adjust themselves to what the child's attention is focused on, and I think that's one of the ways they can be in to get into the child's perspective. 

In the first year, the kids are really trying to learn what objects are and what they do, what they're like when you drop them or kick them, or what kind of sounds they make. And so, the parent can really get in and help them by seeing what they're seeing, and pointing, and talking, and using… As they get older, kids will become much more symbolic, and it becomes much more complex, but that first year, really, the parent needs to be engaged right there with participating with the child's attention. And that's the creative part.

Dr. Mike Patrick: So from a little baby, just introducing them to new objects and letting them feel and touch, and if appropriate, taste and all of those things. And then as they get older, then there are newer objects, so you can make a scavenger hunt. There's all kinds of things you could do creatively.

Dr. Jessica Foster: Sure, and it doesn't require expensive toys. That's a really important message. You can have, again, that foundational safe environment and then that just opens up the world to all of those wonderful everyday objects and interactions that are present in any home.

Dr. Mike Patrick: Great. Dr. Murray, let's talk about healthy food. I think that, you know, we hear this so often. What are just some simple things that caregivers, parents, folks who are taking care of kids during the day, what kind of things can they do to encourage kids to eat healthy?


Dr. Robert Murray: Well, actually the whole concept of healthy food — and in this case brain development — is really the focus that we've taken with Good4Growth. It begins at conception, and young women need to prepare for pregnancy, but during pregnancy they need to have optimum nutrition. They need to be physically active. 

Nutrition is both activity and… They're not separate, the food and the activity are the same kind of partners. So pregnancy is really important that mom hits her marks that she gains the right amount of weight; she eats high quality nutrient rich foods. 

After birth, breastfeeding is optimal. If you're trying to build the brain, that's the way to go, and it's a wonderful experience for mom and baby at the same time. It itself is a communication between the two, and I think that's important.

When we move in to the second half of the first year we're beginning to introduce foods and textures. That's really where the opportunity is to introduce the baby to high quality foods and then maintain that. Really difficult because in the second year, 12 months to 24 months, they'll assume the eating habits of the family for better or for worse.

Dr. Mike Patrick: Especially with little ones, it seems to me… And as I think about my own kids being 18 and 20 now and kind of the things that they eat, and there's some regret in the way that we did as a family. So it seems that it's really important to do this right out of the gate if you can.

Dr. Robert Murray: Very important, along with all the things that we just goes talking about, all the brain-building and stimulation and stuff, our food preferences are really set during that first 24 to 36 months, so it's important to keep introducing new foods all the time and not let the child take things off the table. As far as teenagers, don't despair. They do the drift away in the nutritional world to some far far land, but they come back and one of the things about, 


Dr. Mike Patrick: When they start having health problems, right? 


Dr. Robert Murray: When they pay their own insurance.

Dr. Mike Patrick: Yes. 

Dr. Robert Murray: But you now, the brain's not fully developed until age 25, and it is remarkable to see difference in an 18-year old and a 25-year old in terms of maturity and in terms of kind of self-perception. They'll come back to what you taught them early, so don't despair in adolescence.

Dr. Mike Patrick: I guess we should probably mention — and we've talked about this so much and it seem like the media is saturated with this, but I'll be remised if we didn't at least cover — what are healthy choices?

Dr. Robert Murray: It's a good question, and I think we make it unnecessarily complicated. There are five food groups: vegetables, fruits, whole grains, low fat milk and dairy products and then quality protein sources. And so, the easiest thing for a parent to do is to think every meal, every snack how do I mix and match? Am I hitting more than one food group? Am I mixing them well? And how do I put them together into a dietary pattern? And then, within each food group, look for the highest nutritional values. 

So I know we talked endlessly about getting rid of saturated fat and salt, but as a parent, I would focus first on what are my five food groups that I can pick from? What are the highest quality foods that are in those food groups, and then, how do I present them on a regular basis that keeps them interesting for the child?

Dr. Mike Patrick: One question that we get from time to time is about vitamins and vitamin supplements and multi-vitamins. Are those important for kids?

