Digging into Nature – PediaCast 578

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Show Notes

Description

Drs Pooja Tandon and Danette Glassy visit the studio as we explore the importance of digging into nature. Spending time in the great outdoors boosts physical health and emotional well-being, but there are many challenges to overcome before kids can get out there and have some fun. Tune in to learn more!

Topics

Digging into Nature
Physical Health
Emotional Well-Being

Guests

Dr Pooja Tandon
General Pediatrics
Seattle Children’s Hospital

Dr Danette Glassy
BestStart Washington
Project Nature

Links

Project Nature
Project Nature on Instagram
Digging into Nature: Outdoor Adventures for Happier and Healthier Kids
Nature and Children’s Health: A Systematic Review

FeedSpot
15 Best Pediatric Podcasts
25 Best Hospital Podcasts

Episode Transcript

[Dr Mike Patrick]
This episode of PediaCast is brought to you by Nationwide Children's Hospital.

Hello everyone and welcome once again to PediaCast. It is 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's episode 578.

We're calling this one Digging into Nature. I want to welcome all of you to the program. So, we have a fun and important topic for you this week as we explore the role of nature for the physical and emotional well-being of kids, teenagers, and also adults.

And by nature, I mean just what you think, getting outside and exploring the great outdoors, which isn't quite as easy as it used to be. I mean, there's really a lot of competition for our time and attention. School, screens, sports, family functions, clubs, all of the other scheduled stuff that we do.

And there are fewer opportunities to explore outside due to lack of funding for parks and recreation in many communities, crime and other safety concerns in other places, and sometimes just not knowing what is available in your area in terms of parks and programs. And here's the thing, despite all of the challenges, getting outside and digging into nature is super important for reasons that we will soon discover together. So, it is important to come up with a plan and overcome any challenges that might be in place in your particular community or for your family.

And we have a couple of terrific guests joining us to walk through all of this. Dr. Pooja Tandon, she is a general pediatrician at Seattle Children's Hospital, and Dr. Danette Glassy, also in Seattle, she leads Best Start Washington and their project Nature. And together, they wrote a book published by the American Academy of Pediatrics called Digging into Nature, Outdoor Adventures for Happier and Healthier Kids.

So, they will be with us shortly. Before we get to them, I did want to mention that PediaCast has won a couple of big awards from Feedspot. We are the number two pediatric podcast in the country among 15 contenders.

So, we're proud of that. And we're the number one best hospital podcast with 25 contenders. And that includes not just pediatrics, but adult hospitals as well.

So, we're really, really proud to be the number one best hospital podcast, according to Feedspot. I would encourage you to check out all the other top pediatric and hospital-based podcasts, according to Feedspot. And I'm going to put links to both of those rankings in the show notes, so you can explore some other podcasts in addition to this one, ones that are also award-winning.

Also want to remind you the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you are concerned about your child's health, be sure to call your health care provider.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at Pediacast.org. So, let's take a quick break. We'll get our experts settled into the studio and then we will be back to talk about digging into nature.

It's coming up right after this. Dr. Pooja Tandon is a pediatrician and researcher at the Seattle Children's Hospital. And an associate professor of pediatrics at the University of Washington School of Medicine.

Dr. Danette Glassy is a primary care pediatrician and child advocate. Also in Seattle, Washington, she is the director of Best Start Washington and leads its Project Nature initiative, which supports pediatric medical professionals as they encourage children to spend time in nature. Drs. Tandon and Glassy co-authored a book for the American Academy of Pediatrics called Digging into Nature, Outdoor Adventures for Happier and Healthier Kids. That is our topic today, digging into nature. But before we dive in, let's offer a warm PediaCast welcome to Dr. Pooja Tandon and Dr. Danette Glassy. Thank you both so much for stopping by today.

[Dr Pooja Tandon]
Thank you so much for having us. 

[Dr Danette Glassy]
Very pleased to be here. Thank you.

[Dr Mike Patrick]
Yeah, we are really happy that you guys were able to stop by as well. Pooja, I wanted to start with you. Nature does seem less accessible for kids these days compared to like when we were kids.

How exactly did this happen?

[Dr Pooja Tandon]
You know, families are trying their best, but a lot of things have changed in the way children are growing up these days. For some families, children are just more scheduled in activities and families are running around trying to get them to all their classes. There are, you know, the screens are ubiquitous all around us in schools, in our pockets, and that's a draw away from, you know, two screen time away from green time is one way that we talk about that.

And then certainly there are children growing up in many communities where they just don't have easy access to safe parks and outdoor spaces that have that nature access for them.

