Author: Claire McCarthy, MD

If your adolescent child has been exposed to secondhand smoke, he may already have heart disease. That’s the message of a new study published this month.

Researchers in Finland followed around 500 children from age 8 to 13. Every year they did a blood test that measured their exposure to tobacco smoke in the previous few days. At age 13, they looked at the arteries of the children using ultrasound, to measure their thickness and health, and measured their levels of Apolipoprotein B, which gives a direct measure of the lipoproteins that can cause heart disease. They found that healthy 13-year-olds with exposure to tobacco smoke between 8 and 13 had thickening of the major arteries and higher levels of Apolipoprotein B. While the effects were worse in the kids with the highest exposure to tobacco smoke, they were present in kids with even modest exposure.

This is scary stuff—especially when you add it to what we already know about the dangers of secondhand smoke:
•    According to the American Cancer Society, each year it cases 46,000 deaths in non-smokers who live with smokers, and 3,400 lung cancers in non-smoking adults
•    Every year, it causes between 150,000 and 300,000 lung infections in children less than 18 months old, leading to between 7,500 and 15,000 hospitalizations
•    Children with asthma who are exposed to cigarette smoke have more frequent and severe asthma attacks
•    Children living with smokers can have slower lung growth
•    Secondhand smoke is responsible for more than 750,000 middle ear infections in children every year
•    Exposure to cigarette smoke increases the risk that a baby will die of Sudden Infant Death Syndrome (SIDS)
•    Exposure during pregnancy (just exposure—the woman doesn’t have to smoke herself) can lead to low-birthweight babies
•    While exposure to the actual smoke is the most dangerous, more research is suggesting that the particles that get into things like hair, clothing and furniture (those particles that make people smell like cigarette smoke) are toxic as well—so smoking away from people may not be enough

It’s no surprise, then, that a 2006 Surgeon General’s report said that there is no safe level of exposure to secondhand smoke. But despite this, exposure is still happening—in the workplace, in public places, in far too many homes and in cars (for those who think that rolling down the windows makes smoking in the car okay, a study from New Zealand showed that even with the windows down, the exposure was the same as in a smoky bar!)

It’s time for zero tolerance. Here’s how we can start:
•    If you smoke, quit.  You don’t really want to hurt the people around you, do you? I know that it’s not that easy—but there are treatments that can help. Talk to your doctor.
•    Boycott the houses of people who smoke.  I know this sounds rude, but what’s more important: being polite, or the future health of your family? And who knows, when Grandma or Uncle George realizes that you are serious about not visiting with the kids, it might just be the impetus they need to quit.
•    To the extent that it is possible, don’t let your children be around cigarette smoke. Before you say yes to a playdate, ask if there’s anyone who smokes—if there is, have it at your house instead. Don’t go to restaurants that have a smoking section. Avoid public smoking areas.
•    Support smoke-free policies in the workplace and your community. The goal should be for all workplaces to be smoke-free. Nobody should be forced to take a health risk in order to make a living!
•    Talk to your kids about smoking. According to a 2007 CDC survey, 20% of high school students smoke. That’s better than 23% in 2005, but still too high. Make sure your kids get the message loud and clear from you that smoking is a really bad idea (if you smoke yourself, it’s going to be hard to get that message across!)

Working together, we can make a difference—and we have to.  The lives of our children are at stake.

We’ve all heard the stories in the news about Rebecca Riley, the 4-year-old who died in 2006 of an overdose of psychiatric medication. She made her first trip to a psychiatrist when she was two, because she was active and had trouble sleeping. She was diagnosed with bipolar disorder when she was only three–her ten-year-old brother and four-year-old sister had already been diagnosed with the same—and put on three different medications. By the time she died, she was taking more than ten pills a day. She got sick, and her mother, who was recently convicted in her death, gave her extra pills to make her sleep. Rebecca never woke up.

