7 Science-Backed Reasons To Get Your Kids Outside


(Originally posted for MindBodyGreen)

Most of us intuitively know that we feel better when we spend time outside.

But sadly, as our lives become more dependent on technology, we are increasingly disconnected from the Earth — and this disconnect could be harming our children more than we think.

Acknowledging the adverse effects on children’s well being, author Richard Louv coined the term “Nature Deficit Disorder.” His research has led pediatricians like myself to prescribe time in nature as a way to combat the health ills associated with lack of free outdoor play.

Looking for encouragement to get your kids off the couch this summer? Here are seven research-based reasons to venture into the Great Outdoors:

1. It encourages exercise.

The closer kids are to green spaces, the more likely they are to run around outside: a recent Canadian study found that the physical activity of 11 to 13 year olds rose relative to the amount of tree-filled space in their neighborhoods. Of course, this doesn’t mean you’re out of luck if you’re a city dweller — simply make time for play in a shaded public park.

2. It reduces anxiety.

Children in Maryland and Colorado who played in green schoolyardsreported less stress compared to their peers. They also showed an increased sense of competence, as well as ability to form supportive social groups.

3. It improves focus.

One study of kids in Illinois found that even just a twenty-minute walk in the park led to a substantial attention boost. As the researchers note: ” ‘Doses of nature’ might serve as a safe, inexpensive, widely accessible new tool in the tool kit for managing ADHD symptoms.”

4. It makes kids smarter.

Researchers found that Barcelona school children with more exposure to outdoor greenery performed better on cognitive testing. The effect was greatest when both home and school environments provided “green” time.

5. It builds a sense of community.

Canadian adolescents living in greener environments reported a stronger sense of “place,” or belonging to a healthy community. This finding has important ramifications, as these emotions might also increase kids’ engagement and involvement in keeping their neighborhoods safe and healthy.

6. It helps them develop deeper connections with family.

In a survey of 60 American families, participation in camping experiences was found to improve family relationships.

7. It raises their interest in the environment.

Childhood exposure to natural settings is associated with a greater interest in environmental stewardship — and ultimately with pursuing professional careers and adult hobbies connected to nature and the environment.

HCWH: A Conversation with Pediatrician Lawrence Rosen


Health Care Without Harm’s Safer Chemicals Program seeks to eliminate dangerous chemicals in the health care setting that can adversely affect patient health and employee safety without sacrificing quality of care. To achieve this goal, we focus on promoting a “green” approach to health care that prevents or reduces exposure to toxic chemicals among patients and staff, while also taking into consideration health care’s impact on the environment.

To learn more about the leadership role that physicians play when it comes to greening health care, we spoke with Dr. Lawrence Rosen, a pediatrician and founder of The Whole Child Center in Oradell, New Jersey. Taking a more holistic approach to health care delivery, Dr. Rosen set out to practice an integrated style of medicine that takes environmental exposures into consideration when treating his patients. The Whole Child Center is also a leading example of ecological sustainability in health care, designed in a way that minimizes impact to the environment while promoting health for staff and patients.

(Continue reading on HCWH’s site)

Bats, Birds, Bees and Butterflies In Crisis: What It Means For Us


One of my strongest memories of summers past, despite my lack of affection for insects in general, is the steady buzzing of bees and fluttering of butterflies in my mom’s garden.  These sounds and visions, along with the heat and abundance of time to play outside, were simply what made up “summer” as I knew it.  Adults, as we age, have a tendency to romanticize the “good old days,” yet the truth is – in some ways – things have indeed changed for the worse.  In a major environmental shift now recognized officially by the White House, we are witnessing catastrophic and accelerating declines in the honeybee and butterfly populations.  Furthermore, strange illnesses are increasingly reducing specific bat and bird populations.  What are the causes of these changes?  And why should we care?

The Washington Post notes, “…over the past five years, winter losses of commercial honeybee colonies have averaged roughly 30 percent. A consortium of universities and research laboratories announced last week that beekeepers lost 42.1 percent of their colonies between April 2014 and 2015, an 8 percent spike from the previous year, and that the number of summer deaths exceeded winter deaths for the first time since the survey began in 2010.”  Additionally, the monarch butterfly population now covers only a small fraction of the forest area in Mexico compared with their activity twenty years ago.  Little brown bats, at one time the most common bat species in the U.S., are dying off by the thousands, affected by the fungal “White Nose Syndrome.”  Mortality rates are greater than 90% in many states.  Finally, we are hearing more and more about large-scale bird flock deaths – in some cases, up to thousands at one time.  Most recently, sea birds along the California coast up to the Pacific Northwest have been dying in increasing numbers.