[Dr Mike Patrick]
And this is an important consideration because there really is research into the benefit of exposing children to nature. And so having less opportunity is going to be an issue for sure. Dana, what does research say about the benefits of children being exposed to nature?

[Dr Danette Glassy]
Well, this has been kind of an exciting bubbling up of the research literature that supports improved children's health after they've been in nature or when they can spend time in nature. It kind of falls into three domains. Certainly, physical health is better if children are more active.

All kinds of other physical parameters are improved when children are in nature. There's improvement in mental health. Lots, many studies in children and adults shows a reduction in stress and less anxiety, depression, including some treatments that involve nature for those conditions, and improved cognitive efforts.

Children who have more recess are better able to pay attention. Lots of studies around attention deficit hyperactivity disorder showing time in nature as an adjunct to facilitating better learning for those kids.

[Dr Mike Patrick]
Yeah, yeah, for sure. And for those out there who want to really look at the science and not just take our word for it, and I know we also have a lot of pediatric providers who also listed that may be interested in this, but there was an article in the journal Pediatrics called Nature and Children's Health a Systematic Review, and it really does look at the benefits of nature and evidence-based sort of way, and I'll put a link to that article in the show notes for this episode, 578 over at pediacast.org if you want to take a deeper dive into the science. Deannette, tell us about Project Nature and then also your AAP book, Digging into Nature.

[Dr Danette Glassy]
You bet. So, as a pediatrician over the course of 32 years, it was really obvious that childhood was kind of changing as Pooja just talked about, and at the same time we're seeing more children with an unhealthy weight, more anxiety, more depression, and a question I had always asked families was, what do you like to do outside? I'd ask kids from four years up, what's your favorite thing to do outside?

And less and less could they really answer that. So I started to look at some of the information that was coming out about Park's prescriptions, healthcare providers actually prescribing a nature dose, and then the literature, and so our best start, Washington, was able to come together with Pooja Tandon's research team, Dr. Tandon's research team, and create the resources that pediatric providers, pediatricians, family practice doctors, nurse practitioners, even the clinic staff could use to help empower families to get out. And at the same time, we were finding, you know, most families would love their kids to play outside, but there were all these barriers, and so really coming up with all the clever tools and resources families need to overcome those barriers. We took all of that information that we've been learning in our Project Nature, Project Nature is going to these pediatric practices and helping them with the resources, and then Pooja and I were asked by the American Academy of Pediatrics to put all of that knowledge and all of those resources into a book for parents, and had a delightful time writing, digging into nature outdoor adventures for happier and healthy kids.

So, we hope your listeners will have a chance to get that from their library or pick up a copy where they buy books.

[Dr Mike Patrick]
Yeah, and we'll put a link to the book in the show notes so folks can find it easier. We'll also have a link to Project Nature, and I know you guys also have an Instagram page, and as we think about nature, it is very visual, so I am sure that that's a lot of fun over on Instagram. We'll put links to all of those things in the show notes.

Pooja, as we think about physical health, what are some activities that kids can do outside that will promote their physical health?

[Dr Pooja Tandon]
Yeah, so physical health and physical activity really is, you know, the area that has one of the strongest evidence-based. That review you mentioned, that was actually a team that I was involved with where we looked at all the literature around there on nature contact and health, and physical activity is one of those activities that, you know, is so important for health of all ages. When we move our bodies, it's important for cardiovascular health or cognitive health.

So, getting outside in ways that, in whatever way a child enjoys being outdoors, whether it's walking or biking, and we really encourage this idea of nearby nature. So, although, you know, getting out to our beautiful national parks and maybe faraway state parks and adventures on backpacking or camping, if that's something that, you know, is accessible to you or your family's into is wonderful, but we want children and families to get daily doses of nature. We want to think about, you know, where are those areas of your neighborhood that may be a tree-lined area, maybe your schoolyard that you might be able to linger in a little bit longer at pickup that will allow your child to, you know, to move their body in a way that's just not possible indoors.

And also, you know, as the seasons change, you know, those are all things you can notice as well. And then the uneven surfaces, the unexpected, you know, a puddle that comes up, a little rock that you can climb or jump onto. I mean, those are all things that, especially if you think about our younger children, to get those opportunities to develop those motor skills.

So, it's really, we love to have children and family’s kind of choose, you know, choose their own adventure literally in nature because we think it's good for so many aspects of physical health and it can be done in different ways.

[Dr Mike Patrick]
Do you have an idea of how often this should be happening, especially as we think about physical activity and physical fitness?

[Dr Pooja Tandon]
Yeah, that's such a good question. We get asked that all the time. Like, you know, what is that dose?

