Be Our Voice Blog

Blog Entries from 04/2012

Monday, April 30th, 2012

Making the "Go Outside and Play" Prescription Possible

Posted by: Kristi Fossum Jones, MPH

As the weather gets warmer and spring arrives, pediatric care providers and healthcare professional advocates like to tell patients and families to “go outside and play!”

Play—especially free and unstructured play—is vital to kids’ healthy development physically, socially, and emotionally. And the fact that playtime offers physical health benefits is of particular relevance for healthcare professional advocates fighting childhood obesity. According to a clinical report published in the January 2012 issue of Pediatrics, “Play enhances physical health by building active, healthy bodies. Physical activity beginning in early childhood prevents obesity. In fact, play may be an exceptional way to increase physical activity levels in children and, therefore, may be included as an important strategy in addressing the obesity epidemic.1

Another reason why “go outside and play!” is good health advice has to do with the “go outside” part. According to the CDC, kids ages 8-18 spend an average of 7.5 hours a day using electronic media (e.g. TV, computers, video games, etc.) and 83% of kids six months to six years watch almost 2 hours of TV/videos per day. This sedentary time contributes to childhood obesity.2 In contrast, when kids are outside, they’re usually active doing things like riding bikes, swinging, playing sports, etc.

So clearly “go outside and play!” is good health advice, but sometimes it’s not that simple for families and kids to follow through. Too many kids and families live in areas where going outside isn’t safe, there aren’t any good outdoor play areas nearby, or they can’t afford outdoor recreation programs.

This is where advocacy comes into play! There are many ways in which pediatric care providers and other healthcare professionals can advocate for more and better outdoor play and exercise options for kids and families. Below are resources that may be useful.

Now get out there and start playing!

Connect Children and Families with Nature

Program: Children and Nature Initiative
Organization: National Environmental Education Foundation
Website: Click Here
Description: Training for healthcare providers on “prescribing nature” and on connecting families to natural areas.

Program: Grow Outside: Tools and Resources for Pediatricians
Organization: Children and Nature Networks
Website: Click Here
Description: Links to “nature prescriptions” and sample educational materials, plus information for pediatricians.

Create Affordable, Accessible Outdoor Play/Exercise Options

Organization: KaBoom!
Website: Click Here
Description: A national organization that helps communities build playgrounds.

Program: RecreationRx
Organization: San Diego County Parks and Recreation Department
Website: Click Here
Description: A California program that allows doctors to prescribe recreation and link patients to low-cost recreation options.

Program: Portland Play
Organization: Oregon Parks and Recreation Department
Website: Click Here
Description: A program in the greater Portland metropolitan area that enables pediatricians to connect families with parks and recreation programs.

Program: Make Way for Play
Organization: Healthy Places (an initiative of Healthy Chicago)
Website: Click Here
Description: A Chicago collaborative program striving to make parks more accessible to local residents.

Program: Park Prescriptions
Organization: Institute at the Golden Gate
Website: Click Here
Description: A movement to create a healthier population by strengthening the connection between the healthcare system and public lands across the country.

Advocate for Outdoor Safety

Program: Walking School Bus
Organization: Partnership for a Walkable America
Website: Click Here
Description: This program promotes kids walking and biking safely to school with parents or other adults supervising.

Program: Bicycle Helmet Program
Organization: Bicycle Helmet Safety Institute
Website: Click Here
Description: Information on how to create and implement bicycle helmet programs, providing affordable helmets to patients.

Program: Interactive Demonstrations of Safe Play Areas
Organization: National Children’s Center for Rural and Agricultural Health and Safety
Website: Click Here
Description: For those in rural areas, safe play area demonstrations for farm families can promote active, safe outdoor play areas for kids. This guide outlines how to hold demonstrations.

Program: Safe at Play
Organization: Injury Free Coalition for Kids of Chicago
Website: Click Here
Description: This group, based at Children’s Memorial Hospital in Chicago, helps community organizations build and renovate playgrounds. The coalition is also involved in evaluating playground safety, through playground safety checks and other activities.


  1. Ginsburg KR, Milteer RM, et al. “The Importance of Play in Promoting Healthy Child Development and Maintaining Strong Parent-Child Bond: Focus on Children in Poverty.” Pediatrics Vol. 129 No. 1, January 1, 2012, pp. e204 -e213.