Dr. Robert Murray: It's an irony. I think that the kids that need the vitamins don't get them, and the kids who don't need the vitamins get them. Generally, we do really well in the first year with nutrition that we maintain pretty good nutrition through age five. I think because we are still based on drinking dairy products and we do a good job of hitting those five food groups except for probably vegetables in that first five years.


After that time, things begin to go downhill. So I think that the important thing for parents is again to maintain those high quality foods. Keep your eye on those. Stay away from foods that offer a lot of calories, but not a lot of nutritional value like all the processed foods and things. The real goal is, 

Dr. Mike Patrick: It doesn't take a lot of those foods to get the vitamins that you need, but if you're not getting any of them, then you're not getting them.

Dr. Robert Murray: Yeah. And if you can find those simple things for little kids, hummus or salsa or things that they like, eggs. You're beginning to put really high nutrient foods. 

Again, those five food groups all have really nutrient rich foods. If I can make a simple substitution of spinach-type lettuce or Romaine lettuce or iceberg lettuce, I'm moving up. Always think about just little ways of making incremental change pay for the child.

Dr. Mike Patrick: So the Good4Growth Program, we've talked about these three goals: nurturing environment, the creative play, the healthy food. So we have these ideals, we know they're great, but next really, as a group, you want to get the word out. And one of the ways you're doing that is by collaborative. 

So Melanie, tell us what is a collaborative and what are you trying to accomplish through that.

Melanie Farkas: We have two different learning collaborative. The first one launched in April and that's the Learning Collaborative in primary care environments. We engaged nine practices that are not just from Ohio, but we have practices in Kentucky and West Virginia, and the folks came to Central Ohio and we trained them. We brought in the folks from Promoting First Relationships, which Dr. Murray can tell us more about that. And promoting this parent-child relationship in their offices through the pediatrician's training those parents.


Dr. Mike Patrick: So if we can get the word out to a source that then can get the word out to a larger number of people, then we're going to have a more successful message?

Melanie Farkas: Exactly. 

Dr. Mike Patrick: Now, you've described the Good4Growth Program as a quality improvement program for primary care offices. So the offices you talked about that are involved in the learning collaborative, in what way is it a quality improvement program?

Dr. Robert Murray: Well, the purpose of the quality improvement program is to get clinicians to really use, in their practice, use the most current information in a variety of fields. We have them in the asthma and developmental screening and mental health. 

In this case, what we're trying to do is get them to really rethink the way that we have set up health supervision. When I trained and then later when I trained you, Mike, we went through a thing where the physician had certain topics that they were trying to teach us. So it's this kind of a teacher-student relationship with parents.

The Promoting First Relationships' focus is really on being a partner with a parent in shaping relationship with the child because we got science that says that relationship is so important, as Jessica mentioned. It's so important for not just the early brain development, but their whole life trajectory is really built on that early relationship. So we're trying to train parents improve their clinicians, train them in looking closely at their relationship with the child and getting inside their child's mind so that they understand that back and forth, that serve and volley, and making that work with the child.


And then, we're trying to outside that look at child care providers — that's the second part of the collaborative — as the other environment that a child grows up, and it's really trying to get those early environments.

Dr. Mike Patrick: How do you judge the success of making that happen?

Dr. Robert Murray: It's a good question and we grapple with it for a long time. In the first part of the collaborative that just started in April, it really has to do with physicians mastering the techniques of shifting their health supervision from a teaching mode to a relationship-focused mode. They may not use it on every child every time, but they got multiple visits between birth and age three. 
We want them to take advantage on that to focus on the relationship and draw out the parent. What worries do they have about the relationship? Are they handling behavior well? Do they feel comfortable? Are they happy as a parent? We all know that it's a tough business. Being a parent is not easy day to day, and so we're looking to repair anything that may cause trouble.

Dr. Mike Patrick: It seems like the focus of the well checkups, at least when I was practicing, was really are your immunizations up to date? How do you look on your growth chart? And do you have any questions? So how is this different from that?

Dr. Robert Murray: Well, we still have to do immunizations. And as you know, that's kind of the basis of prevention there. In this case, this is a different type of prevention. As one of my developmental colleague calls that it's immunizing the child against stresses in their life, teaching them how to handle stress. So it's a different type of prevention. 

