School Stress: Rescuing Our Children


Stress, according to noted Slovakian researcher Hans Selye, is neither good nor bad. Instead, it is defined as “the non-specific response of the body to any demand for change.” At some point, though, stress ceases being an impetus for productive effort in the service of positive performance and instead overwhelms our bodies, minds and spirits. The result? Fatigue, withdrawal and, ultimately, breakdown. As a pediatrician, I witness this phenomenon regularly in the form of the American adolescent, one after another, coming to me with debilitating migraines, chronic abdominal pains and severe depression.

The daily life of a high school student is marked by poor eating habits, limited physical activity, lack of adequate sleep, no outdoor time and not one minute of downtime. Any time not spent being “productive” inevitably involves a screen of some sort. According to a recent study, teens manage stress predominantly by playing video games, surfing the internet and watching TV/movies. Snapchat, Netflix, Mortal Kombat… take your pick. These diversions are our kids’ stress coping skills. Sadly, it appears they’re learning well from their parents. While 43 percent of adults report exercising to alleviate anxiety, a whopping 62 percent claim their go-to stress reliever involves screen time. When I ask kids how they believe their parents are coping, most say “poorly.” We clearly need to be better role models for our children. The good news is there are alternative stress-coping methods that are inexpensive, accessible, safe and effective. In a newly published systematic review, my colleagues and I concluded that yoga has a significantly positive effect on pediatric psychological functioning. Specifically, educational programs incorporating yoga in stress management programs improved academic performance, self-esteem, classroom behaviors, concentration, and emotional balance. Mindfulness training for students and teachers is now widely recognized as a valuable tool to improve stress coping, improve focus and complement social-emotional learning initiatives. Pediatrician Dzung Vo, author of The Mindful Teen, has created a wonderful resource for teens to explore and integrate mindfulness meditation in their lives. Finally, kids who spend more time in natural settings have measurable improvements in health, cognitive functioning, and classroom behavior. The Children and Nature Network has compiled a thorough review of research on how nature impacts our children’s well being.

School stress — both academic and social — is a major contributor to deteriorating adolescent health. According to a recently published landmark study, nearly half of 11th grade students surveyed reported “a great deal of stress” on a daily basis. They declared “schoolwork, grades, and college admissions constituted their greatest sources of stress.” While some in the study found moderate amounts of stress could be motivating, an astonishing one in four subjects was suffering with symptoms of clinical depression. So here is the rub — how much stress is the right amount?

Dr. Mary Alvord and Dr. Marya Gwadz are psychologists, experts in the field of adolescent stress. Both were quoted in The Atlantic’s piece profiling Gwadz’s study.

“[T]oo much stress has many effects on the body and mind, Alvord says. In the short term it can cause anxiety; over long periods of time, elevated levels of stress hormones can degrade the immune system, cause heart problems, exacerbate respiratory and gastrointestinal issues, and bring on chronic anxiety and depression. That’s bad for anyone, but it can be especially bad for high schoolers: “Colleges are complaining that kids are disengaged, they’re dropping out, taking a long time to graduate. It’s not developmentally appropriate for them to work so hard,” says Gwadz, one of the authors of the recent study. And since everyone has a different psychological capacity for stress, it’s hard to know when a student is pushed to the point of degrading his or her health.”

 We want to prepare our children for the real world, allowing them to experience challenges and even (yikes!) fail at times, developing resiliency. We must, however, find a better balance, evaluating common stressors, and ask ourselves — what in the educational environment no longer serves us?

Vicki Abeles, director and producer of the seminal educational documentary, Race to Nowhere, and a just-released sequel, Beyond Measure, believes the answers to this question are in fact many of the strategies we are employing to fix a broken-down educational system. Standardized common core curricula and testing measures are contributing unnecessarily to stress while failing to create a productive and healthy educational environment. Abeles challenges our preconceptions with a barrage of thought-provoking questions.

“Rather than ask why our students fail to measure up, the film asks us to reconsider the greater purpose of education. What if our education system valued personal growth over test scores? Put inquiry over mimicry? Encouraged passion over rankings? What if we decided that the higher aim of school was not the transmission of facts or formulas, but the transformation of every student? And what if this paradigm-shift was driven from the ground up? By students, parents, and educators? By all of us?”