  2. CDC Overweight and Obesity. “Childhood Overweight and Obesity: A Growing Problem.”

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Healthy Kids  General Childhood Obesity 

Thursday, April 5th, 2012

The Importance of Advocating for Supportive Breastfeeding Policies

Posted by: Kristi Fossum Jones, MPH

Historically, the decision to breastfeed has primarily been between mothers, infants, and—sometimes—doctors. But increasing evidence suggests that, even if a mother wishes to breastfeed her infant, the current healthcare system does not always provide the resources, policies, and knowledge to support her. According to a 2011 Vital Signs report published by the CDC, “less than 4 percent of U.S. hospitals provide the full range of support mothers need to be able to breastfeed.”1

And this issue isn’t isolated to primary care providers. In its most recent policy statement, the American Academy of Pediatrics (AAP) wrote that “Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice.”2 Breastfeeding has been shown to have a wide array of health benefits for both baby and mom, from lowering the infant’s risk of developing diabetes and ear infections to lowering the mother’s risk of developing breast and ovarian cancers.1 But while most infants start off breastfeeding in the US, within the first week half have already been given formula; and by 9 months, only 31% of babies are breastfeeding at all.1 And low rates of breastfeeding add $2.2 billion a year to medical costs.1

Breastfeeding targets were included in the Healthy People 2010 goals set forth by the US Department of Health and Human Services. But despite this effort to promote the importance of breastfeeding as both a public health and personal health issue, the 2010 targets for breastfeeding duration and exclusivity were not reached. Breastfeeding was again added as part of the Healthy People 2020 goals, but without changes to the current healthcare system we might not achieve those targets, either.

That’s why organizations such as the Baby-Friendly Hospital Initiative and NICHQ offer programs designed not just to reach individual mothers, but to make health systems more supportive of breastfeeding. 

What does this have to do with childhood obesity and policy advocacy? Some research indicates that breastfeeding reduces the risk of childhood (and adult) obesity. In 2007, the US Agency for Healthcare Research and Quality (AHRQ) did a meta-analysis of studies on the health benefits of breastfeeding—including studies on breastfeeding and obesity.3 AHRQ’s analysis demonstrated that breastfed infants showed reduced risks of obesity and type 2 diabetes later in their lives, and that duration of breastfeeding is inversely related to the risk of developing obesity. The array of health benefits for mom and baby both is what makes supporting breastfeeding policies  a worthwhile focus for healthcare professional advocates.

Breastfeeding policy advocacy can happen on many levels, as outlined in the AAP’s Obesity Policy Opportunities Matrix:

  • In the maternity, delivery, and post-partum areas, healthcare providers can encourage and support new mothers as they learn to breastfeed. 
  • If implemented at the institutional level, Hospital Breastfeeding Policies can help ensure that all healthcare providers and staff follow the same breastfeeding protocols and distribute consistent, accurate information about breastfeeding.
  • Systems-level change can include supporting and implementing the10 Steps to Successful Breastfeeding across a hospital. For instance, NICHQ’s Best Fed Beginnings initiative will facilitate hospital participation in a learning collaborative to make institutional changes with the ultimate goal of becoming a designated Baby-Friendly hospital through Baby-Friendly USA.
  • In OB and pediatric offices, healthcare providers seeing pregnant mothers and newborns can provide individual encouragement as well as more tangible support like lactation areas for nursing mothers. And instead of handing out formula samples and coupons to expecting or new mothers, healthcare providers could distribute information about breastfeeding support groups and resources in the community.
  • Outside of healthcare settings, healthcare professional advocates can use tools like The Business Case for Breastfeeding to educate employers on the economic benefits of supporting lactating mothers in workplaces to increase employee retention after childbirth.
  • State-level advocacy provides opportunities to focus on state laws and policies related to breastfeeding, i.e. lactation areas in public places. 
  • At the federal level, the Affordable Care Act requires employers to provide space and reasonable break time for working women to express breast milk, which may open new doors for successful breastfeeding policy advocacy.  

Healthcare professional advocates working on childhood obesity have a plethora of possible focus areas. Breastfeeding is a crucial one because it offers so many health benefits to mothers and babies alike, and it is something that most mothers—regardless of race or socioeconomic status—can do for their infant with support. Healthcare professionals are positioned to provide that support as well as advocate that it be provided in workplaces and in the community. They can be credible and effective breastfeeding advocates because they work with mothers and infants from birth onwards; they have the relationships with patients and families to provide individual support; and they possess the knowledge and the resources to advocate for broader policies to support breastfeeding.

>> For more information about NICHQ's breastfeeding projects, go here.

>> For more information about NICHQ's Best Fed Beginnings initiative, go here.

1. CDC Vital Signs. “Hospital Support for Breastfeeding.” August 2011.
2. AAP Policy Statement. “Breastfeeding and the Use of Human Milk.” Pediatrics Vol. 129 No. 3 March 1, 2012 pp. e827 -e841.
3. Lau, Joseph et al. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Rockville (MD): Agency for Healthcare Research and Quality (US); April 2007.

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General Childhood Obesity