It’s easy to dismiss Rebecca’s case as an extreme, an outlier. But a paper published in the September 2007 edition of the Archives of General Psychiatry noted that there has been a 40-fold increase in the diagnosis of bipolar disorder in youth over the past decade, with widespread prescribing of medications for bipolar disorder that are not FDA-approved for children. The National Institute for Mental Health (NIMH) is studying children and adolescents diagnosed with bipolar disorder, and has found that in many cases, the diagnosis is overused or misused (in response, the American Psychiatric Association has developed a new diagnosis, temper dysregulation disorder, that it hopes will be used instead). This is very troubling.

Data from the National Center for Health Statistics shows that in 2005-2006 (the most recent data available), 5 percent of American children ages 4-17 were prescribed psychiatric medication. That’s an awful lot of kids. The vast majority—89 percent–were treated for Attention Deficit Hyperactivity Disorder, or ADHD; over the past decade, the prescribing of ADHD medication to children under 18 has more than doubled. Here’s another startling statistic: in that same decade, the prescribing of antidepressants to children under 18 has quadrupled.

As scary as all this sounds, it’s important to remember that for many children, psychiatric medications can make a tremendous difference. I have seen it in my practice. For children with ADHD, medication can be the difference between doing well in school and failing, the difference between making friends and having no friends at all. For children with depression or anxiety, medication can change how they see the world. And for children who truly do have bipolar disorder and other serious psychiatric illnesses, medication can be a lifeline for them and their families.

The key is to be sure that psychiatric medications are used sparingly, carefully and responsibly in children. Here are some suggestions to make sure that happens:

• All children should have a thorough, careful evaluation before prescribing medications. Not all active or aggressive children have ADHD, let alone bipolar disorder, for example, and one quick visit with a doctor or the results of a questionnaire filled out by a teacher isn’t enough to sort things out. I get asked frequently by elementary school teachers to medicate children with behavioral problems; people seem to look to medication as a quick fix. But to really help kids, we need to really understand them. The choice of who should do the evaluation (pediatrician, psychiatrist, other mental health provider, neurologist) depends on the diagnosis that is being considered—but whoever does it should be licensed, reputable and have experience working with children. If you are considering medication for your child, talk to your doctor about the best way to proceed.

• Parents need to be aware of all the possible side effects. As with any medication, psychiatric medications can have side effects—and some can be serious. For example, in some children, selective serotonin reuptake inhibitors, or SSRI’s, may make them feel like killing themselves. While this is rare, and these medications are generally safe and effective, it’s important for parents to be monitoring their children closely. Parents should be fully educated on all the possible risks of medications, and told exactly what to do if they occur.

• Medication combined with therapy gives the best chance at success. Studies show that for most children, cognitive and/or behavioral therapy along with medication works better than either one alone. Therapy also allows for closer, more detailed monitoring—and can give support to family members coping with the fallout of mental illness.

• Children on medication should see their prescriber regularly. How often will depend on the medication and how long the child has been taking it. These visits are crucial, to monitor for side effects and for effectiveness. Parents should be wary of a practitioner who routinely gives refills without seeing their child.

• If a child isn’t getting better, or multiple medications are being prescribed, a second opinion may be a good idea. Sometimes it helps to have someone take a fresh look.

Psychiatric medications can be safe, and can improve a child’s life—but only when used wisely. For more information on medications used to treat mental health problems, visit the website of the National Institute of Mental Health.

Have you heard of the choking game?

Don’t feel bad if you haven’t—it was news to me when I read about it in this month’s issue of the journal, Pediatrics. But if you’re the parent of a teen (as I am), you need to know about it.

In this “game”, played in groups or alone, teens temporarily deprive their brains of oxygen.  This causes a “high”, and there is another pleasurable sensation when the blood and oxygen rush back into the brain.

There are three ways teens cut blood flow to the brain:
•    Choking
•    Tying something around the neck
•    Holding their breath while someone hugs them from behind

The danger, obviously, is when the oxygen deprivation goes on longer than it should.  It can cause seizures, neck fractures and brain damage—but it can also kill.  The game is most likely to be fatal when it’s played alone, as the person can lose consciousness and become unable to undo whatever is around the neck, but there have been deaths in group games also. It’s hard to get accurate data on deaths; when teens are found dead with something around the neck, it’s not always possible to know if they were trying to commit suicide or just looking for a high. The Centers for Disease Control has attributed 82 deaths to the choking game between 2005 and 2007, but advocacy groups say it’s much higher, more than 100 each year.