What dose of nature do children need? And so, for physical activity, there are actually some really clear guidance from national experts and societies that school-age children, especially kind of the 5 to 17, 18-year-olds, need 60 minutes a day of moderate to vigorous physical activity. So, kind of the activity that gets you a little bit short of breath, gets your heart pumping.

You know, the guidance does not specify outdoor time or in nature, but we think that, you know, there are those additional benefits when that activity happens outside. In fact, there's this idea of green exercise that the evidence is more in adults, but I think translates to children that when we run or walk or play outdoors, there are additional benefits to our mental health and our stress reduction. And so, we want as much of those 60 minutes a day to be outdoors and, you know, and more succinctly, maybe at least daily, that we want children to have daily experiences outdoors.

[Dr Danette Glassy]
And I would just add that the research is mostly done in school-age children because they're easier to find and measure. But the research that's been done in 0 to 5-year-olds as well and in childcare settings, also national standards recommend daily outdoor time for infants, toddlers, and preschoolers. And we know that they benefit as well, too.

So, you know, all kids, every day is the dose we suggest.

[Dr Pooja Tandon]
Yeah. And one more thing I thought of when, you know, we're talking about physical health, there's some really great literature about the benefits of outdoor time for vision. There are some large studies on, you know, tens of thousands of children in China and other Asian countries, especially, that spending more time outdoors can prevent the progression of myopia or nearsightedness.

And in a lot of those studies, it was about 40 to 60 minutes a day that was recommended. So, you know, depending on kind of the health benefit that you're going for, there's some evidence that even these micro doses, 10, 20 minutes at a time, can be helpful. But, yeah, I think that, you know, the closer that we can get to kind of that 30, 40, even an hour a day of outdoor time, I think the more likely we're to see the range of health benefits.

[Dr Mike Patrick]
That can be a challenge depending on where you live in terms of climate. You know, in the middle of winter here in Ohio, it would probably be difficult to spend an hour outside, even if you're, well, you'd want to be bundled up, but then, you know, for a lot of parents, then they're going to want to be out there with their kid. And an hour might be kind of long to be out, you know, when the wind chills really cold.

You know, there's a lot of areas, I'm thinking like Seattle, where you guys are, you know, you have a lot of rainy days. And also, in a lot of areas of the country, when it's really hot outside, especially when there's a lot of humidity, and when we do see heat exhaustion and all of that, do you have advice for being true to spending some time outside every day while also battling the elements?

[Dr Danette Glassy]
I think you're absolutely hitting on one of those barriers that we're encountering from families who say, you know, why they maybe didn't spend as much time. And there are absolutes to the heat index or the air quality index, the wind chill factor. There are outside parameters that aren't safe for children or adults to be out, even with the best kind of clothing and whatnot.

But we definitely believe in that there's no such thing as bad weather, only the not the best gear. And so really encouraging families to get that gear that's going to make it okay for their infant or preschooler or school-aged child to be outside every day that it's safe to be outside. And that can be also another challenge because kids are growing fast, and all that stuff is a little expensive.

And one of the things we did in the book is compile some ideas for getting no or low-cost boots and gear and snowsuits and suggestions for how to get shade and when to go out. Nighttime is a beautiful time in nature, and if that's a little bit better in those hot climates, to look at the moon and use a flashlight to look for wildlife that enjoys nighttime instead. Those are other ways to enjoy nature in a safe way, despite the weather.

One last thing about cold, you know, in the Nordic countries, all the parents now, this is all the rage, the infants are taking their naps outside. And you know, it's getting like below what we would say is maybe a safe temperature there. They put thermometers in their little prams.

They, of course, bundle them up and they really feel that it adds a measure of health to their infants. So, if they're tough enough to do it, I think we can go outside for 10 or 15 minutes and play with infants too.

[Dr Pooja Tandon]
Yeah, and one thing I was going to add, you know, you mentioned about, you know, parents and sometimes finding that time, especially when it's cold outside and you come home from work and it's evening time. And so, we want to also remind everyone that it doesn't just have to be the parents or the family members. And we really, you know, it's the whole day.

And for many children, they're spending many of their hours with other caring adults at their, you know, their childcare, their preschool, their schools. And so, thinking about, you know, what are the practice or nanny, you know, talking to the other caregivers that are with your child and maybe they're with your child during a time of day when it's a little bit, it's, you know, it's drier, there's more light. Or they have more time at recess.

So, thinking about the whole day and all of the adults in settings where children spend time. So, over the day, it's a, you know, kind of a cumulative exposure.

