Stay healthy at home by establishing structure

This blog was written by Morgan Chojnacki, DNP, APRN, CPNP-PC, who works at the Adolescent Medicine Clinic. 

As a community and larger world, we are all learning how to adapt to disruptive changes to our routines and activities.  As Kentuckians, we proudly social distance for the greater good. This is noble, but it does come with complex emotions and feelings of loss. Allow yourself some time to grieve that loss. It is real, and it is hard, no matter what your story is. When you’re ready, come with me and explore some ways to find your new routine for establishing healthy behaviors at home.

As a pediatric nurse practitioner in primary care, one of my greatest joys is getting to brainstorm with families about ways they can keep their children safe and healthy. I find that often times when a healthy behavior is not happening, it is NOT because people don’t want to do it or they don’t know how. It is because we lack routine and/or resources to support the healthy behavior. Indeed, research shows engaging in appropriately timed behavioral routines that follow circadian rhythms may lead to healthier outcomes regarding nutrition and heart health. Longer sleep duration has also been shown to decrease weight gain in children and adults. And many children struggle with weight gain when school structure is lost during the summer. So, we begin by reintroducing the structure.

Start with structure

You’re going to need a calendar. You and your family need to sit down and discuss what work and school looks like for all in your household. Save yourself some worry: don’t plan more than 2 weeks in advance because it is likely to change again after that! Discuss what hours people will need to be at work (either in home or elsewhere) and who will be in charge of the kids at what time. School-aged children and adolescents need to be part of this conversation to get their buy-in. Yes, you need to engage them for this to work. If they help decide when they do school work, getting them to do NTI packets will be easier. Once you have listed times you need to work, then you can add in times for fun and physical activity. Establish the following in your discussion:

1. Wake up times.
2. Who will make meals.
3. Who is working/doing school work, and when.
4. Ground rules for screen time.
5. A general daily structure with times.
6. Bedtimes.

Increasing activity at home

Identify free times. Pick two 30-minute time slots you could use for family or individual activity time. To establish some creative ideas, make a one-pager.  After dinner one night this week, give each family member a piece of paper and some coloring utensils. Creatively fill the page up with ways you’d like to stay active in and around your home.  Use pictures, words, and phrases to illustrate how you’ll do this. Share the ideas with each other, and post your papers in a spot that is easily visible. Here’s some ideas by age range to include on your one-pager:

Infants

• Encourage infants to cruise around furniture or crawl/walk to get interesting toys.
• Go for a walk while baby wearing or pushing baby in the stroller—this adds good resistance for the person who is carrying. Do some lunges on your walk being mindful of your new center of gravity.

Toddlers/Preschoolers

• Create an indoor obstacle course with toys, blankets, and furniture.
• Throw the ball for the family dog with observation.
• Bring a favorite book to life: Go on a Bear Hunt in your home or neighborhood, Chicka Chicka Boom Boom up and down the stairs, swim around the room with The Rainbow Fish.

Adolescent/Young adult

• Go for a walk or run.
• Access a free high intensity interval training (HIIT) class on YouTube.
• Foam gun war! Divide the family into teams and keep score. If there is a winner who gets bragging rights, your school-aged children will need that victory!
• Play sports such as baseball, lacrosse, soccer, basketball, football or more. 
• Download and try out free training apps like Couch to 5K, Nike Train or MapMyRun.
• Do yard work at your own home, and at neighbors’ homes who might need help such as healthcare providers, grocery store and pharmacy workers, other essential workers, older adults, and more. Now’s the time to support these people, and you can start with the person closest to you, your neighbor.
• Organize support for family or friends who have lost income by charging neighbors for yard work or house projects. Remember to maintain social distancing. We can help take care of each other.

All

• Go for a bike ride.
• Have a dance party in the living room.
• Jump rope.
• Play broom ball inside or out (push a ball into a makeshift goal using a broom).

Increasing intake of healthy foods

Start with the 5-2-1-0 plan!

Encourage your family to do the following each day:

• Eat five servings fruits and vegetables.
• Limit screen time to two hours or less.
• Be active for one or more hours.
• Drink zero sugar-sweetened beverages (soda, sports drinks or sweet tea, for example).

Make healthy choices easy to grab

Buy some fresh fruits and veggies at your next grocery trip, and right when you get home, wash them and cut them up/store them in snack size portions. Pair them with a protein such as nuts, nut butters (sunflower seed butter for allergies), hummus, string cheese, cottage cheese, Greek yogurt (low sugar), nut bars, etc. Make them easily accessible in lower fridge drawers for younger children. And make unhealthy snacks less visible and/or less plentiful in the home.

Plant a family garden

Research has shown involvement in community or home gardening can increase intake of fresh fruits and veggies in people of all ages. Purchase seeds and top soil from a local store (seeds are $2 per packet, and two bags of top soil are just $5) during your next grocery trip. Spread each type of seed out on a wet paper towel, fold the towels into fourths, and place each in a separate plastic baggie. Label them with which seed is where so you don’t forget. Hang them in a sunny window for 1-3 weeks and watch them sprout! Turn this into a science project for Pre-K and school-aged children using journaling and hypotheses about how quickly the seeds will sprout and what they will look like. When they’ve sprouted enough to stand up in dirt, carefully remove them from the paper towel and plant each seedling in its own space of dirt. Short on cash? You can use coffee cans or milk jugs cut in half (with holes poked in the bottom for draining) for pots.

Encouraging a healthy relationship with food, even in times of stress

Teach children to enjoy all foods in moderation, and don’t make any foods "off limits." Vilifying foods will increase the child’s drive for the unhealthy foods. When talking about the health of foods, avoid numbers and talk of calories.  Instead, focus on what the foods can do for your body. For example: For a preschooler, encourage them to eat protein so it will make them strong like mommy (let me see your muscles!), grains so they can run fast like their favorite cartoon character, and fruits and veggies to make them super smart like their favorite book character.

And parents, if you love your own body, your kiddos will love theirs. Sadly, the opposite is true as well. Negative self-talk modeled by parents about their own bodies can effect children’s body images starting at just 2-3 years of age.  Identify how your eating habits change in times of stress and worry. When those feelings pop up and you reach for comfort foods, try a new habit. Deep breathing, going for a walk, reading a book, doing a 2-3 minute mindfulness exercise on your phone or just simply going to bed on time can help you reset. 

But I am well aware stress, anxiety and depression are at peak levels right now, and you may need help dissecting complex emotions and food behaviors intertwined with them. Reach out to a therapist well-versed in disordered eating, and if you don’t know one, your medical provider may be able to help you. Many are offering TeleCare services to help ease access in these socially distanced times.

Be sure to check in on your kiddos’ mental health too. Ask school agers and adolescents open ended questions, and stick to direct questions for younger children. UK Healthcare’s Adolescent Medicine Clinic can help you facilitate these conversations. Our medical providers offer a complete assessment of a patients’ wellbeing, including physical and mental health needs. Patients in need of additional support are encouraged to consider mental health counseling. Our medical providers can match your child with a member of our Adolescent Medicine team for counseling. If you have a child who is between 10-19 years old and would to set up a TeleCare appointment, call 859-323-5643.

Know that whatever you are working towards in this dynamic environment, you are doing the best that you can. Give yourself some grace, and allow yourself to recharge when needed. Start with structure, and make small changes toward a healthier lifestyle for you and your family.