What we're trying to teach physicians to do is to observe the relationship between the parent and child and point out to the parents the way that the child needs them. When we walk in as physicians, we scare them. When they don't like strangers coming in and taking off their shoes and doing all these, so they'll turn to their parent for reassurance, and we'll point that out. If they don't turn to their parent for reassurance, that's a signal to the doctor that there may be an issue, and they want to look very carefully to that.


Dr. Mike Patrick: Sometimes, you'll see more of an adversarial relationship between the parent and the child where you come in, the child's afraid and the mom may be reprimanding the child for their behavior. How do you successfully redirect that relationship without offending the parent, and then they're not listening to anything else that you're saying after that?

Dr. Robert Murray: That's really part of the training of Promoting First Relationships because it isn't easy to not step in between the two, but what promoting first relationship is doing — and it's based on attachment that goes way back — is observing for that opening that is positive. So you begin always with a positive, and you talk with the parent about how the child seems to need his or her reassurance and those kinds of things, and you build out from there.

In the old mode, we were very didactic and black and white, which is kind of a natural for physicians, but in this case, it's much more of this drawing out, and that's the training part. So we'll know we're successful if the physicians are acquiring those skills and those sentences that draw the parent into that discussion.

Dr. Mike Patrick: And then are you looking at the parents who go to these practices to see if there's any meaningful change in the parent-child relationship because they've been involved in a practice that's part of one of these learning collaboratives?

Dr. Robert Murray: That's the second part. Once the physicians feel they've mastered the early counseling techniques, then the second part we're going to look at is the parents. What we're looking for in the parents is have they acquired the skills themselves — the parenting skills where they feel that they have a good relationship with their child, that they're in control of the child's behavior, they understand why the child has that behavior, they feel comfortable talking with them, they got a good routine and they like being a parent?


So in the second part of this, between the ages of 12 months and 24 months, we'll be interviewing parents and stuffs and looking to see whether that Promoting First Relationship style has made them more comfortable as a parent.

Dr. Mike Patrick: And then, do you have plans to publish your findings on the success of the program, or the lack of success of that? I can't imagine that that would be the case, but presume. We are scientists after all.

Dr. Robert Murray: Yes. You know, at the Ohio Chapter, we do a number of these programs and we think of them in terms of waves. In the first one, we kind of learned to make them work and look and see what the pluses and minus. And then, as we repeat them we really hone down looking for more and more results. So yes, we think it's an important part of this talk.

Dr. Mike Patrick: I think, too, just in terms of giving the word out to other pediatricians around the country when you have a peer reviewed article that says, "Hey, this works," it gets a little bit more attention as you're trying to get… If you want to shift the paradigm, I guess you have to go through the route that speaks most to the providers out there.

Dr. Robert Murray: Well, we're also hoping, this is learning collaborative and all pediatricians have to take some form of quality improvement into their practice, so we're hoping to offer this outside the boundaries. 

Dr. Mike Patrick: The maintenance of certification and stuffs.

Dr. Robert Murray: That's right. And make it easy for them to participate in future waves if they wish to.

Dr. Mike Patrick: That's fantastic. Now, so this is the collaborative that you have in place at this point and I know that you also are interested in getting local early childhood centers involved. What do you think, and I know that that collaborative's not in place yet. It's kind of in the planning stages, but what do you think that's going to look like, Dr. Foster?


Dr. Jessica Foster: So this is very exciting, in my opinion. I think, first of all, it's important to understand that over 60% of our children in Ohio are in some kind of out-of-home care setting. And for the majority of those children, they spend most of their waking hours even in these settings. So that's why it becomes such a critical environment for us to target these messages. 

In early childhood world and in Ohio, we already have some wonderful work going on, especially related to nutrition and in physical activity, and building those policies within our early childhood programs to make sure that our children are able to access this healthy environment. So we have a wonderful curriculum called Healthy Children, Healthy Weights that comes out of Columbus Public Health that has been used to build an Ohio healthy programs designations. So early childhood centers can get the designation and can actually gain stars on the star rating system to show that they're really an outstanding high quality program. 

And so the idea is we build on that wonderful success that is in our community. We can add in those elements related to these concepts of stress and toxic stress and building brains and this idea of building resiliency through relationships. That resiliency is really that immunization that Bob talked about.