If you have teenagers, here’s what you need to do:

•    Talk to them about the choking game.  Ask them if they have ever played it, or if they know anyone who has.  Make sure they understand how incredibly dangerous it is.
•    Be aware of the signs that your child might be playing the choking game.  They include frequent headaches, unexplained bruising around the neck, bloodshot eyes, tiny flat red spots (called petechiae) on the face, seeming disoriented after being alone, ropes, neckties or other things that could go around the neck, with knots in them, in unusual places or signs of wear on furniture (from having things tied to them).

If you notice these signs, take it seriously—and take action.  Talk to your teen, increase your supervision and call your doctor for help.

It’s that time of year when we think about immunizations. That’s because every January the American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC) issue an updated immunization schedule. The online version is on the CDC’s web site. There are three schedules: one for birth to 6, one for 7 to 18 and a “catch-up” schedule for kids who start late or have interruptions for whatever reason.

Immunization is an evolving science, and new vaccines are created all the time. Once we start getting experience with them, it’s not unusual to change the timing or number of doses. And sometimes vaccines get taken off the schedule, either because there’s a newer and better version, or (rarely) because of problems.

This year, there are only a few changes:

•    The vaccine against H1N1 influenza was formally added for children 6 months and older (since it was developed after last January, it didn’t make it onto last year’s schedule)
•    A booster dose of meningococcal vaccine is recommended for children at high risk of meningococcal disease (such as those without a spleen, or who have certain problems with their immune system). If your child has already received meningococcal vaccine, check with your doctor about if and when another dose is needed.
•    Whenever possible, doctors are encouraged to use combination vaccines (such as Pentacel, which combines DTaP, IPV and HIB). They work as well as giving vaccines separately, and most kids would agree that the fewer shots, the better!
•    There is a new vaccine against rotavirus, called Rotarix. It’s given in two doses, unlike the three doses of Rotateq. Both are effective. The choice will likely be based on availability and insurance coverage—if you have an infant less than 2 months old (which is when the first dose of either is given), check with your doctor.
•    There are two changes related to immunization against human papilloma virus, or HPV:
First, there’s a new version, Cervarix, that protects against cervical cancer, but not genital warts or vulvar or vaginal cancers. It’s given in the same dose schedule as the existing version, Gardasil.
Second, doctors are encouraged to consider giving Gardasil to boys, to prevent genital warts and help decrease the spread of HPV (which is a sexually transmitted disease). It’s not an official recommendation at this point, just a suggestion. Talk it over with your doctor. You can visit the CDC site for more information on HPV vaccination.

As you look at the schedules and think about how the changes do or don’t affect your children, it’s a nice opportunity to stop and appreciate just how much of a difference immunization has made in the lives of children everywhere.

There’s been a 75 percent drop in deaths from measles worldwide—and the Americas are measles-free. According to a report from the United Nations and the World Bank, immunization saves 2.5 million children every year. And if all countries could fully immunize 90 percent of their children under 5, it would save two million more every year. That’s a lot of children.

It’s easy to get complacent, though, especially when we don’t see illnesses like measles anymore. Even chicken pox, which each year killed 100 children and hospitalized 10,000 before the vaccine was introduced in 1995, has become relatively rare.  When you hardly see illnesses, it’s easy to think that vaccinating against them isn’t important. And indeed there is a “herd immunity” that helps protect unvaccinated children: if enough of the children around them are vaccinated, they are less likely to be exposed to vaccine-preventable illnesses.

But counting on herd immunity isn’t a good idea. First of all, every year there are cases of measles and other vaccine-preventable illnesses, many among children who come from other countries—and every year, they infect unvaccinated children. Second, if everybody starts counting on herd immunity instead of vaccinating, soon there won’t be any herd immunity—and the diseases, which used to kill or disable thousands of children, will come back.

