This year has been filled with unprecedented challenges – physically, mentally, financially – and families are looking forward to putting 2020 behind them. As we collectively usher in a new year, it’s an opportune time to think about small changes we can make to better children’s health in 2021.

Dr. Pooja Tandon, a researcher in the Center for Child Health, Behavior and Development, says this year has caused all kinds of disruptions to children’s lives, unlike anything we’ve seen before. Routines have been shattered, physical activity has decreased, sleep has been affected and the hardships of the year like uncertainty and isolation have impacted children’s mental health.

“Many things are hard right now,” Tandon said. “But for the things we have control over, we can make little changes that can promote health.”

Below, three experts break down three key areas to help support better health in 2021 – physical activity, sleep and nutrition.

Physical health

When schools shuttered, it didn’t just affect children’s ability to learn in a classroom, the closures also affected opportunities for physical activity.

“When schools closed, recess and school-related sports stopped, which for some children may be their only or main source of daily physical activity,” Tandon said. “We know kids need 60 minutes of physical activity every day. When it’s not happening at school, kids are left to whatever is possible in the context of their families, neighborhoods, communities, or socioeconomic circumstance.”

Tandon says the pandemic has also disproportionately affected underserved and under-resourced children.

“It’s really important for children to move every day. Today, children are spending more time indoors and on screens,” she said. “The lack of sufficient physical activity sets them up for all kinds of physical and mental health challenges, and some children are disproportionately burdened by that. I think the pandemic has magnified the importance and need for physical activity. It highlights how challenging access can be and how essential schools are to providing those opportunities.”

As a scientist, pediatrician and mother, these issues worry Tandon, and much of her research centers on how children can increase physical activity in fun and attainable ways. Getting outdoors is one such example.

According to the World Health Organization (WHO), children and adolescents ages 5 – 17 need a minimum of 60 minutes of moderate to vigorous physical activity a day. Preschoolers need lots of active play time. For this age, the goal is at least 2 hours (120 minutes) of active play each day. Exercise can help protect against cardiovascular disease, diabetes, depression and anxiety, as well as improve sleep and cognition.

“We are intentionally focusing on how to do physical activity safely in the context of COVID. Families can think about what physical activities are possible for them. Whether that’s taking a virtual class, using equipment they already have or can easily acquire, and getting outdoors, are all good steps. Being outdoors is one of those ways because you’re removing one layer of risk related to greater risk of virus transmission indoors,” she said.

Tandon believes even as the cold winter months approach, getting outdoors is a great way to promote physical health. Below, she’s compiled a list of things families can do together outdoors.

Go on a nature walk

Exploring the outdoors, whether it’s a park, neighborhood or garden can be done with proper social distancing. Tandon said her family likes to go on scavenger hunts.

“You can create a list of items to find in the neighborhood or natural environment,” Tandon said. “For Halloween, we found spiders and other decorative items.”

Search for plants, animals or other items. Each scavenger hunt can be a unique adventure.

Make nature sculptures

Use twigs, leaves, rocks or other collected items from nature to make sculptures. Tandon says it’s a great way to encourage motor skills.

Bike, walk or hike as a family

Find a hike or explore a new park with your family. Tandon says it’s fun to explore your local neighborhood, but sometimes going just outside the city can feel like a big adventure as well.

Not just mixing up the locations you go, but also the environment, is a great way to promote physical activity. Go on a night walk with glow sticks and flashlights (in a location you feel safe) or bring out rain gear for a rain walk.

“The novelty of using an umbrella and putting on your boots and walking in the rain can be a fun experience,” Tandon said.

Take story time outdoors

Families may need to bundle up if temperatures drop, but by choosing appropriate clothing, many activities can migrate outdoors.

Play with sidewalk chalk

Sidewalk chalk is a great way to express creativity and play outdoors.

Snow play

“Help set kids up for success by thinking about ways to overcome the weather barriers,” Tandon said. “It’s about being warm and dry, and doing physical activity for the amount of time that is fun and comfortable for everyone involved.”

The American Academy of Pediatrics (AAP) offers more great ways to get active at any age.

Small changes for better health

Tandon says she’s seen an increase in weight gain and mental health issues in children.