Why are we seeing these dramatic population shifts in such a short period of time?  Scientific evidence points to several potential causes.  Initial concern centered on increased exposure to pesticides, though more recently, a complex multifactorial answer is emerging – one that has direct relevance for human health.  Possibly related to climate change, a variety of infectious agents (parasites, viruses, bacteria and fungi) are killing the animals and insects noted above.  Circularly, some of the treatments used to limit these infestations are making things worse.  Loss of botanical food sources and habitats are some of the indirect sources of deaths, and each loss of population is compounding the others.  What we have is a complicated cyclical impact of change in climate conditions (air and water temperatures, pollution, effect on food sources) leading to new infectious agents affecting immune health, and the treatments themselves potentially causing further harm to natural immune system repair mechanisms.  Does this sound vaguely familiar?

Concern related to the massive deaths of these species has historically centered on the impact on our economic well-being.  It is estimated that, through direct affects on pollination and crop development, the loss of bees, birds, bats and butterflies could cost the US roughly $15 billion a year.  While the direct costs involved are substantial and deserve our attention, what is especially eerie is that notion that the increase in health morbidities we are witnessing, particularly in children (e.g., immune and inflammatory disorders), may be caused by the exact same sequence of events described above.  Activists have pointed out that climate change will potentially affect human health via an increase in vector-borne infectious diseases, like Lyme disease or malaria.  However, little attention has been paid to how subtle shifts in direct viral, bacterial, fungal and parasitic pathogens will alter the human gut microbiome and its ability to modulate immune function and detoxification.  Disruption in the human microbiome, connected to environmental toxins, then worsened by the overuse of antibiotics, could be seen as the human model of what we’re witnessing in bats, bees, butterflies and birds.

What can we do?  We must devote resources to better understanding the complex infectious etiologies of catastrophic species death.  Reversing true root causes, if climate change is the major culprit, is essential but will take time.  Today, we must develop safe and effective ways to protect these species, perhaps through microbiome modulation (using probiotics, for example, to change microbiota balance). Probiotics for bats, anyone?  In fact, researchers have not only used metagenomic methods to sequence the bat microbiome, they have found some bats are resistant to White Nose syndrome, perhaps due to variations in microbiota on their skin.  Similar work is being done in bees, demonstrating a relationship between levels and types of probiotic organisms and hive health.  Perhaps we can learn something from these experiences that would be adaptable to human health concerns.  Ultimately, addressing the needs of the birds and the bees (and the bats and butterflies) is a win-win situation for all of us.

(originally written for the Deirdre Imus Environmental Health Center)

7 Things I Wish Everyone Taught Their Kids

buddha on scale

Every December, I start to think about intentions for the coming year. Not as once-a-year resolution making but as part of an ongoing process of self-reflection and re-commitment to what is true for me.

Lately, I find myself meditating often on a theme that’s central to my roles as both father and pediatrician: what essential truths must we teach our children?

For me, as I suspect for you, this is and will remain a work in progress. Coming to grips with the reality that — surprise! I’m human too! — has served to deepen (rather than undermine, as I feared) my connection with my patients and their parents.

As we practice together, I welcome your comments and additions to the list.

1. Have the courage to fail.

Both purposefully and inadvertently, we are giving our kids the message that perfection is the goal. So many kids I see are struggling with measuring up to “ideal” that they become increasingly anxious and depressed, giving up prematurely on dreams and withdrawing from friends and family.

The greatest inventors of our time all have one thing in common — they failed, many times, until finding their way. It takes a lot of courage to fail, admit it, and get back up again. Honoring this process is crucial and does not contradict having goals. In fact, I’d argue both are keys to developing self-worth.

2. Nurture your creativity.

When we are young, much of our time is spent freely creating — art, music, dance — anything involving imagination. Creating is simply the act of making something that was not there before. It’s all about freedom of expression. Yet somehow as they grow, our kids learn that things have to look “right.”

No! Musician Peter Himmelman, the most spontaneously creative human I know, offers, “A kid’s greatest asset is a sense of wonder. The freedom to fearlessly explore the world is the bedrock of human creativity.” It is this fearless exploration that I believe will lead us to out-of-the-box solutions to our greatest 21st century challenges.

3. You have much more in common with your fellow humans than not.

Scientists currently estimate we share about 99% of DNA with each other. We have so much in common with our fellow earth-dwellers despite our apparent outward differences. Too often, these differences — racial, ethnic, religious, cultural, generational — are used to justify horrific acts of prejudice and aggression.