[Dr Mike Patrick]
And I'll bet from the kids' lens, like this is something cool that we're bundling up and we're going to go spend some time outside and maybe see some things that we wouldn't see, you know, when the weather's perfect or during a rainy day and being able to splash in puddles. And even though that might seem annoying and maybe a little irritating for adults, kids love that kind of thing. And so, I can see how that really would be beneficial.

Now, in addition to the physical aspect of all of this, so, you know, walking, hiking, climbing, biking, all that, nature really also promotes mental wellness. How does that work, Pooja, and what are some examples of activities outside that can improve our mental health?

[Dr Pooja Tandon]
Yeah, you know, and in that literature review, really that the two strongest areas of evidence base for nature are physical activity that we talked about and mental health. And so, there are, you know, the growing body of research that when we spend time outdoors, when children spend time outdoors, there are benefits to things like depression and anxiety symptoms and ADHD. Some of it can come from movement, but some of it comes from the features of the nature itself, the ability for especially kind of immersive nature or vast landscape to give us that feeling of awe and kind of inspiration and the beauty of it.

And so that's how we think that, you know, it may cause those mental health benefits. So in those cases, I mean, I think, you know, moving outdoors is also always beneficial for many reasons, but even just views of nature or, you know, if a child or family member has a temporary or chronic condition that limits how much they can move their bodies, even sitting in nature, walking in nature can be very, very helpful. And for especially young children, the mental health benefits come from the interactions that they're having with children of all ages, but young children are probably there with caring adults.

And so having those moments of connection and pointing out what's around them, the interactions with peers, the mental health benefits come from those opportunities to connect with each other at a time where, you know, there's a loneliness epidemic.

[Dr Danette Glassy]
I would just add also that the act of free play and managing risky play and navigating, playing outside with a group of your friends, all of those things are life skill building, even for the youngest kids, and all of that builds resilience. And so as stressful events happen throughout a lifetime, that resilience is really going to be money in the bank to kind of buffer against some of the stress that comes later in life. So, nature offers also that opportunity for your future mental health as you bank that resilience in your young child.

[Dr Mike Patrick]
And I would imagine that these same benefits apply not only to kids, but to parents as well. So even though I said, you know, we all have very busy lives, busy schedules, and as a parent, you may think, oh, I got to go outside, especially in bad weather or whatever. But there really is a benefit for moms and dads of also doing this, right, Pooja?

[Dr Pooja Tandon]
A hundred percent. And that's partly how I think I even came to appreciating this work is as a parent, you know, to children when they were younger. I mean, there were times where it was challenging indoors.

And I found myself reflecting that when I got the boys out of the house, you know, when they were digging in sand, when they were running around in a park, I mean, things were, they were easier for me. And so, you know, I think that having that family members or parents recognizing that although there may be some, you know, you got to get everybody out the door and get them ready. And there are some risks involved of being outdoors that we can navigate those.

And it just parenting may be a little bit easier if you're even if you're not with your children. Certainly, there is research and there's evidence that all of the things that we discussed for children, those benefits apply to parents as well. And when parents are physically healthier, when mentally healthier, you know, they have more capacity to be better parents, to be better humans.

And so absolutely. And a specific exercise that I wanted to mention or an activity that we talk about in the book is this five senses activity that I think applies to all, you know, really adults and children and they can do it together. But just taking a moment to think about, you know, five things you see, four things you might feel, three things you hear.

I may be messing up the order. But two things you can smell, something you can taste and really going through a very mindful or intentional noticing of what's around you can be something that can be helpful for people of all ages.

[Dr Danette Glassy]
I love that you're bringing up this idea of the benefit to parents and the job of parenting, because there are some studies and we all who have been parents know that the more you run those kids outside, the better that nap is, the better that nighttime sleep is. And the better the appetite is, too. And so, all of your tasks for parenting later, nature gives you an opportunity for that to go more smoothly.

[Dr Mike Patrick]
Yeah, for sure. And even the little ones. And I know, Danette, you had mentioned in Nordic countries, you know, the little babies bundling up and taking their nap outside.

What are what are some of the developmental benefits of nature for young babies and toddlers?

[Dr Danette Glassy]
Yeah, we've touched on a couple of them. You know, your baby is developing their fine motor skills. And so, the little loose parts that are so interesting and curious and not the same ones you see every day in your playroom or your little play yard, you know, there's rocks to pick up and sticks and to manipulate and move around.

Their gross motor or big muscle skills are being tested by having wide open spaces to move. We know kids move more when they're outside. But also, the uneven surfaces that Pooja talked about, flipping to language when they're out there with their caregivers, parents and babysitters.

Definitely language. You're always what's this? Why is it that, you know, there's a conversation that's going on and bringing along new words and new language that you can then for the social emotional health that they're building and developing that relationship that you have, that shared joy and awe.

