The Power of Play in Childhood – PediaCast 519

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  • “Play time” is important for child development. Structured and unstructured play develops and sharpens skills needed in adulthood. Group play teaches cooperation and conflict resolution. And playing with parents strengthens bonds and sheds light on passions and personalities. Join us as we explore more deeply… the power of play in childhood. We hope you can join us!

Topics

  • Play Time
  • Structured Play
  • Unstructured Play
  • Group Play
  • Playing with Parents

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Transcription

Announcer 1: This is PediaCast.

 

[Music]

 

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 is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We are in Columbus, Ohio.

 

It's Episode 519 for June 9th, 2022. We're calling this one "The Power of Play in Childhood". I want to welcome all of you to the program.

 

So, we're talking about play today. And by play, we mean all the various forms of play during childhood. There is structured and unstructured play, indoor activities, outdoor activities, group play, play with siblings and with parents, sports activities, gym class, recess.

 

0:01:14

 

And it turns out that all of these forms of play are very important during childhood. Playing provides and sharpen skills that kids will need in adulthood. And it provides lots of benefits right out of the gate. Play can provide physical benefits especially when kids are active and burning calories. It can establish habits that keep weight in check and contributes to good cardiovascular health in adulthood.

 

It provides opportunity for creativity and critical thinking. It improves social awareness. It teaches kids how to follow rules and get along with others. And it has a positive impact on emotional health.

 

Now, as I mentioned, play can be structured and complicated, but it can also be very simple. Free play with blocks or logs, household items. These simple activities can reap tremendous impact.

 

0:02:08

 

And of course, parents have big role in childhood play by encouraging both structured and unstructured activities. Getting down on the floor and engaging in some of these activities helps moms and dad get to know their kids better, rekindles the fun and spontaneity of youth. And that can be recharging and refreshing in today's hectic and heavily scheduled world.

 

So, play is important. But it does not really happen without some work on the part of parents, right? We have to be intentional in finding and providing play opportunities. We have to carve out time and encourage our children to play in lots of different ways.

 

What exactly are those ways and why do they matter? I'm glad you asked. These are the questions that we will be answering today. And in our usual PediaCast fashion, we have three terrific guests joining us as we explore the power of play in childhood.

 

0:03:08

 

Dr. Jonathan Napolitano will be here. He's a sports medicine physician and director of the Adaptive Sports Medicine Program at Nationwide Children's Hospital. We also have Breanna Cugliari. She's a certified athletic trainer with Sports Medicine and a leader in the Play Strong Program. And then, finally, to round up our panel today, Dr. Gabriella Gonzales. She is a pediatric resident and soon-to-be Sports Medicine Fellow at Nationwide Children's. They'll be here shortly.

 

First though, I wanted to cover our usual quick reminders. Don't forget, you can find PediaCast wherever podcasts are found. We're in the Apple and Google Podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music, and most other podcast apps for iOS and Android. That includes GoodPods by the way. That's a new one that we're in.

 

If you like what you hear, please remember to subscribe to our show so you don't miss an episode. Also, please consider leaving a review wherever you listen to podcasts so that others who come along looking for evidence-based child health and parenting information will know what to expect.

 

0:04:05

 

We're also on social media. We love connecting with you there. You'll find us on Facebook, Twitter, LinkedIn, and Instagram, simply search for PediaCast. And we have that handy contact link over at pediacast.org if you would like to suggest a future topic for the program.

 

Also, I want to remind you the information presented in every episode of the show is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your healthcare 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 guests settled into the studio and then we will be back to talk about the power of play in childhood. It's coming up right after this.

 

[Music]

 

0:05:19

 

Dr. Mike Patrick: Dr. Jonathan Napolitano is a sports medicine physician at Nationwide Children's Hospital and an assistant professor of Pediatrics and Physical Medicine and Rehabilitation at the Ohio State University College of Medicine. He also directs the Adaptive Sports Medicine Program at Nationwide Children's and has an interest in research and advocacy for the inclusion of people with disabilities in sports and other play activities.

 

Breanna Cugliari is a certified athletic trainer at Nationwide Children's. She's a leader in our hospital's Play Strong Program, which is a medically supervised wellness initiative that seeks to get kids moving and encourages the development of healthy habits at home.

 

Dr. Gabriella Gonzales is a pediatric resident at Nationwide Children's and soon-to-be Sports Medicine Fellow. She has a passion and interest in the importance and power of play which she recently wrote about in a soon-to-be published Pediatrics in Review article called Importance of Play.

 

0:06:10

 

So, let's give a warm PediaCast welcome to our three guests. Thank you all so much for stopping by today.

 

Breanna Cugliari: Thank you for having us.

 

Dr. Gabriella Gonzales: Yeah, we're excited to be here.

 

Dr. Jonathan Napolitano: Really looking forward to it, Dr. Mike.

 

Dr. Mike Patrick: Great. Well, I really appreciate the three of you coming into the studio. It's nice to be face to face after all those virtual interviews. So welcome.

 

Gabby, I wanted to start with you. Why is it that play is important for child development?

 

Dr. Gabriella Gonzales: Yeah, good question. So, there are multiple benefits to play but some of the biggest things that jump out of me and through my literature review and just through observations in clinics, first, it allows children to discover their own worlds and learn about the environments around them through either object, through activities, through toys, things like that. Really allows them to develop their own creativity and interest as well. And sometimes these interests then develop into passions. So, for example, building with blocks or Legos or different structural items, potentially, these children go on to be engineers or architects in the future.