“There are clearly physical health challenges, but there are also mental health components that seem to be related to the pandemic,” Tandon said. “They are hard to disentangle. We’ve seen l mental health issues increase – anxiety, depression. Even if they aren’t meeting official criteria for depression, children are feeling isolated or are struggling in school. I think that finding ways for kids to be more active and be outdoors can be one part of the solution for both physical and mental health issues.”

Small changes can make a big difference according to Tandon.

“I don’t want to add more burden to families,” she said. “Get children involved in coming up with solutions that will help get everybody moving.”

Tandon says it could be as simple as incorporating a walk at the end of the day, climbing stairs between virtual classes, or even jumping jacks during commercial breaks when watching TV.

Steps toward better sleep

Dr. Michelle Garrison, a researcher in the Center for Child Health, Behavior and Development, says sleep has also been greatly impacted by changes incurred due to the pandemic, but there are small steps families can take to get back on track.

In 2021, Garrison says there are a few areas families should focus on to help children get better sleep.

She says for preschool aged children, it’s important to get at least 11 hours of sleep a day, and consistency is just as important as the amount of sleep a child gets.

“One of the things we are seeing, not surprisingly, is that families are being affected differently,” Garrison said. “Some children are getting more sleep, some children are not getting enough sleep, some children’s sleep schedules have shifted, and many families are struggling.”

All children need sleep. It’s important for growth and development and hormonal regulation.

“We know sleep has a huge impact on our ability to deal with challenging emotions,” Garrison said. “This is a time where we’re all dealing with extra stress. Having an extra boost of sleep to cope with emotional regulation challenges is really helpful. Sleep also has a big impact on how our immune system responds to certain things. When we don’t get enough sleep, we can be in a chronic state of inflammation, making us more vulnerable to infections. Sleep also can have an impact on growth and obesity.”

According to Garrison, an increase in 20 minutes a night can be incredibly beneficial – even if that means a child still won’t be reaching the recommended amount of sleep for their age, small improvements still pay off. She says that parents should try to keep bedtime within the same hour timeframe each night. Aim for consistency.

“Parents are exhausted right now, too, especially as it gets close to bedtime. We may not have the same end of the day parenting capacity that we did a year ago,” Garrison said.

“And that’s okay. For some families, the bedtime routine that worked great a year ago may be too ambitious for right now. Instead of beating ourselves up, let’s simplify bedtime routines. Kids do not need complicated bedtime routines. Find something that is calming for your child, but that is feasible for you as a parent to stick with every night without it being a source of extra stress. It can be parent-child foot massages or sitting on the floor to do some stretching exercises together. My child and I listen to really slow music, and we move our bodies really slowly. It brings his body to a more calming place. Find what works for you.”

Garrison says that shifting other aspects of your routine may help make bedtime easier.

“We’ve shifted our ‘big family meal together’ to breakfast,” she said. “Most of our dinners are things we can have on the table under 10 minutes, like making your own veggie pizzas in the toaster oven or lentil quesadillas in the microwave.”

For her family, that shift has made a big impact. An intricate meal at night wasn’t feasible to squeeze in between a long day of work plus homeschooling on one side and the early bedtime her child needed on the other, and so they changed their routine to better fit into their life. As a single parent of a 5-year-old, she found having a simpler evening was a huge help.

Bedtime routines

When making changes to bedtime rules, schedules, or routines, Garrison recommends not making too many big changes all at once, and to not give up too quickly when trying something new.

“It’s really common to get really frustrated and shift course before the benefits of the change have had a chance to kick in,” Garrison said. “It is really common for there to be some bumps where things seem harder at first with a change, and then it starts to smooth out – and so once you’ve made a change, hold it consistent for about two weeks. Then take stock and think about what is working for your family and what small change you might want to make next.”

If your family is trying to get children to bed at an earlier time, don’t abruptly and drastically make the shift. Garrison advises parents to move bedtime by 15 minutes every few days, so the child’s body clock has enough time to shift as well.

“Some families have found it helpful to set an alarm for when to start the bedtime routine instead of for bedtime itself,” Garrison said. “If you’re aiming to get your children in bed by 7:30 p.m., try setting an alarm at 6:45 p.m. That way families have a reminder that tells them when it’s time to start winding down, and don’t feel rushed trying to squeeze in the bedtime routine.”

