Category Archives: Children

Nature Champions and Park Prescriptions


by Avril Swan, MD

In late September of 2010, I had the opportunity to gather with a group of like-minded health care providers who believe, as I do, that time spent in nature is important for the physical and mental well-being of children. The occasion was a workshop sponsored by the National Environmental Education Foundation called “Train the Trainer”. We spent 3 days learning, collaborating, and brainstorming about how to link healthcare and our public lands through the use of “Park Prescriptions.” Park Prescriptions is the newly coined term that refers to an actual prescription given by a doctor to a patient that instructs them in an individualized plan for spending time in parks or other natural settings. Medical literature is starting to become available that provides data to support what we all suspect: time in nature is important to human health.  Time in nature has been linked with increased physical activity, decreased stress and depression, better concentration, and even improvements in breathing function. (McCurdy L, et al.Curr Probl Pediatr Adolesc Health Care 2010;5:102-117)  At the end of the three-day conference, participants came away with knowledge about the current medical literature on the subject and tools to teach other physicians how to write park prescriptions. Most importantly  we developed new relationships with community organizations such as  US Fish and Wildlife and the National Park Service.

As a result of this training, I met another physician, Nooshin Razani, MD,MPH a Pediatrician with the Pediatric Environmental Health Specialty Unit at UCSF, and Howard Levitt, director of communication and education at the National Park Service in San Francisco. We were all enthusiastic to get to word out about park prescriptions, and decided to collaborate to get the ball rolling. After many meetings we have started to put together a pilot project to write park prescriptions to get kids from all parts of the city out to Crissy Field. The program will involve our training physicians at UCSF and hopefully in the Community Clinics throughout San Francisco. These physicians will then incorporate park prescriptions into their practice, handing them out to youth as they see appropriate. The children  will be given incentives (small prizes) for every 3 visits they make to Crissy Field.

The project has been helped along by students at Expressions College of Art and Design in Emeryville who have created a public service announcement, prescriptions pads, and a “passport” that the kids will get stamped by a staff member at Crissy Field to record their visits.

Ultimately, of course, anyone can go spend time in nature with or without a prescription, but, we hope by formalizing the process that it will help emphasize that physicians recognize and want to improve on the health problems that result from our personal and societal disconnection to our land.

Why Park Prescriptions? Take a look at some of these statistics:

7.5  hours/day: Average daily media time spent by children ages 8-18 (Rideout VJ et al. Kaiser Family Foundation Report. 2010)

40: Percentage of adults who do not engage in any leisure time physical activity (Center for Health Statistics. Health, United States, 2007 with Chartbook on Trends in the Health of Americans. 2007)

33%: Estimated population born in the year 2000 to eventually develop diabetes over the course of their lifetime (Narayan KM et al. JAMA 2003:290:1884-90)

9.5%:  Percent of children ages 4-17 estimated diagnosed with ADHD (Pastor PN, et al. Vital Health Stat 2008;10:237)

To reverse the statistics above, we need to think outside the traditional Western medicine chest. We also know that people who spend time in nature for their own benefit are more likely to become advocates for the preservation and support of the lands that they use. It is a symbiotic relationship.

Park prescriptions almost always make sense and only have positive side effects. No pharmaceuticals can claim the same.


The Benefits of Unstructured Play


By Avril Swan, MD

The nature of an average child’s free time  has changed. For the past 25 years kids have  been spending decreasing amounts of time outdoors. The time that our kids do spend  outdoors is frequently a part of an organized  sports activity. Other activities taking up our children’s time include indoor lessons and organized  events such as music, art and dance lessons. Another big indoor activity, taking up to 7.5 hours a day of our children’s time according to a Kaiser Family Foundation study, is electronic entertainment. Of course some of these activities bring joy and fulfillment to our kids, but, in return, time for unstructured play has decreased.