So we want to develop this approach and then bring this to our colleagues in the child care, early childhood learning settings, in the form of a learning collaborative because we know that adults, just like children, if adults are really engaged in their learning, that's when we're going to see a change.


Dr. Mike Patrick: And this goes a little bit of a step further in that it's not only promoting the relationship between the parent and the child. It's really also the relationship between the caregiver and the child in these centers.

Dr. Jessica Foster: That's absolutely right because those relationships that children are engaged in throughout their day, each of those relationships is critically important. And again, because of the number of hours we know our children are spending in this out-of-home settings, it makes those relationships just a critical piece of that child's development. 

And again, as we build this message to our community, you can see how parents and child care providers can be really advocates for sending this message to maybe your Sunday school settings or other community settings where children are interacting with their parents as well. 

Dr. Mike Patrick: Yeah, absolutely. And this is one of those things too where once it's set up, you can look at the results, like what are the outcomes? What are the relationships between kids and caregivers, both when you start the program and after the learning collaborative takes place?

Dr. Jessica Foster: That's exactly right. So you set it up so we have some really concrete outcomes that we're following. We collect data along the way and we use that data to demonstrate that we're making a change. And if we're not making a change, we go back to the drawing board. That's part of the quality improvement process, and again, part of what really drives true change to occur.

Dr. Mike Patrick: What about getting this message out to in-home child care providers? So it seems like there would be a lot of kids who have that, have first relationships not just in centers, but in someone's house. How do you get a message out to them?

Dr. Jessica Foster: That's a great question. So you're exactly right, the child care community in early childhood education community is very diverse and so I've been talking about centers, but absolutely we have some wonderful in-home providers who are also responsible for the same wonderful Ohio children. 


Those providers face some different challenges when trying to access education because they are often the sole provider of care. They are the sole business manager. They are the menu writer, the food cookers. They are the whole enchilada. 

So we indeed are planning on working on a more modular way to approach these types of providers so that they are able to access the same kind of information, but in a way that allows them to access the same kind of learning experience without having to take those precious days away from their homes.

Dr. Mike Patrick: I'm thinking there's probably a lot of moms and dads listening right now who are like, "I want to take this training program. Forget that my pediatrician's going to take it. I want to know these things for myself." Is there a plan to make it readily available on a more widespread basis for anyone who wanted to learn these things?

Melanie Farkas: That's where the website comes in. We have a lot of resources on the website all ready for parents around creative play and nutrition. And then, we are adding this challenge coming up in August that ties all of these things together to really easy inexpensive ideas to connect with their child around play and nurturing environment and nutrition. 

We've been working with a team of physicians and a team at the Cardinal Health Foundation and also a focus script of parents to talk about what is realistic for parents to accomplish.

I'm a working mom. Both my kids are in child care. All day, the child care employees often spend more time during the day with my kids than I do. So it's important for me to get home, get dinner on the table, get baths, get all that done, but I also need to really be intentional about connecting with my kids. 

This challenge that we have some really cool ideas and very easy, doesn't take up a lot of time because lots of parents don't have any time. In the evening, my son goes to bed at seven p.m. and we get in the door at six p.m. So I have a really small amount of time to get all that done with him.


Dr. Mike Patrick: And like Dr. Murray was talking about making those things happen while you're involved in their daily lives, 

Melanie Farkas: Right. The magic in those everyday moments.

Dr. Mike Patrick: Yeah, yeah, absolutely. I don't want to gloss over the Columbus Public Health website because there really is a treasure trove of outstanding resources that are available there. And I'm going to put links on the Show Notes. So folks who are listening to this program, if you go to, look for the Show Notes for Episode 321. We'll have links for all the things that we're going to be talking about. 

That site — and we'll get to Good4Growth site in a moment — but that Columbus Public Health website, particularly their Healthy Children, Healthy Weight's parents' page just has a tremendous amount of resources. So it includes nine ways to keep your kids healthy. An Hour a Day for Play is one of the resources here. Making Snacks Count, Building Children Up With Words, Healthier Drinks For Healthier Kids, Healthy Gardening, Tips On Reducing Screen Time, Taking Time For Meals, Making Breakfast Count, Good Rest Is Best, there's stuff for healthy eating, healthy activity, healthy pregnancy. I can just go on and on. There are just so many resources available for parents. You guys just have done an outstanding job with that.