 

0:07:15

 

It also allows them to discover their worlds in a very spontaneous and joyful way. It's very different from structural learnings in the classrooms and things like that.

 

Sociodramatic play in particular, which is actually observing roles and activities in others and then rehearsing them their selves, allows them to come back at these roles that they see adults or other people around them doing and to rehearse them prior to doing them as they grow as well.

 

So psychosocial stimulation really allows for both the benefits at the time of the activity. But also, long-term benefits have been associated with lower rates of depression and anxiety, better conflict resolution, less violent behaviors as they get older. And higher educational attainments are just some things associated with early psychosocial stimulation.

 

0:08:12

 

Dr. Mike Patrick: Absolutely. And I love the way you put that. You're really sort of preparing for success in adulthood, right, by playing? And you'd mentioned sociodramatic play like playing house or pretending you have a restaurant and using pots and pans and cooking in the kitchen pretending. Maybe waiting at folks at the table and all those kinds of things can really be not only fun but also really preparing for adulthood.

 

And when you think about the different types of careers that are available, like you'd mentioned, you may start out with building with blocks, but then you could develop the interest to be a builder and architect, any number of things. And we use mathematics when you play games and keeping score. And really beginning to learn what language means and concepts as you start to follow rules for playing particular games with other board games or a game maybe that you made up. So just lots of useful skills, right?

 

0:09:11

 

Dr. Gabriella Gonzales: Exactly. Yeah, and you can learn them in a very loving and comfortable way, kind of rehearse those prior to performing them as you get older.

 

Dr. Mike Patrick: Yeah, if you make mistakes, you're in a safe environment. You have lot of love and support, Then, the next time, you'll keep building and building on your confidence and all very important things. We can kind of divide types of play into structured and unstructured play. Tell us about each of those and why both of them are important.

 

Dr. Gabriella Gonzales: Exactly. So structured play, I'd like to think of it as goal-directed play or goal-oriented play. It's usually directed by adults or caregivers. Unstructured play, in contrast, is child-lead play is the way I like to think about it. So, as you mentioned, there's a place for both and I think that you should supplement each other and not replace each other.

 

0:10:01

 

So structured play, obviously, would be examples including after-school activities, sporting events and things like that. And then unstructured play, examples would be building forts in the living room or playing with pots and pans while parents are cooking in the kitchen.

 

And the unstructured play in particular is like I said child-lead and by nature, more creative and open-ended than the structured play is. It allows, like I had said earlier, children to discover their own world and manipulate their environments around them, to kind of really discover in a very spontaneous way.

 

And it also allows for caregivers and people observing children in unstructured environments to learn more about their child as well, things that they find humorous, or they find interesting. Really just kind of observing how they manipulate their world also gets us a window to the minds behind their eyes.

 

0:11:00

 

Dr. Mike Patrick: Absolutely. Bre, I wanted to bring you in. So, with the Play Strong Program, you are really tuned in to the types of play that kids can do. What are some examples of indoor structured and unstructured play? You may have some ideas that many parents may not think of just right off the top of their heads.

 

Breanna Cugliari: Yeah, so for indoor structured play, we think of things like Wii Fit, activity video games. So, if you're playing tennis with each other, it's competitive. We also have Ping-Pong, yoga, musical chairs. There are lots of different activities that you can find inside your own home. Just pick up things and put them together.

 

That also kind of feeds into our indoor unstructured play, where you can do, like Gabby said, building forts. Kids love to play the Floor is Lava, so just take things and throw them on the floor and create your own obstacle course in the house. But it allows you to be creative with the things that you have in your home while also having fun and playing.

 

0:12:01

 

Dr. Mike Patrick: The activities that you mentioned, a lot of them really do involve physical activity. And you can sit down and play a board game. And there's something about that, because you're exercising your brain and you’re learning rules and perhaps doing math as your scoring and all of those things.

 

But it is important to work in physical activity. And even if it's a dreary middle of the winter here in Ohio, we haven't seen the sun and days, sort of afternoon, it's still good to be physically active indoors, correct? 

 

Breanna Cugliari: Yes. And we encourage families to try to do these activities together. Just because your child is in Play Strong does not mean that they're the only ones that need to make changes. The family can work together to be active, and it promotes activity in the family if you all do it together.

 

Dr. Mike Patrick: Absolutely. And then, as the sun does come out here in Ohio and we have warmer weather, as long as it's not raining, what are some examples of outdoor structured and unstructured activity or play?

 

0:12:59

 

Breanna Cugliari: Our outdoor activities would include our sports like soccer, basketball, volleyball, things like that. Outdoor unstructured would be more of those obstacle courses. Going to the playground, just being creative with what you can find in your neighborhoods. And obviously, there's times to explore or go hiking. There's always those options as well.

 

Dr. Mike Patrick: If you're going hiking, with our kids, it was always fun to do a scavenger hunt. So not, "Okay, so we're going to go hiking. We're going to be out in nature, but let's also have a list of things we're trying to find." And now, a lot of kids have a phone in their pocket and a camera, you could also take pictures of whatever it is you're trying to find. And then all get together, maybe have a picnic or go out to dinner and look at each other's pictures and recount your time of scavenger hunting while you're out hiking. I mean, you can really take just about anything and make a game or something fun out of it, right?