Unstructured play is that set of activities that children create on their own without adult guidance. Children naturally, when left to their own devices, will take initiative and create activities and stories in the world around them. Sometimes, especially with children past the toddler stage, the most creative play takes place outside of direct adult supervision. Unstructured free play can happen in many different environments, however, the outdoors may provide more opportunities for free play due to the many movable parts, such as sticks, dirt, leaves and rocks which lend themselves to exploration and creation.

 Some parents find it challenging to provide unstructured play time for their kids.  Letting our kids play without constant supervision, especially outside, can be even more difficult. It  feels hard to balance reasonable concern,  over-vigilance, and the desire to let our kids experience freedom and learn from their own mistakes and experiences.

We worry because we have absorbed the  message that our children need to succeed and be competitive at younger and younger ages. Many parents start thinking about college before their children are even born. We want to give them every advantage and prepare them as early as possible. We worry about missing a crucial developmental window if they aren’t introduced to letters, extra languages, or a sport. We are also  hesitant to send our kids outdoors to play due to many fears. Surveys of parents reveal that we worry about “stranger danger,” crime, traffic,  and even weather.  In fact, violent crimes against children  and traffic related fatalities over all  have actually gone down in recent years (Bureau of Justice, CDC.Gov Traffic Safety Facts). Chronic illness, on the other hand, much related to sedentary indoor lifestyle factors, has increased dramatically. This is despite the high levels of participation in team sports. Encouraging free play, especially the outdoors, may be an antidote to the risks of indoor modern life.

Why might we need to loosen up and get over some of our fears in order to get our kids outdoor unstructured play time?  In the January 2005 Archives of Pediatric and Adolescent medicine , Burdette and Whitaker wrote on the importance of free play. They argue that free play promotes intellectual and cognitive growth, emotional intelligence, and benefits social interactions. They describe how play involves problem solving which is one of the highest executive functions. ” Children plan, organize, sequence, and make decisions,“  they explain. In addition, play requires attention to the game and, especially in the case of very young children, frequent physical activity. Unstructured play  frequently comes from or results in exposure to the outdoors. Surveys of parents and teachers report that children’s focus and attention are improved after outdoor physical activity and free play and some small studies suggest that time spent outdoors improves focus in children with ADHD.

Socialization and emotional intelligence  benefit through shared interactions and physical movement that take place during play. Children must work together to decide  which game to play, what agreeable rules are, and how to manage scenarios that invariably involve their differing perspectives. This “work” builds the social qualities that we all wish for our children: empathy, self-awareness, self-regulation, and flexibility. Emotional development is promoted along with physical health when people spend time moving. In adults and older children physical activity has been well documented to decrease stress, anxiety, and depression, and to improve overall mood. Though the research is sparse in younger children, it seems likely that our youngest children benefit as well. Free play in toddlers and young children most frequently involves spurts of gross motor activity over a period of time with multiple episodes of rest in between. Most children are smiling and laughing when they engage in play, and it is reasonable to assume that their mood is improved during and after play.

So how do you incorporate more free time into your children’s schedule?

1. Consider the number of extra-curricular activities:

There is no magic right or wrong number of extras, but if you or your child aren’t taking joy in the activities or if the activities are eating all of your free time, drop one or some.

2. Change your mind set:

Successful adults are programmed to be productive. Children are not small adults. Their play is their work and is their productive activity.

3. Let your child go a little outside your comfort zone:

Consider that a child taking calculated risks  in natural environments may learn and improve their judgment. There is no teacher greater than experience. Learning how to climb a rock or a tree now might decrease hazardous behavior later in life by teaching limits.

4. Practice letting your child be bored

As you might remember from your childhood, we don’t need to have every moment scheduled, and, in fact, some of the best creativity comes from being bored.

5. Consider Neighborhood Solutions

Pedestrian/Play Advocacy: Traffic calming measures including speed bumps and traffic roundabouts have shown to decrease pedestrian vehicle accidents.

6. Allay your fears by getting organized:

Groups of parents can get together and take turns watching while kids play on the block.

There is no one right way to organize our time, and moderation usually ends up being the best course of action in all things. I hope that unstructured play time, however, continues to gain publicity as an important element of our children’s lives.