The film (and its accompanying book), thankfully, does not simply point out what’s gone wrong but also offers us models that could serve as templates for a brighter future. The schools profiled in Beyond Measure nurture creativity, collaboration, persistence and resiliency as critical life-long skills. They provide for us a much-needed road map to a different kind of success — one that does not sacrifice our children’s well being in the process.
(originally written for the Huffington Post)

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)

Health is a Creative Process

health is creativeOne of my staff members recently observed me going from room to room, seeing patients in my pediatric practice, without paper and without a laptop. This is my usual routine. I must have seen three or four kids in a row that afternoon when she asked me how I seemed to know who everyone was and how I remembered the details of their lives and of our encounters. It occurred to me that, after 20 years of practicing medicine, the "how" of each encounter had become as important as the "what."

Yes, I am keenly aware of what is happening in the room when I'm with patients. It wasn't always this way. As a medical student and resident, I was taught to focus on "taking a history" and "doing a physical exam." The very words that describe these basic tenets of practicing medicine convey a one-sidedness, something that doctors do to patients. At the same time, we are taught that the medical history — literally, the patient's story — holds the key to their diagnosis 90 percent of the time. I use the word "diagnosis" not simply as a label but as a guide to understanding what needs to change to create optimal health. I have come to understand that the interaction itself — the sharing of stories — is critical in this creative process. In order to be effective, the encounter needs to be a two-way engagement. Healing is not something I do to my patients, it's something that we create and facilitate, together.

Being aware of what's happening in the room — paying attention to the process — requires an intention, a willingness to be present, to show up and engage with our patients in a way that is mutually respectful and says, "I am here with you and what you have to say matters as much as what I have to say." Maybe it's my training as a musician, but I've come to see my time "in the room" with patients as an interactive creative process, closest in my mind to playing in a jazz ensemble. We each introduce themes, one playing off the other, improvising at times, taking the conversation where we need it to go to allow healing to happen. And when it does, it's magical. Amy Begel, a groundbreaking family therapist and jazz musician, introduced this idea to me years ago in very literal terms. Amazingly, she has pioneered the use of jazz musicians as consultants in family therapy. She asks them to listen to the family's dialogue from behind a one-way mirror, come in the room, and then "play" what they've seen and heard. The family members can in turn respond to the musicians' interpretations. The impact on the therapeutic process can be remarkable. Honoring the creative aspect of the clinical encounter in this way, to me, is genius. Why does it work when it works? Amy comments, "The creative process for both musician and therapist is dependent on the practitioner's ability and willingness to give up control of the outcome." This openness to sharing the process requires what Dr. Brene Brown has described as "the courage to be vulnerable" in order to enhance our connection, which in turn leads ultimately to healing. And that, I believe, is the point.

The Rx Life Solution

“Insanity is doing the same thing over and over again and expecting different results.” – attributed to Albert Einstein

The Problem

Americans are sicker than ever before, and despite throwing tons of money at the problem, we continue to be sicker than citizens of most other affluent countries. According to the Institute of Medicine:

“The United States is among the wealthiest nations in the world, but it is far from the healthiest. For many years, Americans have been dying at younger ages than people in almost all other high-income countries. This health disadvantage prevails even though the U.S. spends far more per person on health care than any other nation.”

The Solution

Americans are being prescribed, taking and spending more money on medications than ever before. Staggering fact for the day: More than 10 percent of Americans (and more than one-third of those 60 and older) used five or more prescription medications in the past month, according to this 2008 CDC/NHCS survey.

Note to self: It’s not working.

Our “one ill-one pill” solution is expensive, ineffective and (in an increasing number of cases) unsafe. We need a new approach. I’m proposing a new solution, one that is more affordable, accessible, effective and safe for the chronic health conditions I see in practice every day — conditions that in most cases are caused or exacerbated by stress. It’s a solution that is truly preventive rather than reactive, one that creates health and wellness. It’s participatory and collaborative. I’m calling it “Rx Life.”