In nature is very powerful in building your relationship and then taking it back into later as children process their day. They often then can you can talk about what the day was like. What did we do that was new and different today?

And encourage that child to share that back for language and social emotional health. So, nature just opens it up wide. You definitely have all of those opportunities indoors, but it's just so much more powerful outdoors.

[Dr Mike Patrick]
Yeah. And I think about you mentioned, you know, kids picking up rocks and sticks and probably insects and earthworms and all that. One of the things, especially with the young kids, they tend to like to put things in their mouth.

And so, supervision is really going to be an important thing for these younger kids. How do you know when your kids are ready to embark a little bit more on their own or to say, hey, it's OK if you and your friends go down the street to the park? How do you know when that's a safe thing to do?

Because you don't want suddenly a kid to be a teenager and they're doing something on their own for the very first time. That just sort of is a disaster waiting to happen. So how do you gradually let them have some autonomy when it comes to exploring nature?

[Dr Danette Glassy]
Well, one thing I would add is if you're not letting them do it until they are a teenager, they're very anxious about it. There's almost like this window where children are up for it, and they can build that their skills and confidence in that. Take those risks of either being out alone or moving out of the safe home space to another one before they get too anxious about that themselves.

Pooja has a good description about that, but also, it is step by step and be ready for little mistakes along the way. Right. So, your kind of back away from your toddler while they're messing around with things.

And all of a sudden you see that rock go into their mouth. You have to run in. Well, that child probably shouldn't be out there without any supervision at all.

They're going to eat rocks. So, you wait till you have a couple of those times outside where they're not really putting things in their mouth anymore. And then maybe you can step away and not have your eyes glued on them.

For venturing farther away, that's what we did in our family. You know, the seven- or eight-year-old that wants to go to the neighbor's house around the corner. You know, I'm going to I stand in the yard and see how you take off.

I test you at crossing streets. And then when it seems like you're really there, we let you go. And then I call that that family to make sure you made it OK.

You know, step by step, little by little, make a plan in your head. Pooja, I know you have some things to add to that as well.

[Dr Pooja Tandon]
Well, I think of, you know, the job of parenting is so much around scaffolding. Right. It's like, you know, you help your little child with things that they can't do.

And, you know, there's some kind of generally typical developmental milestones that you can get a sense of what seems safe and appropriate for your child. What are their peers able to do? And some that might be individual based on their own, you know, personalities.

Certainly, with technology, you know, there are pluses and minuses. But as children get older, you know, as their tweens and teens have cell phones that in some ways makes that piece a little bit easier. Or, you know, I know families will, you know, track their children or, you know, you could tell your teenager once you get to, you know, once you get back from your hike, once you're on the trailhead there, you know, we want them to do these things with their friends.

But send me a text, you know, let me know you're on your way. And so, figuring out those boundaries and guidance with your own child, I think, is really helpful.

[Dr Mike Patrick]
We, you know, we talk about risk versus benefit of a lot of things as pediatricians. And, you know, some families have different risk tolerances and, you know, what might be OK for one family may be more difficult for another family. But one thing that all of us share, regardless of where you are on the risk scale, there's just a lot of stress in life today.

And being able to bounce back from stressful situations, something we would call resilience, is really important. And we know that there's a lot of toxic stress and resilience is a way that we can mitigate some of that stress. Where does nature fall in, Danette, in terms of mitigating stress and promoting resilience?

[Dr Danette Glassy]
Well, definitely as you're building your relationship, whether it's as a child with your parents, your grandparents, your other caregivers, that relationship is one of the best ways to build resilience, especially against toxic stress. And so, of course, that nature time experiencing the awe and the wonder together is a great way to do that. And your supervision and your directing their what they're doing as a child gets older and they start managing some of the risky play on their own, maybe making the plans, maybe requesting and making plans for the whole family to go out in nature again is building up some resilience and self-confidence about my place in the family and what that my interests are can be shared with the people I love or with my school or my friends. Getting together and organizing all your friends with a flashlight tag kind of thing at night is building that resilience and confidence and again, buffering against that toxic stress within the bubble of a safe community, safe space, safe family, safe, stable, nurturing environments that we talk about.

[Dr Mike Patrick]
Yeah, absolutely. And that that kind of then the last comment really does bring us back to some obstacles for being able to actually get out there and enjoy nature. And we've talked about some of those, you know, in terms of just parent interest, parent time, you know, building it into our schedules.

But there are so many other barriers to spending time outside. And as you function, you know, community safety, availability of green space, those sorts of things. So, Pooja, what are some other obstacles and how can we overcome these and still really take advantage of nature, even when it might be challenging to do so, depending on where we live and what our community is like?