 

Breanna Cugliari: Yeah, absolutely.

 

Dr. Mike Patrick: And then, of course, in the summertime, swimming, in the beach, and the warm activities. It's good to try to get all of those things in, right?

 

0:14:02

 

Breanna Cugliari: And you can still do go on a hike when it's snowing outside, just dress long for the weather, obviously. But you just want to make sure that you do it in a time when you can see well, so nobody gets injured. But you can do these things year-round. It's just using that time and being creative with what you can do.

 

Dr. Mike Patrick: And in rain, you just get wet, as long as there's not lightning. Lightning is dangerous.

 

Breanna Cugliari: Exactly.

 

Dr. Mike Patrick: Stay indoors when there's lightning. So, if there's no lightning or thunder, then have at it, I guess.

 

All right, so a lot of these, we have talked about things that kids sort of do independently or maybe with their parents. But group play is also important. Tell us about that, Gabby.

 

Dr. Gabriella Gonzales: Yeah, group play is equally important, I think. And a lot of the activities Bre mentioned were involving groups and other peers as well. So, it really allows for social and emotional intelligence developments. So, children learn cooperation, rule following, obviously working towards a common goal, either through a board game or through a sporting activity.

 

0:15:03

 

They also learn what results in approval or disapproval from others from the way that they interact and kind of the reactions that they get. They also learn about the importance of working together, like I said to a common goal. They also learn conflict resolution as well. As we know, arguments or disagreements always come up on the playground or doing board games and they learn how to do this in a loving environment.

 

And finally, they learn that sometimes building these relationships with their teammates or with their peers might actually even be more important than getting the victory in the game or in a sporting event, and those relationships are life-long and things that you can build on. And so, you continue to grow on each.

 

Dr. Mike Patrick: Yeah, so there really is a large social component to play, especially when it's in a group, whether it's kids or parents that are engaging or whether it's kids with their peers. And I love the way you put that with social and emotional intelligence is really something that's a goal through play and playing with others, and learning to follow rules, and conform and conflict resolution. All these things are so important.

 

0:16:13

 

And so, when we say, "Oh, just play," there's way more that kids are getting out of this than just time spent doing something, right?

 

So, let's move over to our physician that we have in the room. And Jonathan, talk a little bit about the physical benefits of play from a healthy wellness standpoint.

 

Dr. Jonathan Napolitano: So those are a lot of the first things we often think about when think about play, right? The ability to go out and run around and get your heart rate up and get your breathing heavy. And those benefits affect everything within your body. They reduce the risk of what we call comorbidities or other health problems. They keep us fit. They are better able to manage weight to healthy areas.

 

0:17:09

 

Bre was talking about our Play Strong Program, and we'd incorporate that with healthy weight and nutrition. So being active can help you manage blood sugars. It can help you maintain healthy activities as well.

 

Outside of that too, we really know a lot of benefits of that for our musculoskeletal system. Our bones get stronger the more we run on them and walk on them. Research of astronauts is where we learn that kind of stuff. If we're sitting around and we don't have gravity, we don't have that bone health.

 

So, when we're active, our muscles, the more we move, the more those muscles stretch. As you grow taller, your muscles are going to be tight. And so, the more you run and are active, you're stretching out those muscles, and they get stronger. And those stronger muscles help you mature in many different ways.

 

0:18:00

 

And then, putting it all together, the neuromuscular control, the ability to understand how to jump, how to land, how to be safe in those motions becomes then almost subconscious, right? You know how to move. And that's really what some of our biggest risks are when we're eliminating gym classes or free play in these different environments. Is that these kids don't learn how to jump and land safely, and therefore, they're at risk for other injuries as well.

 

Dr. Mike Patrick: And you bring up a good point. That is, in some school districts, as recess and even gym and sports get kind squeezed out. If our goal is to educate a person to be a whole adult, I mean, the physical activity piece of it is just as important as anything else.

 

Dr. Jonathan Napolitano: Yeah, it really is. And so far, today, we've talked about the structured and unstructured. In a lot of our sports medicine research, we talked about it as free play versus the organized play. Even if it's a structured activity like a sport, we have seen significant benefits to free play and kid-initiated sports, right?

 

0:19:10

 

Getting together with the kids on the sandlot and playing your own game of baseball is less likely to lead to shoulder pain and elbow injuries than if we are directed by adults, that these are practices, and this is what we're doing. Because there's less of that pressure to perform and succeed and if you're getting tired and overusing something, kids are able to regulate that on their own. Where outside of that organized activity, we may not be able to do that if you feel that pressure.

 

Dr. Mike Patrick: I remember in the summer and things were quite bit different when I was a kid. It's been a little long time. But we would get a kickball. So, kickball by itself, we'd play that a few times and it'd get kind of boring. So, we would get like a Wiffle ball bat with a kickball and just make up a game and make up some rules. So then, you're not only being physically active but you're really using your brain to come up with something new and create something.

 

0:20:09

 

Dr. Jonathan Napolitano: Really inspires that mind and as you said, kind of leads to future creativity in all aspects of life.