Melanie Farkas: We work really closely with Columbus Public Health because they have that expertise and they have all those amazing resources, and why recreate the wheel when we were providing these resources in our website and the Good4Growth website? So Columbus Public Health has been at the table for every meeting when we've been developing the website because we wanted to provide parents with these ideas and a one-stop-shop, and with trusted names like the Ohio Chapter of American Academy of Pediatrics, Columbus Public Health and the Cardinal Health Foundation.


Dr. Mike Patrick: Absolutely. What is the Build Children Up with Words? What is that?

Dr. Robert Murray: That's the really interesting part of this whole thing. One of the seminal studies really was done by a pair called Hart and Risley, and they looked at highly educated families who are higher socioeconomic and those who had less formal education and were lower socioeconomic. And what they realized is that there was difference in… 

The first realization is difference in the number of words. There was 11,000 words a day were said to the higher socioeconomic kids. And so, they calculated that by the time that kid was in school they had heard 30 million more words than the lower socioeconomic kid.

But subsequent research indicated it wasn't just the number of words, that it had to do with the fact that much of the serve and volley in those highly educated families was developmentally appropriate and very affirmative. So the child was exploring their environment, and the parent was encouraging them and helping them and communicating with them around that.

In those who were less educated and didn't understand development as well, they tended to do more limiting — "You're going to fall," "Stop that," "Take that over," "You're making a mess," those kind of things and much less affirming of the child's exploration of their environment. 

So one of the things that we think is really critically important is that parents understand development at their child's age. It's very important for them to understand why the child behaves that way.


Dr. Mike Patrick: And you can imagine in some of those families that's the way that the parent was talked to, and that's what they grew up around. It's really hard to break that cycle, isn't it?

Dr. Robert Murray: It is, but I think that one of the things that they did realize as they did more studies — I like the study a lot — was that it was not the socioeconomic status, and it was not their education. It had to do with their awareness of development. People who weren't aware of development thought the kid couldn't understand what they were saying anyway, so why talk with them? Whereas the other highly attuned parent were right there with the child the whole way, even when they're non-verbal and really making that connection. It makes all the difference.

So I think awareness is the main thing, 

Dr. Mike Patrick: Which is part of the collaborative to get the word out to providers and to child caregivers too.

Dr. Robert Murray: And all parents want what's best for their kids. It isn't like social strata. They all want what's best. You just have to make them work.

Dr. Mike Patrick: And even the negative ones, when they say, "Don't do that, you're going to get hurt," what they have underlying is they don't want their child to get hurt. They're trying to protect them.

Dr. Robert Murray: One of the thing that I think is important to what Jessica was saying and Melanie just talked about was we learned in the last decade or so that if the parent can't or won't provide the type of relationship that's needed to protect the child, that other people in their life can do that and still achieve the same goal of creating a strong independent and resilient child. 

So this is where the caregiver comes in, and this is why we're working with Healthy Children, Healthy Weights in Columbus Health Department. We want to get that brain information in there, too, to childcare provider. So they understand they may be the only one that can provide that role if the child doesn't get it elsewhere.

Dr. Mike Patrick: And it may be another family member as well. Maybe a grandparent, maybe an aunt or uncle or an older sibling or someone who if there's a child in your sphere of influence that you can take under your wing.


Dr. Robert Murray: Absolutely. That's really important.

Dr. Mike Patrick: Let's talk about the Good4Growth website specifically — and I'll have a link over to that as well — but it has some great sections on it too. It talks about prenatal parents, kids who are in the zero to five age groups, school-aged kids, ways to get involved. What are some of the other resources that you have there?

Melanie Farkas: As I've said, we worked with the Columbus Public Health to develop these resources and as you mentioned, they have a message — an hour a day to play and to make snacks count — and we partnered with them to provide more resources on those topics these year. We have a treasure trove of them on our website. 