If you watch young children at play, you see how easy it is for diverse people to get along without judgment. What is profoundly sad is that we train this tolerance out of our children. This must stop! Think how much more peaceful a world we would live in if we honored our shared dreams, visions and desires.

4. Embrace your differences.

Though we are far more the same than different, it is also important to celebrate the things that make us unique. While not an excuse to exclude or judge others, we can acknowledge we all have special gifts and challenges. For example, we all learn differently. Anyone who spends enough time with babies realizes that they display noticeable variation in motor skills, language development and social play. Yes, some children have extreme challenges requiring specialized support and educational assistance. But much of what we diagnose today as a “disorder” is in fact well within the bell-shaped curve of “typical.” These variations need not be “treated” but respected and nurtured.

5. We are the Earth, and the Earth is us.

Native Americans have taught me a crucial ecological belief, one I’ve tried to impart to my children and my patients. The well being of every living entity is absolutely interconnected. How we treat the earth and our fellow creatures has a direct impact on our health. The most recent example? Pregnant women exposed to high levels of air pollution are more likely to give birth to children ultimately diagnosed with autism. Global climate change is real, it’s here, and it’s going to cause universal harm – unless we act now.

6. When left alone, we usually heal ourselves.

One of the most powerful lessons I teach my patients is that our bodies have such innate powers, such wisdom, that they spontaneously recover from most common ills. Colds, coughs, sore throats, and fevers do not usually require heavy-duty medications to resolve, and many of these treatments offer more potential for harm than good.

I often point out during office visits how well minor scrapes or cuts are healing, and kids are amazed that their little bodies have done that all by themselves. A tincture of time is an extremely powerful prescription.

7. You can’t get rid of all the stress in the world but you can learn how to better cope with it.

There are days I wish I could wave a magic wand and evaporate the stressors plaguing my patients (and my kids). Yet I’ve learned that, one, I can’t, and two, nurturing equanimity in the face of challenges is one of the greatest gifts we can bestow on our children. We must teach them more effective ways, like yoga and meditation, to cope with what inevitably will come their way.

(Originally written for MindBodyGreen)

Food as Medicine


Recently, I was honored to be included in Mother Earth Living magazine’s piece on foods that “fight illness” (or better yet, prevent them).  I was one of several integrative practitioners, including Andrew Weil, Tieraona Low Dog, and Aviva Romm, who contributed recipes for yummy and healthful dishes.  My “Sautéed Wild Medicinal Mushrooms” recipe – perfect for a cold winter evening – can be found here.  Bon appetit!

Plastic Babies: The DEHP Dilemma

New Page
(Originally posted for the Deirdre Imus Environmental Health Center)
DEHP (di-(2-ethylhexyl)phthalate) is a compound commonly found in plastic medical devices made from polyvinyl chloride (PVC).  This chemical has come under increased scrutiny with respect to the care of our most vulnerable children: critically ill newborns hospitalized in neonatal intensive care units (NICU’s). The incredibly sophisticated level of care found in the NICU saves the lives of thousands of premature babies every year, but it seems that the very equipment used to aid these infants may in fact be causing serious harm. The FDA lists the following products commonly used in NICUs as containing DEHP:
– IV bags and tubing
– Umbilical artery catheters
– Blood bags and tubing
– Nasogastric feeding tubes
– Respiratory tubing
– Enteral nutrition feeding bags
Concerned by the widespread exposure of sick newborns to these devices, researchers at Johns Hopkins Bloomberg School of Public Health – asreported by NPR – “determined that a critically ill preemie hooked up to multiple tubes and devices containing DEHP could be exposed to 16 milligrams per kilogram of body weight a day of the chemical, which is 160,000 times higher than desired to avoid liver damage.”  Why would this be a concern?  For one, DEHP has been linked, per report by the U.S. Environmental Protection Agency (EPA), to endocrine disruption, birth defects, asthma and cancer in animal studies. Additionally, Dr. Eric Mallow, the lead researcher on the Hopkins report, notes, “DEHP and other phthalates are proinflammatory, and most of the injuries that preemies get are inflammatory in nature.”  A recent review of the adverse effects of DEHP and related phthalates on children’s health found that “fetal and childhood exposure to some phthalates may perturb normal development, with several studies consistently reporting increased risk of allergic diseases” and offered that “providers can counsel concerned patients to reduce phthalate exposures in order to protect the developing fetus and child from potential adverse health outcomes.”
In this spirit, some hospitals have tried to eliminate or reduce the use of phthalate-containing products.  However despite  best intentions, hospitals have been unable to replace DEHP in all areas including the NICU. Why? Because there is a shortage of  vendors able to supply alternative, theoretically safer products.  “Consistent supply is essential to getting hospitals to switch to DEHP-free products. Additionally, as more healthcare facilities create demand, the more manufacturers will respond,” comments Kyle Tafuri, Sustainability Advisor at Hackensack University Medical Center in New Jersey.  Erin S. Ihde, MA, CCRP, researcher at the The Deirdre Imus Environmental Health Center at HackensackUMC, advises, “One of the keys to the success of DEHP-free medical products is having clinicians and administrators advocating for the change within their departments. It only takes one person to educate others and move the process forward.”
Does the benefit of current medical therapy in NICU’s outweigh the harm? While one would not advise abandoning the use of feeding tubes, IV’s, blood products and breathing tubes given their life-saving contributions, we should be concerned about the ongoing exposure of premature, critically ill babies to potentially toxic plasticizers.The theoretical, animal and preliminary human evidence linking DEHP and its metabolites to the disruption of hormonal and immunological pathways is deeply troubling.
Sadly, studies to evaluate the immediate and long-term impact of DEHP on babies’ endocrine, immune and neurological systems are lacking.  Under the precautionary principle guidelines, many environmental health scientists advocate for avoiding the use of any potential toxic chemicals until we can adequately insure human harm will not result from exposure. Yet, this is not the current regulatory environment in the United States. Too often, chemicals are introduced into mainstream use, even in the healthcare industry, without adequate proof of safety.  As we’ve previously noted, children in particular are quite vulnerable and are frequent victims of environmental injustice.  For the preservation of our children’s health, and our future, we must work together to adopt new integrative strategies to address the complex environmental challenges we now face.