[Dr Pooja Tandon]
Absolutely. Yeah. I mean, I think there are, and it really does depend on often unique, you know, your family, you know, where you live.

So, time and weather are two that we've talked about. And I think, when possible, for time, like bringing indoor activities outdoors, you know, things we may not even think of, whether there are, you know, birthday celebrations or play dates or meals or art or homework or music. And we, you know, have seen and examples and talk about all of these in our books that, you know, there just may not be things we think about.

But when the weather is conducive, we can do a lot of indoor things outdoors. That's one piece of it. I think, you know, the access one is trickier.

You know, one in three people in our country don't live within a 10-minute walk of a park, about half a mile. And that's some national data. And so, you know, that that makes it trickier.

But I think thinking about, you know, is there if you have a porch, you know, can there be nature? Can you bring some plants there? Can you look up at the clouds and the night sky?

Is there a little pocket park or public spaces available in your community around libraries or houses of worship and then schoolyards? I you know, some of my work really focuses now on the critical role that schoolyards can play in offering those equitable opportunities for outdoor play, certainly at recess and during school activities. But more and more communities around the country are going into what are these shared use agreements where the schoolyard can be open after hours and on weekends, essentially as a as a community park and in neighborhoods where there may not be other land to build a park or there may not be safe spaces.

Sometimes these public spaces can be, you know, can be a resource for families. So, as parents, as families, as community members thinking about, you know, how can we advocate for more of those types of that type of access?

[Dr Mike Patrick]
I love that you mentioned that so many folks live even more than 10 minutes away from a local park. And I think as parents, as we think about our own communities, there is definitely a role to play in advocating not only for your own kids, but for your community of kids. And we also, you know, have a lot of folks who listen to this podcast.

I'm sure there's community leaders from various places. There are school leaders from various places. This is really a time when parents and community leaders and school officials really do need to come together to figure this stuff out.

And sometimes it does take a parent being the squeaky wheel to get a community board to approve a new park or to open up playground access after-hours. And so, I guess all of us really do have a role, including communities, schools and parents. Right, Pooja?

[Dr Pooja Tandon]
100 percent. And, you know, in increasing those that physical spatial access, sometimes even that is not enough. You know, you may have a park, but you don't feel safe going there.

And that might mean, you know, having programming, having kind of more options, curated options for some families. They may not have the time or space to do it. And that's where community programs, summer camps, after school programs that are low cost and accessible can be the way that for some children, environmental education.

So, there are so many ways that our communities and our school and leaders can come together to prioritize nature access.

[Dr Mike Patrick]
Yeah, yeah, absolutely. Dana, what are some more of those structured programs that parents can look for to help their kids enjoy nature?

[Dr Danette Glassy]
Yes, I love the idea of parents being the nidus to kind of pull the community together, too. So, thanks for mentioning that. It's always that one parent on the PTA or goes to the community meeting and says, hey, can we make this clean this park up or what can we do to help our school or childcare be more green?

The other programs Pooja touched on are some of the community groups. You'd be surprised. You should Google outdoor opportunities for kids and see what Google tells you about your area.

Some of these are targeted to specific groups, maybe inner-city kids who don't have access to more landscape kind of nature. They've just got their nearby nature. Maybe it's groups that are targeting or trying to facilitate time for children with special health care needs or a particular kind of special health care need, like the kids with neurodivergent, maybe autism, cognitive delays, those kinds of things.

So, there's often in your area, lots of those. And the afterschool and summer programming, Pooja and I laughed. Someone was saying they needed to quickly get off or they were late to a Zoom because they their parks department had opened up the registration in February for the summer.

And if they didn't get their kids scheduled for the summer programming, they were you know, their whole summer plans were dashed. But they thank goodness we have these community resources to help and especially children with special health care needs or other medical conditions. Parents, those parents are even more busy than and stressed often than our other ones.

And sometimes it's just easier, I think. Well, it definitely is easier than to think about how they're going to overcome the barrier of that particular medical condition or special health care need. And sometimes those kids aren't outside as often as their less encumbered peers.

And so, whatever you can do to help families with that, with community programming, as health care people, we really need to have those hard conversations with our families that have either their own medical challenges or their children with challenges about how they can find nature in a safe and accessible way. And it's each situation is so different. It's hard for us to go into this on your podcast.

But in our book, we kind of detail some of the more common medical conditions and how to navigate that and empower families to take the next step to more time outside, even with medical conditions.