And with An Hour a Day to Play, there are easy ideas for indoors and outdoors stuff. We know some kids don't have a yard to play in or don't live in a neighborhood that they feel comfortable to play outside. So there are plenty of ideas for parents to help their child get that hour a day and that physical activity wherever they live.

Dr. Mike Patrick: And that's, the number four, so good4growth, number four, not F-O-R. And again, we'll put a link to that in the Show Notes for 321 over at

You'd mentioned the Seven Day Connect Challenge. Tell us a little bit more about that and when it's going to happen and how parents can find out about it.

 Melanie Farkas: Sure. So we're working on this challenge right now. We're going to launch it in August and again, we're working with the Columbus Public Health and also the Cardinal Health Foundation and also the leadership at the Ohio Chapter of the American Academy of Pediatrics. 
We have, along with Dr. Murray and Dr. Foster, some amazing experts with the chapter around the state of Ohio to help us develop this challenge. And we're asking parents, caregivers, child care workers, any one, grand parent, aunt, uncle, neighbor, anyone who has a child in their life that they want to support and they want to help connect with and help empower. 

To take this challenge, you'll be able to sign up on our website, and you'll receive The Seven Day ay Connect Challenge, and each day has one idea to connect with that child. As you mentioned, one of those days is get rid of screens.
Dr. Mike Patrick: I love those days.


Melanie Farkas: It's hard. It is so hard.

Dr. Mike Patrick: It is very difficult. 

Melanie Farkas: As a parent, I even find myself thinking, "Well, I'm connected with my kid, but 'm going to look at my phone, and we're going to watch…" My son loves watching videos of trains, but the challenge is for one hour, no phones, no tablet, no TV. You can do other things, but you're turning off those electronics and getting rid of that background noise.

Dr. Mike Patrick: And you can do it for an hour. I mean, really.

Melanie Farkas: An hour is doable. Maybe after that 60 minutes, you're all going to be clamoring to check Facebook. But that's one of the challenges and that one is kind across-the-board developmentally for every age. 

But there are some other challenges. There's one that I actually tried this out with my kids, which is let your child pick an activity and do it for half an hour. I asked my four-and-a-half-year old, "Lia, what would you like to do? Just you and me spend some time together." She wanted to make silly faces in the mirror, and so we did that for half hour.

Dr. Mike Patrick: Oh, that is really cool.

 Melanie Farkas: By the end, my stomach hurt from laughing so hard . It was the highlight of my week because I took the time out to forget work, forget mowing the lawn, and forget everything else that I needed to think about, and connect with my daughter. And she still talks about it, and it's been a month, "Remember, when we did that?" It really made an impact on her. I knew the impact it made on me, but then it's been really great to see that it stuck in her brain as a really meaningful time with me.


Dr. Mike Patrick: And that's one of those things, even with teenagers, you know it's like we're trying to figure out what do you want to do? It's so easy to have your own ideas and opinions, and you're trying to get your own needs met and figuring out instead of just letting it really be what your kids want to do and putting them first. I want to encourage folks out there. It's difficult to do that.

Melanie Farkas: It is. Different ages, you're going to hear a lot different, and obviously, you're going to want to make sure that what you're doing is safe and that is within reason. Your teenager might say, "Well, I want you to pay for me to go to a movie." So you have to… 

The program manager for Good4Growth said her daughter would probably say, "Well, let's get on the computer, and you can look at my Instagram feed with me, and we can look at Instagram pictures." And you know why is that bad? It's going to be her, sitting with her daughter, talking about these pictures, maybe seeing pictures she didn't want her daughter to see and talking about why. It's a chance to connect, and it's a chance to really make that connection stronger between the child and parent.

Dr. Mike Patrick: And that's one of those things we can say, "Well, that involves a screen," but we don't want to be militant about that. It may be that your child wants to play video games together, but you're going to collaborate and talk and do that activity together, not in isolation. So you have to really look at the value overall of things.

Melanie Farkas: It's really interesting, and I'm really looking forward. We're asking people to share their stories with us and I can't wait because I want to hear, I know, when I tried the child let activity how big of an impact it made on me. And I want to hear how big of an impact it's making on other parents. What did your child choose? 