 

Dr. Mike Patrick: Yeah, absolutely. Bre, I wanted to talk a little bit about in addition to the physical benefits of play, we mentioned briefly that there's also social and emotional benefits to play. Tell us a little bit more about those.

 

Breanna Cugliari: So, Gabby mentioned a few of those benefits, but just being able to interact with other kids your age and your peers and being able to keep with kids that are the same age as you is really important to some of these kids that we see, especially in our Play Strong Program.

 

And then, there's also the teamwork aspects. There's collective achievement. They feel good and they feel accomplished when they do something physical. Especially when you're working together, you're going to have that teamwork aspect, and everyone feels great when they finish.

 

0:21:01

 

And it also builds confidence, "If I can keep up with other kids my age, I can do anything." So hopefully, that keeps growing in their life as they get older.

 

Dr. Mike Patrick: Yeah, absolutely. We do have some evidence-based benefits, social and emotional, that play can provide to kids that's really based on evidence. Not just what we think it does this, but there's actually research and publications on it, that being involved in play decreases anxiety and depression.

 

I think Gabby had mentioned, decreases violence and fighting and conflict as kids get older and they learn how to manage their emotions and how to resolve conflicts. Higher IQs as adults, higher educational attainment, better general knowledge, those are all evidence-based. I know you've mentioned some of those, Gabby.

 

I think they're just so important that folks and parents remember that there is again a lot more than just spending time playing, because we are learning and growing in both physically and mentally.

 

And it's not just the kids who benefit, right, John? Tell us about the benefits of play for parents.

 

0:22:11

 

Dr. Jonathan Napolitano: The benefits for parents and even in other siblings is it continues to be shared throughout. We've talked earlier and already so far about how these lessons can go on to lead that child or individual to grow up with better healthier habits and activity and other things there. But then for the parents, as that adult engaging with their kids in play really, the benefits are countless.

 

So, you can say that the ability to know your kid better, to learn where they are developmentally. Most often, that's going to lead to being impressed with their problem-solving abilities. But then, there's also the ability that you are now spending that time with that child in a new and different way.

 

And you may notice things that you haven't. Otherwise, that may concern you and things that you can bring up in those pediatrician appointment or just what is expected and what is not. It lets you kind of get a better handle of their emotional development, physical development as well.

 

0:23:14

 

And then that benefit of being a fun parent, too, right? Like you're always looking for how do we really connect and engage with our kids and to be out there and to be active with them as a friend would is really… When we talk about the little ones and make believe and playing along and being involved in that play really can kind of help that relationship grow.

 

But then, from the physical aspect as well, getting the parents healthy is just as important as getting a kid active as well. So, when the whole family is going on that hike and scavenger hunt, it's really better for everyone.

 

Dr. Mike Patrick: And as you said that my mind goes back to when my kids were little, some of the sweetest memories really are playing with them, trying to be creative playing with whatever toys they have and making up new ways to play with them. And just so much fun and when you think about how busy our lives are and how scheduled and how stressful, just how sweet is it to take some time out of the day and just be a kid again yourself.

 

0:24:22

 

Dr. Jonathan Napolitano: Yeah, it really is. I was just thinking as you're mentioning, that Bre talked about even when the weather is bad or other reasons where you may not be able to bring a kid out, right? Like say, you have a little one who is unable to join you on a bike ride but getting outside and putting that kid in the carrier on the bike and bringing them along with you. The benefits of being outside have been a lot of statistically proven benefits to that as well, very young in life and then shares that growth throughout their life.

 

Dr. Mike Patrick: Yeah, absolutely. As we think about play, there are some resources that you need, right? Whether it is toys or whether it's sports equipment or just a parent that is engaged with a kid to have some structured activity or to encourage unstructured activity. I mean it doesn't often just happen magically on its own.

 

0:25:17

 

And we know that there are entire neighborhood and communities that may not have those resources, but the wellness and development of those children are just as important as any child. And so Bre, what are some of the opportunities that are available when a neighborhood is under resourced in terms of providing opportunities to play?

 

Breanna Cugliari: So obviously, we encourage that unstructured activity. So, finding things around your home that you can play with and keep an eye out for things like school playground that you might have access to, that are safe areas. The metro parks, community parks that you might have access to, using what you have for indoor and outdoor play.

 

So, if you only have a kickball, maybe you get creative with that kickball and you shoot some hoops with it. Or you play foursquare instead of playing kickball. Like you said, you add in a baseball bat to play it.

 

0:26:15

 

So, there are different ways that you can be creative at home with what you have but also look out for those resources that might be in your neighborhood that you weren't expecting, or that you didn't know were available to you.

 

Dr. Mike Patrick: Absolutely. And there are certainly going to be neighborhood and community programs that a lot of families may not even know are out there. And so, if you are a parent that is aware of those programs, maybe spreading awareness, spreading the knowledge amongst your neighbors, amongst the kids that are there, as you develop relationships and just maybe becoming an advocate for play and finding out what's available.

 

And if there's nothing available, searching out other communities, what do they have? Is it something that could be replicated in some way? Going to elected officials or going to businesses to see if they could sponsor something. I mean, there's a lot that we can do as parents, right, to kind of push resources to be available. But it takes a lot of work.

 

0:27:09

 

Breanna Cugliari: It does.