So take a moment this January to learn more about immunization. The CDC’s web site is a great resource, full of information about specific vaccinations as well as the risks and benefits of immunization in general. Talk to your doctor. When it comes to your child’s health, the more you know, the better.

It’s that time of year when we think about immunizations. That’s because every January the American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC) issue an updated immunization schedule. The online version is on the CDC’s web site. There are three schedules: one for birth to 6, one for 7 to 18 and a “catch-up” schedule for kids who start late or have interruptions for whatever reason.

Immunization is an evolving science, and new vaccines are created all the time. Once we start getting experience with them, it’s not unusual to change the timing or number of doses. And sometimes vaccines get taken off the schedule, either because there’s a newer and better version, or (rarely) because of problems.

This year, there are only a few changes:

•    The vaccine against H1N1 influenza was formally added for children 6 months and older (since it was developed after last January, it didn’t make it onto last year’s schedule)
•    A booster dose of meningococcal vaccine is recommended for children at high risk of meningococcal disease (such as those without a spleen, or who have certain problems with their immune system). If your child has already received meningococcal vaccine, check with your doctor about if and when another dose is needed.
•    Whenever possible, doctors are encouraged to use combination vaccines (such as Pentacel, which combines DTaP, IPV and HIB). They work as well as giving vaccines separately, and most kids would agree that the fewer shots, the better!
•    There is a new vaccine against rotavirus, called Rotarix. It’s given in two doses, unlike the three doses of Rotateq. Both are effective. The choice will likely be based on availability and insurance coverage—if you have an infant less than 2 months old (which is when the first dose of either is given), check with your doctor.
•    There are two changes related to immunization against human papilloma virus, or HPV:
First, there’s a new version, Cervarix, that protects against cervical cancer, but not genital warts or vulvar or vaginal cancers. It’s given in the same dose schedule as the existing version, Gardasil.
Second, doctors are encouraged to consider giving Gardasil to boys, to prevent genital warts and help decrease the spread of HPV (which is a sexually transmitted disease). It’s not an official recommendation at this point, just a suggestion. Talk it over with your doctor. You can visit the CDC site for more information on HPV vaccination.

As you look at the schedules and think about how the changes do or don’t affect your children, it’s a nice opportunity to stop and appreciate just how much of a difference immunization has made in the lives of children everywhere.

There’s been a 75 percent drop in deaths from measles worldwide—and the Americas are measles-free. According to a report from the United Nations and the World Bank, immunization saves 2.5 million children every year. And if all countries could fully immunize 90 percent of their children under 5, it would save two million more every year. That’s a lot of children.

It’s easy to get complacent, though, especially when we don’t see illnesses like measles anymore. Even chicken pox, which each year killed 100 children and hospitalized 10,000 before the vaccine was introduced in 1995, has become relatively rare.  When you hardly see illnesses, it’s easy to think that vaccinating against them isn’t important. And indeed there is a “herd immunity” that helps protect unvaccinated children: if enough of the children around them are vaccinated, they are less likely to be exposed to vaccine-preventable illnesses.

But counting on herd immunity isn’t a good idea. First of all, every year there are cases of measles and other vaccine-preventable illnesses, many among children who come from other countries—and every year, they infect unvaccinated children. Second, if everybody starts counting on herd immunity instead of vaccinating, soon there won’t be any herd immunity—and the diseases, which used to kill or disable thousands of children, will come back.

So take a moment this January to learn more about immunization. The CDC’s web site is a great resource, full of information about specific vaccinations as well as the risks and benefits of immunization in general. Talk to your doctor. When it comes to your child’s health, the more you know, the better.