Educating the Whole Child


This month marks the public television premiere of a very important film, Race to Nowhere. Vicki Abeles’ provocative documentary tells the story of children, parents and teachers who are increasingly frustrated by an educational system pushing our kids to breaking point. As a pediatrician and a parent, I am heartbroken by the growing number of kids I see with anxiety, depression and mind-body ailments like ulcers and migraines associated with the stress of just trying to keep up. Shockingly, some of these children are in elementary school.

(Continue reading at Huffington Post)

Food Allergies: Why They’re So Common Today + What You Can Do


Growing up, I don’t remember my friends and classmates having food allergies. In fact, there was one kid in my entire elementary school with a peanut allergy — it was so unusual we all knew who he was.

Today? The prevalence of food allergies has skyrocketed, and it’s estimated that 8% of children and adolescents 18 and under have been diagnosed. Amazingly, 30% of these kids have multiple allergies. Equally concerning is that the severity of reactions has worsened over time.

What’s going on and what can you do about it? Here are answers to five questions many people have about food allergies.

(Continue reading at MindBodyGreen)

Top Nine Natural Cures For Summer Ills


Bumps, burns, bruises and bites: a typical summer day in the life of anyone with kids. The good news? These and other common summer ailments typically respond to safe and easy-to-use natural remedies. Some parents are skeptical that natural cures don’t work as well as conventional OTC treatments – you know, the ones loaded with chemicals you can’t pronounce but sure sound like serious medicines.   My advice? Skip the chemicals – and the side-effects – and check out my top nine natural summertime cures.

(Disclaimer: If you’re concerned an illness or injury may be serious enough to warrant immediate medical attention or is worsening with any home treatment, call your doctor.)