 

Dr. Mike Patrick: It doesn't just happen. One of those is a hospital-based program like our Play Strong. And we'll talk more about Play Strong in just a few minutes. And this is a podcast that goes out across the country. I'm sure there are other hospital-based programs. too. So that's something to look into as far as that particular resource.

 

Breanna Cugliari: Yeah, definitely. I mean, if you have a pediatrician that is associated with a hospital system or even if there's a large hospital system in your community, then you can look on their website and see different avenues of physical activity for your child.

 

We have great resources here which I'm sure we'll talk about. So, it's just doing a little bit of the research makes all the difference sometimes.

 

Dr. Mike Patrick: Yeah, absolutely. And elected officials who are interested in providing those opportunities…

 

Breanna Cugliari: Absolutely.

 

0:28:01

 

Dr. Mike Patrick: Go to town halls when the candidates are there and ask them. How can we have more resources available for our children?

 

Now, in addition to resources being required, you also have to have some capability physically, intellectually, to play. Some kids are challenged by physical disabilities, intellectual disabilities. What opportunities are available for those kids who are challenged to play?

 

Breanna Cugliari: Hopefully, there are programs similar to like a Play Strong Program that kids will have access to. We also have a great adaptive community here in Columbus on our Adaptive Sports Medicine website. There's a calendar that list a bunch of different activities for adaptive athletes.

 

And it's kind of the same thing, doing a little bit of that extra research. Or like you said, going to those town halls and talking to your elected officials about what are you doing to help our kids be physically active with these challenges?

 

0:29:01

 

Some other great organizations are like Buddy Up, the Special Olympics. Those are all great avenues to go down as well.

 

Dr. Mike Patrick: And we have a fantastic Adaptive Sports Medicine Program here at Nationwide Children's which Dr. Napolitano knows all about. I'm going to put a link to that in the show notes so folks can find it easily. But we keep talking about Play Strong. What exactly is this?

 

Breanna Cugliari: So, Play Strong is a physical activity program. And our goals are basically to increase physical activity, not just with our patients, but our patient's households. So, involving the family, we only get these patients for 12 weeks. We do see them twice a week for about an hour. But we do encourage a lot of the activity to occur outside of just the Play Strong Program.

 

So, we do provide them little lessons that might have a list of activities that are indoors, outdoors, different field trips that they can take. So, a list of the metro parks, or go to COSI for a day and just walk around, go to the zoo.

 

0:30:04

 

We also have different departments of our Play Strong Program. So, we have an assistive program as well, which may include patients that need a little extra help. So, mom or dad gets involved or guardian joins them. Sometimes we encourage siblings to also join into those classes. And we're also working on getting our adaptive Play Strong Program back up and running as well.

 

Dr. Mike Patrick: Yeah, absolutely. So, it's not only a structured environment for play a couple times a week. You're really teaching habits and giving folks ideas of what they can do outside of the time that you have with them. It's like give someone a fish and you feed him for a meal but if you teach them to fish, then they could eat for a lifetime kind of thing, right?

 

Breanna Cugliari: Exactly. And our goals are to kind of include those homework assignments. We give them a paper that, "Here's the lesson for this week." It's about time management or it's about indoor activities that you can do when the weather is bad or what to do when you have homework? When do you include physical activity during the school year?

 

0:31:06

 

So, all those lessons are sent home with our patients. And we just encourage them to work with our family members to find ways to be active when they say there's not enough time in a day.

 

Dr. Mike Patrick: And the four primary goals of the program, develop positive thoughts and attitude toward physical activity, develop active habits for home, develop functional movement skills such as strength, endurance, balance, and coordination and develop confidence to engage in variety of activities with peers and friends. That social element in a group, I mean, you're doing all of those things.

 

Breanna Cugliari: Yes.

 

Dr. Mike Patrick: So very important. And what is the typical participant? Who refers folks to Play Strong? How do families get connected to it?

 

Breanna Cugliari: So, most of our referrals do come from the Center for Healthy Weight and Nutrition to encourage physical activity in that population. But we also get referrals from Behavioral Health. We might get referrals from a primary care physician, sports medicine. So, they come from a variety of different departments. But we're always open for new referrals from any child that needs physical activity.

 

0:32:11

 

Dr. Mike Patrick: Absolutely. And we'll put link to the Play Strong Program at Nationwide Children's Hospital in the show notes. And that's something that, so you may not be here in Central Ohio, but this is really a passion for you want to advocate for the importance and the power of play during childhood, check out the Play Strong Program. And then see if that's something that you could find a group of people that would want to replicate that in your community.

 

So, I'd encourage you to check that out. And again, we'll put a link in the show notes over at pediacast.org for this episode, number 519.

 

Now, as we think about kids in play, Dr. Napolitano, I mentioned that really, we're trying to include all children, right? Whether you have resources or you don't have resources, whether you are physically challenged or not, it's really important for all children to play. Why is that important?

 

0:33:03

 

Dr. Jonathan Napolitano: Inclusion in this realm is the peak of it. It's the most important part here. Some of those reasons are because these benefits that we have just shared, the need to work on strength and coordination, the need to work on social health and teamwork is often benefits or challenges that are removed from or isolated from populations that may need that the most.

 

And so, inequality and an inclusion of everyone really helps make sure that everyone's getting that same benefit. So, if we think about individuals with physical disabilities, those who may use a wheelchair or an assistive device for walking, they may be isolated. They may not engage with classmates or peers either with life disability or their friends who may not have disabilities.