This year I’m resolving not to tell you anything you don’t already know. At risk of sounding like a broken record, I’m going to recommend doing these three things in 2010:

1.    Eat better
2.    Get more exercise
3.    Spend more time together as a family

My guess is that, if I left it at that, we’ll be sitting here next January talking about the same things. Resolutions are often dependent on a turning-over–a-new-leaf mentality that passes when the calendar flips to February and they don’t fit into the reality of our lives (it’s hard to go to the gym every day after work when you have to pick the kids up from daycare and get home to make dinner). We also try to make these changes independently, relying only on ourselves to count calories, get out for a run or schedule a family date-night.

So what if, this year, you make family resolutions instead of personal ones? By picking resolutions that have a direct impact not only on your personal health and well-being, but also on your entire family, you’ll feel more responsible for following through all year and you’ll have the added element of familial peer pressure to keep yourself—and each other—motivated.

Here are three resolutions that could go a long way toward improving your health and happiness, and some practical ideas for making them happen. I’ve broken them down into basic goals you can achieve with small changes to your lives and stretch goals you and your family can shoot for if you’re feeling competitive. Add your own ideas—and it’s totally fine (recommended, even) to change the approaches throughout the year.

Eat better
I know, you’ve heard this before. But I can’t emphasize enough how important it is; not only are we in the midst of a really scary obesity epidemic, but a healthy diet can help prevent everything from heart disease to cancer and Alzheimer’s. Small steps like these can make a big difference:

Basic goals:

• Add one extra serving of fruits or vegetables into everyone’s diet each day. Slice an apple and serve it with breakfast, insist on a few bites of vegetables with dinner, keep baby carrots handy for snacks.
• Pack lunches and snacks instead of buying them, whenever you can. Start with once a week (doing it the night before makes it easier), and do more as it’s possible.
• Plan meals together—and shop—as a family. That will make you less likely to get fast food. Again, start with what’s feasible, and work up.
• Make changes in how you shop. Don’t buy soda. It’s not good for anyone, not even diet soda. Don’t buy chips and other junk food. If it’s in the house, it gets eaten. If it’s not, it doesn’t. Buy less juice (everyone should be having no more than one glass a day), and when you do buy it, make sure it’s 100 percent juice.
• Check out the American Dietetic Association Web site for more ideas. Talk about them as a family, and pick the ones that are most appealing to you.

Stretch goals:

• Go for the goal: five servings of fruits and vegetables each day
• Join a Community Sponsored Agriculture farm, which allows you to get really fresh fruits and vegetables and even do some work in the fields to help pay for your share
• Be adventurous: try vegetarian recipes, veggie snacks—or soy milk. You just might like them!

Exercise
This is another one that we hear all the time for good reason. Exercise is absolutely crucial to overall health. Here, small steps can make a big difference.

Basic goals:

• If it’s possible to walk instead of taking the car (to school, to a playdate, etc) do it.
• Park the car a little farther away; take the stairs instead of the elevator
• Do one physical family activity every weekend (roller skating, family swim, walk around the block)
• Play outside every day. This used to be a childhood routine; it’s not so much anymore, and it’s a huge lost opportunity for exercise. Reinstate it in your family (don’t let weather stop you—jumping in puddles and making snowmen are fun!).
• Pick some sort of physical activity for each family member—basketball, karate, Zumba, whatever. Try out different things throughout the year.

Stretch goals:

• Training for a race together! Lots of races are family-friendly
• Don’t just try an activity—join a team! There are plenty of options for kids and parents

Spend more time together
Stronger relationships go a long way toward preventing stress and depression—and for kids, they can keep them out of trouble, and help them do well in school.

Basic goals:

• Have more family dinners (studies show they are great for kids!). Have the kids help you cook.
• Read bedtime stories (snuggled in bed even better). This isn’t just for little kids; reading chapter books aloud is fun too.
• Have movie or game nights (stock up on popcorn)
• Instead of doing chores or watching TV once the kids go to bed, spend a few minutes reconnecting with your spouse.
• Check out local museums as a family. Let the kids pick. Eat lunch there.

Stretch goals:

• Do an activity with one or more of your children, like a book club or an art class
• Have a weekend mini-“staycation”: spend a night together in a local hotel. Find one with a pool. Go out to a restaurant, swim and watch movies until really late.
• Institute a weekly family meeting to discuss issues and plans together.