  1. Bites: For pesky insect bites, go to your kitchen cabinet before your medicine cabinet. Baking soda has alkaline properties that help neutralize insect bites. You can apply topically as a paste by mixing the baking soda with a small amount of water. Apply as needed until the pain and itching subside.
  2. Bumps and Bruises: My go-to option for bumps before they become bruises is Arnica montana (aka “wound herb”), derived from the daisy family. Arnica can be applied topically in ointment form or can be taken orally in homeopathic form (under the tongue). I generally recommend the 30c dilution for acute oral use. A typical regimen is 5 pellets given every 15 minutes for the first hour, then hourly for four hours and then every 2-4 hours for the remainder of the first 24 hours (while awake).   I then recommend taking 5 pellets three times a day for several days until any soreness or bruising has resolved. For children who cannot or will not put the tablets under their tongue, you can dissolve the pellets in water and let them sip gradually over a few hours. Topical arnica can be used separately or in addition.
  3. Stings: “Like cures like” according to one of the core principles of homeopathic medicine. Therefore, for bee stings, I recommend homeopathic Apis mellifica, derived from the honeybee. For acute use, again, the 30c strength is optimal, and this is definitely one remedy you want to start ASAP to limit the pain, redness and swelling from the sting. You can follow the same general dosing guidelines used for Arnica cited above.
  4. Sunburns: If you have one plant in your house, it should be Aloe vera. The medical use of the Aloe plant can be traced back over 6,000 years to early Egypt based on evidence from ancient stone carvings. The sticky gel found inside the spiky leaves contains numerous natural chemicals that block pain, itching, inflammation and infection, while increasing circulation to speed healing. Of course, you can buy Aloe vera gel if you don’t have a plant handy, and you should apply the gel to the sunburn as often as needed to soothe the inflamed skin.
  5. Scrapes: My first-line option for minor skin irritations is topical Calendula officinalis, derived from the marigold. Calendula possesses potent wound healing capabilities. Apply topically as needed, usually three times a day. Calendula comes in ointment, cream and gel formulations, and it’s so safe that it’s included in many baby diaper rash products.
  6. Impetigo: Cuts and scrapes “gone bad” can lead to weepy, crusty skin infections known as “impetigo.” Caused by staph or strep skin bacteria, impetigo does not necessarily need antibiotic treatment. The best natural solution? Honey. Not by mouth, but directly on the skin. Yes, you read that right. In fact, one special type of honey – Manuka, from New Zealand – has incredible natural antibacterial properties. Apply a small amount to the infected area three times a day and prepare to be amazed.
  7. Swimmer’s Ear: Some kids swim so much each summer you’d swear they’ll grow gills. Not likely, but some actually do get horrible ear aches known as “swimmer’s ear” or otitis externa, an infection and inflammation of the ear canal. Typical conventional prescriptions include topical antibiotic and steroid drops, but there are two safer alternatives you can try first. Apple Cider Vinegar (ACV) contains acetic acid, proven effective in treating the pain and swelling from swimmer’s ear. Place a few drops of ACV into the affected ear three or four times a day for relief. Another DIY option is garlic oil eardrops. Crush a clove of garlic in a tablespoon of olive oil, stir well, and warm slightly on the stove. Mix well and strain out the garlic pieces. Be careful to not make it hot – even room temperature is fine. Instill a few drops of the garlic infused olive oil into the affected ear three times a day until the pain has gone. Both the garlic and olive oil have natural anti-inflammatory and anti-bacterial properties.
  8. Dehydration: With summer comes heat. Some kids are better than others about staying hydrated, but even the most diligent can suffer from heat exhaustion on particularly steamy days. Looking for a good alternative to artificially colored and sweetened sports drinks? Consider coconut water, perhaps nature’s best rehydration solution. Rich in natural electrolytes, coconut water is now readily available and provides a more holistic option to stay hydrated on those hot summer days. Taste an issue? Flavor with a small amount of herbal tea like mint or lemon.
  9. Motion Sickness: Summer road trip on the agenda this year? Long rides in cars or on boats, planes or trains can be tricky business when traveling with motion-sickness prone youngsters. Next time you’re faced with this dilemma, consider giving your child some ginger. All forms of this natural anti-nausea gem can be helpful, including chewables, capsules or teas. Give a small amount just before you go and regularly throughout the journey as needed. An additional remedy I find really effective are “sea bands,” those wrist bands that come with little buttons on the inside. Place the bands on both wrists so that the button lies on the P6 pressure point (an acupressure trigger point located three finger breadths below the main crease below the palm of the hand, right between the two stringy tendons you’ll feel there). Your child can massage the points gently over the bands for added pressure (and distraction) if need be. Happy traveling!

Is Happiness the Key to Eco-Action?


As a pediatrician, I am incredibly lucky to work with children, day in and day out. It’s impossible not to be captured by their amazement with the mundane and their joy in the smallest moments.  I’m often reminded of Winslow Homer’s 1872 painting, “Snap the Whip,” depicting boys playing with abandon in a field outside their rural schoolhouse. So eloquently portrayed is the simplicity of another time, kids out in the natural world for no other purpose than to play, freely and without a care in the world.

Contrast this with contemporary schoolyards with their meticulously designed jungle gyms and artificial surfacing, often empty throughout the day as more and more schools abolish recess or replace free play with highly structured, adult-supervised activities. I’ve realized, as I see increasingly anxious and depressed children come to my office looking for guidance, that the answers often lie not in my prescription pad but outside my window.

(continue reading at Children and Nature Network)