[Dr Mike Patrick]
Yeah, yeah, that's a that's a really good point. And being outside is really good for the health of everyone, even those with chronic conditions and physical limitations and all of those things. And it really can be a challenge for families to get those kids exposed to nature in a real everyday sort of way.

There is a group of camps across the country called Serious Fun Camps. And we are fortunate enough here in Ohio to have one called Flying Horse Farms. I happen to be on the on the medical advisory committee for that camp and volunteer my time during the summer as a camp doctor.

But they'll have a week, you know, for kids with GI problems, one for kids with hem-onc disorders, you know, kids with cancers and kids who are wheelchair bound and like really provide a true camp experience for those kids. But unfortunately, that's one week in the summer. And, you know, it'd be great if there are other opportunities.

Pooja, for families who are impacted with, you know, have kids with chronic illnesses and physical limitations, what are some things that they can do in their community on a day-to-day basis to make sure their kids are getting that exposure without, you know, just relying on like a week at a special camp?

[Dr Pooja Tandon]
For sure. I mean, we want, you know, all children to have those daily and frequent nature time. So, I mean, one thing is that, you know, public parks and playgrounds should have, you know, ADA compliant structures, but some playgrounds and parks are better than others.

And so really getting to know and recognizing local resources around that. I think, you know, in our area, there are some beautiful examples of parks that have come up in the last few years that are built to be more inclusive for those with physical limitations. And so, you know, and as health care team, maybe getting to know those community assets so you can share that with your, you know, with your families and patients.

So, I think even, you know, beaches and hikes and trails, there are ways that more and more are trying to become more inclusive spaces. So being, you know, being familiar with those, maybe there are some programs after school or community programs. I know there are, for example, swim lessons that are, you know, have better teacher child ratios for children that that may need that because of their health conditions.

And then really working with your health care team to figure out, you know, what is an appropriate or safe plan? Danette has this wonderful story about a patient. Danette, I'll let you tell the story of the little boy, the cardiac condition.

[Dr Danette Glassy]
It was a family, a little boy who his big dream was to play in the major leagues, baseball. He lived, breathed. He was working towards that major league time.

And when he was about 10, he was. And so, and a really good baseball player, I'm going to tell you, he was diagnosed with a heart condition and arrhythmia that could endanger his life with physical exertion. And so, until some cure, or some remedy was made for him, he couldn't be physically active.

And his cardiologist could have stopped it, just saying no more baseball, no more physical activity, you know, and left it at that. But really recognized how important sport was to this child and suggested fishing for this family because his mother and then his sister was diagnosed with the same thing. And it became a very important family and fun activity for them that they thank goodness for that cardiologist to suggest that because we've all seen kids who get that kind of limitation on their dreams and they just withdraw, become depressed.

It's it can really make them get kind of lost in their life journey. So, but for this family, it turned into this newfound joy for them. I also wanted to add that how important it is for the health care team to really help the family with this.

Often children, when they're first diagnosed with something, there are true limitations. They need to be inside recovering, whatever. But then there comes a time when maybe now they can go back outside and do more.

And, you know, we don't always, as the health care provider, remember to say, well, now you should be back outside. And parents don't know that. They're following the instructions they got at the beginning.

And so, revisiting that with families as children evolve in their life with their medical condition, I think, is really important.

[Dr Mike Patrick]
And, you know, we've kind of been describing being a nature mentor or a nature ally just in terms of being that squeaky wheel with your community and with your school. The things that communities and schools can do and also the things that primary care pediatricians and even cardiologists can do. So, we all want to be, you know, recognize the importance of what we're talking about and be allies and mentors and helping this all happen.

One of those things is Project Nature in terms of really supporting physicians and encouraging kids to dig into nature. We talked a little bit about Project Nature. But what, Danette, what resources are available for maybe a pediatrician in Alabama who is really looking, you know, how to address this in their in their practice?

Can Project Nature help with that?

[Dr Danette Glassy]
You bet. Our website, projectnaturewa.com, is geared toward parents. But as a pediatric practitioner, I encourage those health care providers in their whole practice to take a look at it.

There are there are resources that you can bring up with families at your well visits. You can direct them now towards our little activity books for one- to four-year-olds and five- to 10-year-olds that maybe you can give them the link to or a QR code or put it on your own practice website for families to go explore that. You can write to us and tell us what your local activities are, and we'll put it on there.

We're always trying. I wrote down your serious fun camps. We're going to get that on the website.

So, we're always adding these great resources for other physicians. And basically, the idea is that as trusted advisors, we're meeting with the family. We're talking about whole health.

And it's as simple as what do you like to do outside and then finding out what their barriers are. We've heard of parks prescriptions, but families don't just drop everything and do what we tell them to do. You got to understand what their barriers are and then start addressing them as we've talked about.