The most important thing with all of these suggestions is to be creative and flexible. If one idea doesn’t work (the kids balk at museums, you don’t like Zumba), try another one. But keep trying. Show your kids (and yourself) that perseverance is possible—and that being healthy and happy is important. That, in and of itself, could make a big difference in everyone’s life—and not just in January.

From swine flu to obesity to dangerous plastics, many issues that affect children’s health garnered media attention in the year 2009. Here’s a rundown of the some of the biggest and most important stories:

H1N1

This is the story that caught the most attention—for good reason. Not only is the H1N1 influenza virus very contagious, it appears to particularly affect young people. H1N1 caused more pediatric hospitalizations and deaths than we usually see with the seasonal influenza virus, which is very scary for parents (and pediatricians!). The virus led to countless school closings—sometimes to control the spread, and sometimes because there weren’t enough teachers left to teach!

We’ve had some good news recently: The vaccine, which appears to be effective and safe, is now plentiful. While there was some concern about resistance, H1N1 is still generally treatable with medication (although it’s rarely necessary). And the number of new cases is steadily dropping—but it’s important not to let our guard down completely, because nobody knows for sure what this new virus will do next.

Bottom line: Keep washing your hands, and get vaccinated.

Health Care Reform

We all know that our health care system costs too much money, and doesn’t reach everyone. But how do we fix it? That’s the question President Obama and others have been struggling with. There are no easy answers, and lots of competing stakeholders. It’s very clear that the response will need to be multifaceted and built on compromise.

Children’s Hospital Boston has been doing its part not only to help, such as by working with insurers to cut costs and improve care, but to make sure that the needs of children aren’t lost in the debate. Dr. Judy Palfrey, the current president of the American Academy of Pediatrics and a staff member of Children’s since 1974, has spoken and written eloquently about the health care needs of children.

Bottom line: This is an important issue that will affect each one of us. Stay informed—and talk to your elected officials!

Media, Technology and Kids

The media and technology are playing an increasing role in the lives of US children, and researchers are raising some red flags. Here are just a few of them:
•    Children who spend more than two hours a day in front of screens are more likely to be obese
•    Exposure to sexual content on TV has been linked to early initiation of sex—and multiple studies have shown that media exposure leads to more sexualized behavior in girls, and more dissatisfaction with their bodies
•    The more children are exposed to violence in the media, the more likely they are to have aggressive behavior
•    Excessive TV viewing is associated with poorer grades—and attentional problems
•    Some studies have linked early TV viewing (before age 3) with lower developmental scores
•    Teens who are addicted to the Internet are more likely to harm themselves
•    According to a Pew study, half of teens 16 and 17 have talked on a cell phone while driving, and a third of them have texted behind the wheel

The ramifications of all this for our children are tremendous—and scary.

Bottom line: Pay attention to the media and technology use of your child. Set limits—and enforce them.

Obesity and kids

Since 1980, childhood obesity rates have tripled. Right now, a third of US children are overweight or obese—and numbers are steadily rising. That’s an awful lot of kids destined to have heart disease and diabetes and all the other health (and social!) consequences of obesity.

Legislators and advocates are taking action, and we are seeing progress. More restaurants list calories, soda is coming out of more school lunchrooms, some companies are decreasing the sugar content of their foods and awareness is rising about the effect of ads for junk food and soda on children.

It’s a start, but it’s not enough; we’re going to need a grass-roots, comprehensive strategy to save our kids. That strategy needs to start at home; with two-thirds of U.S. adults either obese or overweight, grownups are hardly setting a good example.

Bottom line: Don’t ignore that “baby fat” or assume your child will slim down when he’s older.  Make exercise and healthy eating part of your family’s everyday life—now.

Dangerous plastics

This year, many states raised concern about Bisphenol-A (BPA), a chemical used in many plastics, including baby bottles. Scientists have been concerned for years about possible health effects, especially for infants and pregnant women. In fact, Canada and the European Union have banned the use of BPA in products used by infants and small children.