The Rx Life Solution:

1. Rx Food

Eat real food, not a long list of processed ingredients mashed together masquerading as food. Teach your children that food comes from the earth, not from a can. Grow and prepare your own food. Cultivate a garden or a farm. Buy and eat locally-grown, chemical-free food. Learn why Dr. Mark Hyman believes in the “power of the fork” and spread the word. Teach your kids that eating is a mindful process, not only about ingesting calories but also about nourishing your body, mind and soul. Eating is and ought to be a community activity.

2. Rx Activity

Move your body. Start with something — any amount, as much as you are able, and build on that foundation. Get your heart rate moving and see what it feels like to be so active that even your hair sweats. Get outside. Experience what author Richard Louv calls the “transformative power of the natural world” and refuse to let your children suffer from nature deficit disorder. Support school recess and encourage free play in natural settings. Inspire creativity — dance and sing, draw and paint, make things with your own hands, and cultivate your children’s imagination.

3. Rx Rest

Make sleep a priority. Create opportunities for rest, especially for teens; they always need far more sleep than they get. Instill good sleep habits from the beginning. Create a quiet, calm place for restful activities. Take time to simply be. Unplug and recharge. Value downtime. Remind your kids — and yourself — that it’s OK to stop. Listen to Dr. Aviva Romm when she tells you to stop pushing, pushing, pushing… and just breathe.

4. Rx Mindfulness

Be here now. Pay attention to the process. Realize that the most important time is now, the most important person is the one you’re with and the most important thing to do is what are doing right here, right now (thank you, Jon Muth — oh yeah, take time to read stories to your kids like The Three Questions). Practice yoga and meditation — anything to cultivate what Elena Brower calls the “art of attention.” Accept that you will never make all the stress in the world disappear and help your children build their stress-coping toolboxes. Take time to look someone in the eyes, listen to her story, and let her know that you hear her. Be willing to sit in the mud until it settles and the water clears.

My promise to my patients and their families — and to my family and to myself — is to spend more time prescribing and living life, to honor the power of food, activity, rest and mindfulness to promote healing and prevent illness. I am fully and authentically committed to walking this walk. Will you join me?

‘Let Them Read Books’: Stories as Stress-Busters

Stress is everywhere. Most recent estimates are that 1 in 4 teens
are diagnosed with an anxiety disorder. We've seen these numbers
explode in recent years following traumatic weather disasters like
Hurricanes Katrina and Sandy. Along with poverty, food insecurity and
pollution, stress is a major environmental factor negatively impacting
other health conditions like asthma. What has been the medical
system's response? Predictably, medication prescriptions for conditions
like anxiety, depression and ADHD
have risen dramatically in recent years. At times, these drugs can be
lifesaving, but they are widely over-prescribed and have significant
potential adverse effects. The good news is that we have safer, equally
effective and less expensive alternatives readily available.


– Originally published in the Huffington Post

‘I’m From Jersey’: A Pediatrician’s Reflections on Sandy

Understand, I was born and raised in New Jersey, and I have lived my
entire life here with the exception of college and medical school. N.J.
is not just where I live; it is a part of who I am, as much as it is
for the families I care for in my pediatric practice. I am deeply
embedded, consciously, within my community. And now, I am feeling its
pain, and I'm struggling to find a way to help my patients.


– Originally published in the Huffington Post

The Last Well Child

Q: "What is a well person?"
A: "A well person is a patient who has not been completely worked up."

As I enter the exam room, a smiling 10-year-old boy greets me. Pete,
my last patient of a long day, is here for his annual well visit. I
chat with him about his life — home, school, nutrition, exercise,
sleep, etc. — and I'm struck by something. Pete is really well. He's
well-fed (but not too much), active and well-rested, and, most
importantly, he's happy. He has not been to see me in an entire year,
and only comes in for preventive health counseling. I think back on my
entire day… and on my whole week. Pete is different from every other
child I have seen this week. He is, in fact, the only truly "well" child
I have seen in a long, long time. And I wonder — is he the last?


Originally published in the Huffington Post