Limiting screen time

Many schools have shifted to online learning, and so children are using media much more. Physical activity has decreased while media use has exponentially increased. Many children are spending up to eight hours a day in virtual school and then more hours on screens to socially connect with friends and family or playing video games at night.

Garrison says it’s important to limit screen time an hour before bed.

“The blue light emitted by screens can throw off melatonin and have a negative impact on sleep,” she said.

Many people assume children are relaxed watching screens because they are quiet and seem to zone out, but according to Garrison, their minds can be running quickly to keep up with the video or game. “When that happens,” Garrison said, “they can feel so pulled in that they aren’t noticing when they are tired (or even when a parent calls to them from across the room!), and they can have a hard time calming down enough mentally for sleep.”

Most importantly, Garrison says it’s important to create a bedtime routine that is truly feasible for your unique lifestyle, and to make changes that will be attainable.

“Be consistent, make sure children are getting an adequate amount of sleep and limit screen time before bed,” Garrison said.

That’s a good recipe for better sleep and a healthier 2021.

Healthier eating in the new year

Phuong Truong, a clinical dietitian at Seattle Children’s Odessa Brown Children’s Clinic (OBCC), helps under-resourced families and children with myriad issues from failure to thrive, lactation, obesity and more. One area that has been especially impactful this year is an area in which she’s passionate: food insecurity.

She said since the pandemic began, she’s seen an increase in families without enough access to food, children overeating, families feeling strained, inactivity and stress.

“It’s the perfect storm to create weight problems,” said Truong.

Truong wants families to know she is here for them however they may need help. Beyond providing thoughtful and compassionate dietary advice, she helps families with other needs as well, like making sure they have enough diapers.

“I’m here to help take some stress off of your shoulders,” she said. “It’s heartbreaking to see families in need. Many of my conversations with families start not by asking what is in the three meals they are eating a day, but if they are getting three meals a day.”

What fulfills Truong is finding solutions to make the lives of the families she serves easier. She wants them to know she is in their corner, advocating for them, supporting them and cheering them on.

Eating a balanced diet

According to Truong, eating three meals a day is important, so above and beyond helping to ensure they are getting three meals a day, she also helps them understand food using a simple analogy.

“We are all different sizes and different shapes. We’re all beautiful,” said Truong. “Nutrition is the fuel. We are like cars. Food helps keep our cars running, but some fuel is better than others. Together, we find things that will work and focus on what’s most important. What’s inside matters. If people feel good, they will feel better inside and out. The kid is the driver, the parent is in the passenger seat; I’m just the navigator. I’m not there to tell them what to do or what not to do, I’m here to help.”

Truong advises families to try to eat a balanced diet, incorporating protein, whole grains, starch, fruits and vegetables.

She recommends beans and lentils, peanut butter, canned vegetables and frozen vegetables to help stretch budgets.

For fun ways to incorporate frozen vegetables into a family’s diet, she recommends recipes like macaroni and cheese broccoli. Not only is the recipe budget friendly, but it incorporates vegetables.

Truong says she, like many other providers at Seattle Children’s, has seen an increase in children who are overeating and not being active. Truong advises to get children involved in the kitchen. It helps them understand the food they are eating and also can help make them feel accomplished and more likely to eat the foods they create.

“Kids can help meal plan or prepare foods in the kitchen,” she said. “Give them a little task like sorting vegetables. Kids love helping.”

There are many helpful websites that families can peruse for inspiration, like recipes from ChooseMyPlate.

As the pandemic continues and families continue to be burdened financially, physically and emotionally, Truong says it’s important to be able to find resources to help.

“We’re all in this together,” she said.

Resources for families in need

Truong wears many hats at OBCC and in the community. In March, in response to the disruption of a bi-monthly pop-up food bank at OBCC, the community team (community care coordinators, social workers and dietitian) started a “mobile food bank”.  The team helped provide food to families in clinic, but they also delivered food to families in the community – more than 1,800 bags of food since March.

“We will continue for as long as we’re needed,” said Truong.

Below are additional food resources for families in need of food.

Food Resources

Meals for Children and Teens

Washington State Food Resources

  • Food Lifeline – Find local food banks in Washington state.
  • Washington 211 – For information on free meals and food pantries, call 2-1-1.
  • Parent Help 123 – Find local food resources and other information on support in Washington state.

King County