To avoid BPA, look for the number 7 inside a triangle on the product; if you see that, don’t use it. While you’re at it, avoid 3 and 6; they contain phthalates, which are also possibly dangerous. 1, 2, 4 and 5 are better. Try not to use plastic containers when you heat things in the microwave, and wash them by hand instead of putting them in the dishwasher, as heat releases more chemicals.

Bottom line: As we figure out which plastics are dangerous and just how dangerous they are, try to use less plastic in general. Use glass, ceramic, and metal instead. Buy fewer plastic toys.

What pediatric health issues were you talking about this year? Are there any pediatric health issues (or general health issues) that people weren’t talking enough about in 2009? Look into your crystal ball: What do you see as the big health stories of 2010?

While you’re here, check out U.S.News & World Report’s listing of the top 10 health stories from 2009.

It’s nearly school vacation time—and you’re probably making plans (or will, once your shopping is finished) for things that will keep the kids busy during their time off. Museums, concerts, playdates—whatever fills the days in a useful, educational way. Because you can’t leave the days blank, right?

Actually, you can. And sometimes leaving them blank is exactly what children (and families) need.

Don’t get me wrong: if there’s some really cool exhibit you’ve been waiting to see (my family wants to see the Harry Potter exhibit at the Museum of Science), or Christmas wouldn’t be the same without a trip to The Nutcracker, go for it. And if that one kid your daughter has been dying to play with is finally free over vacation, by all means set up a playdate.

But sometimes it’s important to remember the real meaning of vacation, which comes from the Latin vacare: to be empty, free. Children need this, especially these days when being scheduled (sometimes highly scheduled) is the norm. They are so scheduled that in 2006 the American Academy of Pediatrics (AAP) issued a report entitled “The Importance of Play in Promoting Healthy Child Development and Maintaining Strong Parent-Child Bonds.” It’s sad when the AAP has to remind parents to let their kids play.

The thing is, unstructured play is important. It’s particularly important for child development, because it’s through imaginary play that children explore the world, practice decision-making skills, learn to work in groups and learn to share. It’s also how they learn how to entertain themselves without the aid of an electronic device, and how they practice self-control. Unstructured time is important for mental health, because it gives kids a chance to decompress and relax; without this, there’s a higher risk of stress and depression.  And it can be good for physical health, especially when that unstructured time involves physical activity.

Families need downtime, too. With everybody running every which way, we miss chances for connecting with and enjoying each other. Not to mention the stress on the parents who do all the scheduling—and the drop-offs and pickups and snack- and gym bag-packing.

So how about using vacation as a relaxation and reconnection time? Here are some suggestions:

• Turn off the alarm clocks and get some sleep.
• Turn off the TV and computer screens. You may face some resistance on this, as screens are often what kids want to use to fill blank days. But turning off screens turns on all sorts of creative possibilities.
• Offer your kids materials to make stuff—like clay, blocks, paint and paper. Cut out pictures from magazines and make collages. Build a city. Leave it up all week and add to it.
• Make a fort out of sheets and chairs. Bring pillows inside. Have a picnic there. Use flashlights.
• Go outside a lot. Go for walks or to the park. Build snowmen if there is snow.
• Play music. Dance.
• Get out the board games. Have a marathon Monopoly game in your pajamas.
• Take part. This is really important.  Don’t just set the kids up with something and pull out your laptop or get on the phone—play with them. Your kids will love it, and I bet you will too.

If you approach the vacation this way, you just may find that when it’s over, everyone will be not just rested but happier. You might even find yourselves wanting to spend more time this way. Which would be really wonderful—for everyone.

Built any good forts lately? Ever made origami animals out of used holiday wrapping paper? What does your family like to do together during vacation time?

Related posts:

1. Healthful eating during the holiday season
2. My whole family enjoys Guitar Hero, but I’m concerned about the lyrics – what should I do?
3. Shopping for toys this holiday season? Here are some tips for buying safely