Is it time? Is it access? Is it weather?

Is it something else that's totally no one else has thought of? But in your practice, this is an important one. Have those resources.

Where can you get low and no cost boots for the growing toddler to be out in the rainy and snowy weather? So just kind of gathering that stuff up, having it ready to go. And just asking that simple question at every well visit, where do you like to go outside?

We have suggestions for nature books and nature toys as well. And if you have the resources as a pediatric practice to hand out magnifying glasses and bug jars, pocket kites, bubble wands for the little guys to look at what wind does. You know, there's so many ways that you can connect your patients.

We were talking to a pediatrician this morning that has been doing this for several months. And she said, not only did it delight the families and the children to talk about these things and get these nature toys, but it made the visits go better. You know, crying over shots, but so delighted and skipping out of the practice with their toy really made it very worthwhile.

And I think she was trying to express how, you know, it was resilience building for the pediatric practice to not have burnout because it was a joyful part of their well visits.

[Dr Mike Patrick]
Yeah. You know, a lot of pediatric practices give out stickers. So, this may be better than stickers in terms of like, hey, go do something with this.

Outdoors. And that's better than it goes on the clothes and either goes through the wash and is a mess or, you know, it gets thrown away as soon as you get home.

[Dr Danette Glassy]
Or nature stickers. Yeah, with the Project Nature website on it.

[Dr Mike Patrick]
Yeah, absolutely. And we'll put a link again to Project Nature so folks can find it very easily. And then, you know, your book, Digging into Nature, even though that's really written for parents, I would imagine that pediatricians could get a lot out of this book as well.

And then maybe even recommend it to their families. You mentioned very briefly prescribing parks. Can we write a prescription for nature?

[Dr Pooja Tandon]
I mean, so that Project Nature sort of started with that idea. And it's something that has become, you know, more common around the country. But as we've discussed, it's not one size doesn't fit all.

Each family has a unique circumstance. So, in spirit, Project Nature or all that we just discussed is this idea of prescribing or recommending going to parks. But it's deeper than that.

It's really understanding, you know, what the child or family enjoys doing, what their unique circumstances are in their communities. And so, it's kind of a parks prescription 2.0 sometimes we like to call it. It's a little more than just 30 minutes a day for, you know, go here because we recognize that, you know, there are unique ways that this is going to work.

And we think that nature looks like so many different things. And so, we want people to find what resonates with them.

[Dr Mike Patrick]
Yeah, yeah, absolutely. Well, this has been a wonderful conversation. And as I mentioned, we are going to have a lot of resources in the show notes over at pdacast.org.

This is episode 578. Again, we'll have links to Project Nature, to the book Digging into Nature, Outdoor Adventures for Happier and Healthier Kids. And also, that article in the journal Pediatrics, Nature and Children's Health, A Systematic Review.

All of that will be in the show notes if you'd like to dig in a little bit deeper. Once again, though, Dr. Pooja Tandon and Dr. Danette Glassy, both from Seattle, Washington. Thank you so much for stopping by and visiting with us today.

[Dr Pooja Tandon]
Thank you for digging into this topic. 

[Dr Danette Glassy]
Thank you so much. It was a great time.

[Dr Mike Patrick]
We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that. Also, thanks again to our guests this week, Dr. Pooja Tandon and Dr. Danette Glassy, both from Seattle, Washington. Don't forget you can find PediaCast wherever podcasts are found. We're in the Apple Podcast app, Spotify, iHeartRadio, Amazon Music, Audible, YouTube, and most other podcast apps for iOS and Android. Also, don't forget over at YouTube, we are making some very short topical videos for parents on childcare.

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We also have a sibling podcast called PediaCast CME. It's similar to this program. We do turn the science up a couple notches and offer free category one continuing medical education credit for those who listen.

And that's not only for doctors, but also nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists. And since Nationwide Children's is jointly accredited by all of those professional organizations, it's likely we offer the exact credits you need to fulfill your state's continuing medical education requirements. Shows and details are available at the landing site for that program, PediacastCME.org.

You can also listen wherever podcasts are found. Simply search for PediaCast CME. And then finally, an additional podcast that I host, this one just got started a couple months ago.

It is called FAMEcast, F-A-M-E-C-A-S-T. It is a faculty development podcast from the Center for Faculty Advancement, Mentoring, and Engagement at The Ohio State University College of Medicine. So, if you are a teacher in academic medicine or a faculty member in any of the health sciences, then this podcast is for you.

And you can find FAMEcast at Famecast.org and wherever podcasts are found by simply searching for FAMEcast. Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.