 

0:34:01

 

And so, finding accessible ways to include everyone is extremely important. We've done a lot of research in this realm as well and it's currently in the process of publication. But what we looked at is when surveying individuals with disabilities involved in adaptive sports, is what we call it when a sport is adjusted or accustomed to increased inclusion, when we find those individuals, there are themes that they report in their interviews. Where yes, it made them feel improved mental health and wellness as well as physical health and wellness, which we talked a lot about. It helps with relationship building, problem solving and really, a social and community engagement.

 

And also, they discuss a number of benefits and challenges that they encounter with access. But overall, when we surveyed this group, when we had done complete objective outcome measures to see how they're performing, we found that our group of participants in adaptive sports with disabilities had the same life satisfaction and happiness and social engagement as those within the general population.

 

0:35:15

 

So that's contrary to what a lot of previous research would show that those with the disability have a lower life satisfaction or feel more isolated. But if we are engaged through sport and play, that really eliminates that and can really improve overall health.

 

Dr. Mike Patrick: Yeah, very important. As I think about people who are really in a position to advocate for play amongst all children, whether they have resources or not, whether there's disabilities or not, and that is going to be community primary care providers. And we do have a lot of those who listen to this podcast.

 

So, what are things that pediatricians, family practice doctors, nurse practitioners, what can we do as medical professionals to really advocate and encourage play in all children?

 

0:36:03

 

Dr. Jonathan Napolitano: So, the number one thing to do in that scenario is what's already in front of you. So, when a patient comes in that door, is that you are breaking down the barriers that that patient or family may have that says, "That's just something else I can't do or something else I shouldn't do." So, on the individual basis, number one is most important.

 

And then within the community, I look around with an open eye and a different eye every time I'm out there. And looking at it's not so much accessibility that we're looking at, but universal design. Meaning, that it benefits everyone in the community. So, it doesn't work great if you have limited access to a track if there is one of those mazes back and forth that you got to walk because you can't get a wheelchair through there.

 

Otherwise, the wheelchair is a great place to train on a track. Other things as far as adaptive baseball diamond. We have a couple of those here in Central Ohio, a new one up in New Albany. And that allows for seated or wheelchair participation in baseball and sports.

 

0:37:06

 

It's really about looking at what already exists in your community. And if you find that, truly, your community is lacking in this, looking at what else is done through the other communities across our country. Bre had mentioned a couple of good organizations.

 

Special Olympics is not a four-year event. It's a year-round event and there are millions of participants throughout our nation and internationally, as well. Buddy Up is a great activity. Miracle League, TOPSoccer . There is a something for everybody out there and just kind of getting yourself familiar.

 

Another good resource if you're looking nationally is Team USA. They have their Paralympics page that links individual community programs that you search by a zip code as well.

 

Dr. Mike Patrick: Yeah, and I'll put a link to the Team USA webpage so people can find that easily over in the show notes.

 

0:38:00

 

As we're thinking about primary care providers, Bre, you had mentioned that you have like a list of activities that you provide just to give folks idea of what they can do to be active and play structured and unstructured, inside, outside. And that's something else that primary care doctors could develop a list of possible activities just that you hand out at well checkups, right?

 

Breanna Cugliari: Yeah, and that would be a great resource to hand to families, just to say "Hey, look how many activities are on this list. I bet you didn't even think about half of them." And sometimes, we have the kids go through the list, find the activities that they already enjoy. And then, they go through the list a second time and they start checking off things that they would like to try.

 

And then, we tell them, "Hey, why don't you try this during this week?" And then for the next week, you guys can try a different activity. And it's also a great way to incorporate other family members to have them look through that same list. And you can all try different activities that you might not have thought you might like, but in the end, ends up being a group activity the family can do, and you might enjoy it.

 

Dr. Mike Patrick: Yeah, absolutely. And that's something you could even give them, that checklist while they're waiting.

 

0:39:04

 

Breanna Cugliari: Absolutely.

 

Dr. Mike Patrick: While they're waiting in the exam room. In addition to the checklist for depression, anxiety. It seems like a play checklist would be a fun one to put in there as well and could stimulate conversation. Even if it's not during the exam itself, it might be on the car ride home. The kids are like, "Hey, can we do this sometime?" It might get the parent to be passionate about something that they hadn't thought of it would be really fun to do with their kids.

 

So, lots of opportunity there for pediatric providers to get involved. And then, also, encourage families to take pictures of the play activities that maybe you can get permission to put on your practice's website or just encourage them to share in social media, just to again increase awareness about play amongst other families that folks are connected to in their sphere of influence in social media.

 

And then we have talked about, in addition to pediatricians, you talked, Jon, about just community members paying attention to these things as well and what's available, may not be available, trying to be an advocate to have resources. It's all really an important thing not only for medically minded people like ourselves but, really, for everybody in the community.

 

0:40:19

 

Dr. Jonathan Napolitano: And there are those organizations that exist. And each of those organizations is really ran by an army of volunteers. So that's another way to get involved too, is to whether it's on the advocacy side or it's just on the helping outside. If you listened to PediaCast and you have children of your own, you can still get involved with this group.