Another time, my family and I, we just moved to a new home and we had all these giant boxes and my daughter wants us to make a spaceship so bad. And here I am thinking, I want my new house to look perfect, and we had a giant cardboard spaceship in the middle of our living room. My kids play in that every day. They'd love it and they tell their friends about their spaceship. And that 's where that creative play and letting them use their little heads to come up with these, 


Dr. Mike Patrick: Yeah. It's in the middle of your living room?

Melanie Farkas: Yes.

Dr. Mike Patrick: I love that. That is fabulous. And where can folks sign up then for this Seven Day Challenge? And when is this going to happen? 

 Melanie Farkas: We're launching in August, but what you can do is go to or we also have, just in case. And you can sign up for our newsletter in upper right hand corner of the website, and when we do launch this challenge, I'll be sending an email to everyone who's interested. We'll also be sharing the information in the Ohio Chapter, American Academy of Pediatrics, Facebook page, our website, and our Twitter pages to let everyone know.

I've heard some interest. Like I said earlier, we had a parent focus group to see, we wanted to make sure we were choosing activities that were fostering that child, parent or caregiver-child connection, but also were doable for different developmental ages. What you can do with the infant is much different than what you can do with the teenager. 

We've heard a lot of interest. We're going to give the ability for companies to do company challenges. The Cardinal Health Foundation is really excited about this. They have employees all across the country, and they're going to ask them to take the challenge as an employee-based at Cardinal Health. 

But also Columbus Public Health and the Ohio Chapter AAP were talking about doing that challenge. Not everybody at our office is a parent, but they can still do the challenge with a niece or nephew or a neighbor. 

And we have interest from some teachers who think it would be a great opportunity for them to try these challenges with their students, but also share with their parents. So across the board, it's available for anybody to use and we're launching it on August.


Dr. Mike Patrick: That is fabulous. We'll just go around the table here real quick. What are some of your favorite no-screen family activities to do just to get some ideas out there. What do you like to do at your house?

Melanie Farkas: We play on our spaceship.


Melanie Farkas: I have a two-and-a-half-year-old and a four-and-a-half-year-old so we read a lot of books. That is something that we've done since my children are born, is read books. And so, when things get turned off — tablets and phones and stuff get turned off in my house –we read books. We play with our spaceship. My daughter's also really interested in outer space, and so we've been trying to think of a way to make planets. Paper mache, maybe? 

Dr. Mike Patrick: Yeah, yeah. Or the glow-in-the-dark stars on the ceiling. That's always fun.

Melanie Farkas: Oh my gosh, yeah. 

Dr. Jessica Foster: Game time for sure. So my boys are 9, 12 and 15. And so turning off those electronics can be a huge challenge, but we all love board games. There is nothing more fun than sitting down with the five of you for a game night.

Dr. Mike Patrick: What are some of your favorite game that you guys play?

Dr. Jessica Foster: Oh gosh. So we love Blokus. Blokus is probably one of our very favorites.

Dr. Mike Patrick: Blokus.

Dr. Jessica Foster: Yeah. It's this really cool game with the little shapes that are different colors, and you have sort of a board in front of you and you have to connect the little shapes that are your color and try to take over as much of the board as possible.

Dr. Mike Patrick: Oh, we have to look into that one. We have a whole basement. We have several shelves just full of games, because we're always trying new ones. The ones we've been playing lately, Sorry, the classic Sorry game. That's one that we didn't have and my son has job. He bought it. It was like, "This is a classic game. What? You've never played this, dad?" And we've been playing that one like crazy here lately.


Dr. Jessica Foster: That's a great one.

Dr. Robert Murray: It's a classic because it's a great game.

Dr. Mike Patrick: Yes. There's no dice. You got to use these cards.

Dr. Jessica Foster: And you can never go wrong with monopoly.

Dr. Mike Patrick: Yeah, yeah, yeah.

Dr. Robert Murray: I have a three-year-old and a five-year-old granddaughter. And so whenever I get a chance, I take them. We have little woods in my neighborhood, and we go down there and just goof around. First time that we were there, the little one said, "Oh my God, it's a jungle."


Dr. Robert Murray: Too much Dora the Explorer. 

