The Cutting Garden invites children to observe plant-pollinator relationships, participate in social practices of creating bouquets, and to delight in the sheer beauty of angiosperms—flowering plants. At markets or in fields, children can help choose objects of seasonal beauty, arranging and rearranging them for aesthetic and celebratory displays. Families can take walks past neighborhood or public gardens to observe the insect and wildlife visitors foraging from the flowering displays. And, of course, families may wish to grow their own flowering plants in containers, backyards, or community plots. For children, seeing the enormous plant that grows quickly from a single sunflower is a delight and a wonder.
Nature observation play is a flexible type of play that may include quiet observation such as butterfly or bird watching, or lively, active play such as trying to catch insects, fish, frogs, and tadpoles. Across the spectrum, this type of play invites children to surreptitiously develop attention and classification skills. Walks in local parks, nature trails, or simply the walk to school or bus stops, can offer opportunities to observe nature in many kinds of settings. A look at the night sky—available to all of us no matter where we are—offers the opportunity to observe discreetly and over time.
How to promote nature play
Given the demands of a busy pediatric practice and the growing list of anticipatory guidance items in routine pediatric visits, adding another task to the checklist may seem daunting. However, questions about nature play can be easily integrated with the questions that we all ask regarding safety, play, and physical activity. For infants, guidance about safe clothing and sun protection can be provided along with messages about the importance of being outside. Developmental screening questions about types of play in toddlers and preschoolers can be asked along with the location of such play—time indoors versus outdoors, and free versus directed play. School-aged children and adolescents should be encouraged to get 60 minutes of physical activity daily,13 and pediatricians should emphasize the added benefits that being outdoors may confer. Specific examples of anticipatory guidance from Bright Futures14 are listed in Table 2.
In addition to discussing nature play with parents and patients, pediatricians should consider promoting nature within their offices. One simple practice to promote nature is to decorate offices with photos and other artwork depicting the natural environment. Providing such natural scenes also may have some direct benefit for patients. One study in adults found that participants who viewed photographs of nature scenes had quicker autonomic function recovery following an acute psychologic stressor when compared with those who viewed scenes of the manmade built environment.15 Thus, decorating with such scenes may help children manage the stress of a doctor’s appointment as well as demonstrating that the pediatrician’s office values the natural environment.
Finally, pediatricians should be advocates for local nature areas and parks. In addition to the developmental and other health information handouts that usually are available for parents to browse in the examination and waiting rooms, offices should include lists of local parks and other opportunities for families to get outside. Such information could include maps of local hiking areas; information about local outdoor play groups; local, state, and national park educational activities; and summer camps for children.
Examples of national and international advocacy groups are listed in Table 3. Many of these organizations offer free downloadable handouts for parents promoting nature play. The possibilities are numerous, and having such information readily available in the office may also spark conversations about the importance of families and children being outdoors together.
1. Yogman M, Garner A, Hutchinson J, Hirsh-Pasek, Golinkoff RM; Committee on Psychosocial Aspects of Child and Family Health; Council on Communications and Media. The power of play: a pediatric role in enhancing development in young children. Pediatrics. 2018;142(3):e20182058.
2. Bravender T, Smith Bravender L. Expanding the definition of pediatric environmental health. Pediatr Res. May 11, 2019. Epub ahead of print.
3. Ladd HF. No child left behind: a deeply flawed federal policy. J Pol Anal Manage. 2017;36:461-469.
4. Dragoset L, Thomas J, Herrmann M, et al. Race to the Top: Implementation and Relationship to Student Outcomes (NCEE 2017-4001). Washington, DC: National Center for Education, Evaluation, and Regional Assistance, Institute of Education Sciences, U.S. Department of Education; 2016. Available at: https://files.eric.ed.gov/fulltext/ED569959.pdf. Accessed February 3, 2020.
5. Murray R, Ramstetter C; Council on School Health; American Academy of Pediatrics. The crucial role of recess in school. Pediatrics. 2013;131(1):183-188.
6. Razak LA, Yoong SL, Wiggers J, et al. Impact of scheduling multiple outdoor free-play periods in childcare on child moderate-to-vigorous physical activity: a cluster randomised trial. Int J Behav Nutr Phys Act. 2018;15(1):34.
7. Raney MA, Hendry CF, Yee SA. Physical activity and social behaviors of urban children in green playgrounds. Am J Prev Med. 2019;56(4):522-529.
8. Hunter MR, Gillespie BW, Chen SY. Urban nature experiences reduce stress in the context of daily life based on salivary biomarkers. Front Psychol. 2019;10:722.
9. Piccininni C, Michaelson V, Janssen I, Pickett W. Outdoor play and nature connectedness as potential correlates of internalized mental health symptoms among Canadian adolescents. Prev Med. 2018;112:168-175.
10. Beyer KM, Szabo A, Nattinger AB. Time spent outdoors, depressive symptoms, and variation by race and ethnicity. Am J Prev Med. 2016;51(3):281-290.
11. Währborg P, Petersson IF, Grahn P. Nature-assisted rehabilitation for reactions to severe stress and/or depression in a rehabilitation garden: long-term follow-up including comparisons with a matched population-based reference cohort. J Rehabil Med. 2014;46(3):271-276.
12. Reber SO, Siebler PH, Donner NC, et al. Immunization with a heat-killed preparation of the environmental bacterium Mycobacterium vaccae promotes stress resilience in mice. Proc Natl Acad Sci USA. 2016;113(22):E3130-E3139.
13. US Department of Health and Human Services. Physical Activity Guidelines for Americans. 2nd ed. Washington, DC: US Department of Health and Human Services; 2018.
14. Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. Elk Grover Village, IL: American Academy of Pediatrics; 2017.
15. Brown DK, Barton JL, Gladwell VF. Viewing nature scenes positively affects recovery of autonomic function following acute-mental stress. Environ Sci Technol. 2013;47(11):5562-5569.