Some of the biggest ones here in our area are the local recreation and parks, both in Columbus and Cincinnati and Cleveland. Each of them all have a Paralympic or a para-adaptive sports program where they're looking at that inclusion, but other smaller organizations as well throughout the country.

 

0:41:02

 

So being involved there, the school athletic associations is huge as well here in Ohio. We have both track and field. It has been, I believe since 2013. So, they're coming up on their tenth year of a seated division in track and field, so meaning wheelchair competitions on the track and throwing shotputs and stuff like that. And then it was 2019 that they expanded those offerings for Winter Sport for swimming and other adaptive events in the pool as well.

 

Those continue to grow. We have other local sports teams here in sled hockey and rugby and wheelchair basketball. So really being creative and how do we really make sure that every community has a way to engage in. Because the access piece is huge, not only ability-wise but funding is an issue, too.

 

So, when these groups are funded by either governments or community or larger corporations, that's always a good benefit for the entire population.

 

0:42:05

 

Dr. Mike Patrick: Yeah, and whenever you see these programs, someone started it, right? I mean, it had to start as an idea that someone would advocate for to make that resource available. And so, if you're really passionate about this and there's not something in your community, find that in a different community and then reach out to the people who lead it, find out who started it, and connect with them on LinkedIn.

 

No, really, connecting and engaging and getting ideas from others about how to start these programs really can go a long way to making them available in your community if they're not already there.

 

Dr. Jonathan Napolitano: Yeah, the willingness to share and the excitement of sharing this across the country is something that those groups really thrive on. So, we should not feel hesitant at all to reach out because it all started somewhere, as you said.

 

Dr. Mike Patrick: And you can really make a difference for a lot of kids. And now that we're kind of coming out of the pandemic and it's a little bit safer for all of us to get together and play, hopefully, we've imparted upon all of you the listeners the importance of play and why all of us are so passionate about it. And hopefully, we've ignited some passion in you as well, not only for your family and your kids, but also kids in your neighborhood and community and beyond.

 

0:43:21

 

All right, as we move on, one thing I did want to mention here, since we do have a lot of families that listen. Sometimes, the medical training system and what kind of doctors you see can be sort of confusing for families.

 

So, we mentioned, Gabby, that you are a pediatric resident and that you're going to be a Sports Medicine Fellow. Kind of explain for families, what is a resident doctor and a fellow doctor and how does that all fit into a medical training.

 

Dr. Gabriella Gonzales: Yeah, for sure. I know, even my own family members who are not medical in any way still get confused whenever I describe the level of training that I'm in. So, I'm currently a pediatric resident. I'm in my third year. I officially graduated last week but finishing residency in a few weeks now. Finished medical school prior to coming to residency. So that's when we officially obtained our medical degree.

 

0:44:14

 

And we are practicing physicians, but we have a supervising physician on top of us. So, for example, Dr. Napolitano would be an example of a preceptor or an attending physician who still oversees the patients that we see.

 

So here at Nationwide, we have a three-year pediatric training program. And there are many different subspecialties you can go into, depending on your passions and interests. There's adult medicine, family medicine, PM&R, like Dr. Napolitano trained in, and multiple different subspecialties that you go into after medical school. And then, after that, then you enter fellowship if you choose after completing residency or go straight into working as an attending supervising physician.

 

So here at Nationwide Children's Hospital, we actually have subspecialties within our pediatric residencies. So, we have residents who are training in pediatric neurology, pediatric medical genetics. We have a few research track oriented. We have an osteopathic track when I started residency. But we currently do not have that track offered here as well.

 

0:45:21

 

So even within your own specialty, there are kinds of subspecialties that you can choose to go into. And about 60% of us I think here at Nationwide then go on to do subspecialty training after we complete residency. For example, I will be doing sports medicine fellowship next year.

 

And so, to speak about fellowship, so sports medicine in particular is a one to two-year training program. Like I said, there are various different specialties you can go into. And based on what you choose, the training length varies.

 

So, I can speak to sports medicine, the program here is one year, the one that I'll be entering here at Nationwide Children's. And it's a busy year. We do quite a bit of different rotations and experiences during that time.

 

0:46:10

 

But Sports Medicine is, the fellowship Sports Medicine is particularly geared towards primary care specialties. So, pediatrics, family medicine, internal medicine, EM, PM&R, kind of those ones that are most linked to the community. Because as we've discussed this entire morning, there's a big community presence of sports medicine physicians and those who also work with the field of sports medicine.

 

So, during fellowship, you learn how to be integrated within a community. You see patients in the primary care setting. Part of that is also covering sporting events and different athletic activities as well. You're the team doc for different high schools around here or depending on where you trained for fellowship, some professional teams as well, too. So that's really exciting.

 

0:47:03

 

And the other component of your fellowship training is kind of advocacy in community orientation. I particularly have an interest in advocacy here at residency. I completed advanced competency in advocacy training. We have a pretty robust track here, So I thought that was very important since I will be a community provider, to kind of advocate for play and for other things that we discussed here. Physicians can be the best advocates for their patients, as well as parents and families as well.

 

Additionally, in that year, you do different specialty trainings in different areas that complement sports medicine and do some ultrasound training, too. So, like I said, a busy year but a lot of exciting things in life.

 

Dr. Mike Patrick: Yeah, I can tell you're passionate about it.

