Pediatric Reflections: Back to Nature, Back to Health

Published on in Children's Doctor

The first time I was shocked. Now it happens every day. I walk into a room to greet my patient, and the parent and child are both glued to their cell phones. I introduce myself — no response, no eye contact, no interaction.

This is a microcosm of what is now family time: family members sit in the same room on their devices instead of separate rooms. Multiple studies have documented the negative effects of parents distracted by cell phones and teens who spend excess time on social media. It is not surprising that a recent study of teenagers revealed 30% are overweight or obese. Another 30% struggle with anxiety and/or depression.

General pediatricians are exhorted to address these issues since they are major predictors of future morbidity. Is there an intervention to address both physical and mental health and reduce screen?

Yes. A nature prescription.

NaturePHL.org is a collaborative project being piloted in two CHOP primary care practices, Cobbs Creek and Roxborough. CHOP and its partners — the Schuylkill Center, Philadelphia Parks and Recreation, and the U.S. Forest Service — have joined forces to prescribe nature to our patients.

Screening and guidance

Children ages 5 to 12 will be screened for nature deprivation — limited outdoor activity — at well checkups. All children will be educated on the value of nature and will be directed to a website developed for this project, NaturePHL.org, which locates and describes parks and nature spaces by zip code. The website also has an up-to-date listing of nature events available to families.

Children who are nature deprived will also have the help of a nature navigator, a health educator who will work with their families to encourage family time outdoors and also help plan family activities for our patients on weekends.

Nature as medicine is not a new idea. In Japan, patients are frequently prescribed “shinrin yoku,” forest bathing. A study in Japan split patients into a group that walked in a forest and another group that walked in the city. Those patients who walked in a forest had a 16% reduction in cortisol levels compared to those who walked in a city. Other studies have examined nature’s effects using functional MRI. Neural activity in the subgenual prefrontal cortex, a brain region active during rumination — repetitive thought focused on negative emotions — decreased among participants who walked in nature versus those who walked in an urban environment.

More than exercise

Exercise has been prescribed for years to address the obesity epidemic. As a general pediatrician, I routinely encouraged participation in sports. However, sports are competitive and therefore inherently include some performance pressure. Coaches can be encouraging or, unfortunately, critical and demoralizing. Sports are frequently costly, shutting out some children, while nature is free and available to everyone. In addition, with sports, the parents are frequently sedentary observers while NaturePHL encourages nature exploration as a family activity. All members of the family have the opportunity to unplug and increase activity and nature exposure together.

The NaturePHL program is just beginning, and we look forward to sharing some outcomes in the future. But Philadelphia-area PCPs don’t need to wait. Encourage your families to go to NaturePHL.org now and start exploring.

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In this podcast episode of Primary Care Perspectives, Christopher Renjilian, MD, a primary care sports medicine physician and adolescent medicine fellow at Children’s Hospital of Philadelphia, discusses the NaturePHL program, the unique benefits of nature-based play, and how pediatricians can be ambassadors for outdoor play for kids and families. Listen now »


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