What's interesting is creativity is really based on boredom. That's something that you have to realize, that when you take away the screens and all the stimulation and stuff and put them in an environment like the woods, or there's a cornfield, OSU has a cornfield not too far away.

Dr. Mike Patrick: We have a concrete cornfield, too.


Dr. Robert Murray: That's Dublin. 

Dr. Mike Patrick: Yeah.

Dr. Robert Murray: But you know, it's fascinating, you put them in that environment and they kind of explore bugs and bark and climb on stuff that they wouldn't otherwise climb on. I think that's part of that creative learning, is putting them in these environments and letting them go. 

Dr. Mike Patrick: Yeah. Absolutely. I'm off tomorrow and we're going to Clifton Gorge, John Bryan, Glen Helen kind of area and do some hiking as a family tomorrow. In fact, my daughter's like, "What time are we getting up to go in the morning?" So it's fun and when you get started when they're young, it continues to be important for them and then they'll do that with their kids too.

Melanie Farkas: You know, when I was a kid, we didn't have a lot of money, and my mom worked at a fast food restaurant. She would bring home boxes, and we made life size paper dolls out of them because we didn't have a lot to do, we didn't live in a very safe area that we could be running around all the time and my mom was working a lot. We would put her clothes on the paper dolls. She did not like that part, but I think that that did help me realize that out of boredom came these really amazing experiences and bonding with my siblings and my mom as a child. 


It's funny to say we made our spaceship out of cardboard box with my kids, and it's really exciting to see what they can do when we do kind of shut up all the background noise and get bored.

Dr. Mike Patrick: Absolutely. We have a ton of games collected over the years, but you don't have to have a ton of games. You can also make up your own games and a lot of the games that are out there now are games that people made up once upon a time.

Dr. Jessica Foster: And I'll tell you, it's amazing what that boredom does for those sibling relationships. You know the, "Mom, I'm bored. Mom, I'm bored," and we are fortunate, I can kick my kids outside and they can play, and the things that they come up with. Once they've said, "Mom, I'm bored," then all of a sudden, that's 45 minutes later, and they're really engaged with each other in whatever sort of crazy imaginative thing they're doing, and that's just magical.

Dr. Mike Patrick: Yeah, absolutely. Well, I really appreciate the three of you stopping by and talking to us about the Good4Growth Program. So again, the three main points are those nurturing environments and that relationship between the caregiver, parent and the child, and then creative play and physical activity and healthy eating. So thanks for stopping by, really appreciate it.

Melanie Farkas: Thank you.

Dr. Robert Murray: Thanks, Mike.

Dr. Jessica Foster: Thanks.

Dr. Mike Patrick: All right, let's take a quick break and I'll be back. We'll wrap up the show, right after this.


Dr. Mike Patrick: All right, we have just enough time to thank each and every one of you for taking time out of your day to make PediaCast a part of it. Really do appreciate that.


Also thanks to Melanie Farkas, Director of Communications and Immunization Programs at the Ohio Chapter of the American Academy of Pediatrics, Dr. Robert Murray, President-elect of the Ohio AAP and professor of Human Nutrition at the Ohio State University, and Dr. Jessica Foster, Physician Administrator for the Ohio Department of Health's Bureau for Children with Developmental and Special Health Needs.

That's all the time we have today. PediaCast is a production of Nationwide Children's Hospital. Don't forget, you can find PediaCast in all sorts of places. We're in iTunes and most podcasting apps for iPhone and Android, including the Apple Podcast App, Downcast, iCatcher, Podbay, Stitcher and TuneIn.

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And, of course, we always appreciate you talking us up with your family, friends, neighbors and co-workers, anyone with kids or those who take care of children, including your child's healthcare provider. Next time you're in for a sick office visit or a well-check up or sports physical, or a medicine recheck, whatever the occasion, let them know you found an evidence-based pediatric podcast for moms and dads. We've been around for nearly a decade. Lots of content that's deep enough to be helpful, but in language that parents can understand.

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It's been great spending time with you today. And until next time, this is Dr. Mike, saying stay safe, stay healthy — and I'm going to put special emphasis on it today — be sure stay involved with your kids.

So long, everybody. 


Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast. you next time on PediaCast.

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