 

[Laughter]

 

Dr. Gabriella Gonzales: Yeah.

 

Dr. Mike Patrick: Absolutely. No, it's really fantastic. So, for folks who are wondering kind of the timeline of all of this, after high school, you do college for four years. And then you mentioned medical school for four years.

 

0:48:10

 

At that point, you're a doctor when you graduate from medical school. But you still need some supervision and some training in whatever field you're going into and that's where residency is. And it can range, as you said, for straight pediatrics, it's three years, but there are other ones that are longer.

 

And then, fellowship, as you're subspecializing, and then you're an attending after that. So, it's a long road, but you learn so much. I mean, if I look back at my life, I wouldn't do anything differently, I don't think. Maybe I'd be a TV weatherman, but I don't know. Okay, so that's a story for another day.

 

I'm going to put a link, by the way, to the Pediatric Residency Training Program at Nationwide Children's and the Sports Medicine Fellowship Program here. We'll put links to both of those programs in the show notes so people can find those easily.

 

And then, Dr. Napolitano, tell us about the Sports Medicine Program in general at Nationwide Children's that has really grown over the past few years.

 

0:49:08

 

Dr. Jonathan Napolitano: Yeah, it sure has. We're really excited to welcome Gabby to our team, for her additional training over the year coming up. But yeah, our program is quite large. We have nine different, as she's considered, an attending physician. So, nine different faculty members. Then, we see patients all across the city, from as far west as Marysville, to as far east as Canal Winchester and everywhere in between.

 

We see people for traditional muscular skeletal injuries. So, an injury is an inevitable part of play, and it should not be a disincentive for it. We should not have a fear of injuries. And so, our purpose of those evaluations is not only just to heal an injury but rather to go through a program of figuring out how do we prevent such injuries in the future. What is that neuromuscular imbalance that may have been missed and how do move safer and be stronger to that?

 

0:50:08

 

So, lots of further details within our program. We evaluate individuals with imaging modalities like X-ray and MRIs but then in clinic, we also have the opportunity to use ultrasound evaluation, as Gabby had mentioned.

 

And then, our treatments, we are not surgeons in our Sports Medicine Department. We would refer to orthopedic surgeons for those intervention that would require that. But we regularly use the services of athletic trainers like Bre who works in both our Play Strong, but also our Functional Rehab Program.

 

We send patients to physical therapy. We may use braces or casts. And then, again, the focus is ultimately on that return to play and wellness and continued lifelong changes as well.

 

Dr. Mike Patrick: And concussions.

 

Dr. Jonathan Napolitano: That's correct, yeah. Outside of muscular skeletal injuries, we do have our head injuries as well. So that's a unique thing about sports medicine I described in every clinic I have. Most musculoskeletal injuries are structural issue, whereas a concussion is a functional injury of your brain. And you have plenty of shows on that, I believe, over the years.

 

0:51:19

 

But yeah, we have concussion clinics where we evaluate injuries to athletes throughout the year and help them not only get back to play but get back to the classroom and get back to the normal daily lives.

 

Dr. Mike Patrick: Absolutely. And we'll put a link to the Sports Medicine Program at Nationwide Children's Hospital in the show notes so folks can find that easily. We're all going to have lots of links that I've mentioned throughout this program. So, the Play Strong Program, the Adaptive Sports Medicine Program, our Residency Training Program, and the Sports Medicine Fellowship, all of those links over in the show notes. Team USA was another one that we'll put in there. So be sure to check that out over at pediacast.org again, Episode 519.

 

0:52:02

 

So once again, Breanna Cugliari, certified athletic trainer and Dr. Gabby Gonzales, pediatric resident and Dr. Jonathan Napolitano, Sports Medicine physician, thank you all so much for stopping by today.

 

Breanna Cugliari: Thank you so much.

 

Dr. Gabriella Gonzales: Yeah, it was a very fun discussion.

 

Dr. Jonathan Napolitano: A great time as always, Dr. Mike. Thank you.

 

[Music]

 

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.

 

And of course, thanks to our guests this week, Dr. Jonathan Napolitano, with Sports Medicine, Dr. Gabriella Gonzales, pediatric resident and Breanna Cugliari, certified athletic trainer with Sports Medicine. All of them from Nationwide Children's Hospital.

 

0:53:10

 

Don't forget, you can find PediaCast wherever podcasts are found. We're in the Apple and Google podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music, and most other podcast apps for iOS and Android, including GoodPods. Be sure to check us out there if you have that on your listening device.

 

Also, our landing site, pediacast.org, you'll find our entire archive of past programs there, along with our show notes, our Terms of Use Agreement, and that handy Contact page if you would like to suggest a future topic for the program. 

 

Reviews are helpful wherever you get your podcasts. We always appreciate when you share your thoughts about the show. And we love connecting with you on social media. You'll find us on Facebook, Twitter, LinkedIn, and Instagram. Simply search for PediaCast.

 

We have another podcast. It's our sister show. It's called PediaCast CME. That stands for Continuing Medical Education. It's similar to this program. We do turn the science up a couple notches and offer free Continuing Medical Education for those who listen. And that includes doctors, nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists.

 

0:54:10

 

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. Of course, you want to be sure the content of the episode matches your scope of practice.

 

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.

 

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.

 

[Music]

 

0:55:00

 

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

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