A multidisciplinary team within Norton Children’s Heart Institute, affiliated with the UofL School of Medicine, worked together to save the life of an infant born with congenital structural heart defects and complete atrioventricular block (CCAVB) that led to a slow heart rate. The patient was too small for the traditional path of care, driving the innovative team to perform the first known human implantation of a novel-designed tiny pacemaker in a premature infant.

“It is remarkable how our team of pediatric specialists came together with the device company to offer a resolution for such a small patient weighing less than three pounds at the time of implant,” said Soham Dasgupta, M.D., pediatric electrophysiologist, Norton Children’s Heart Institute, and UofL assistant professor of pediatric cardiology. “This case is unlike any other and we are so pleased to see this patient thriving as a result of the innovative approach.”

Approximately 1 in 22,000 infants are born with CCAVB. Untreated, the condition has a high incidence of prolonged illness or death. The usual treatment involves implantation of a pacemaker once the patient meets a minimum body size, typically 4 1/2 to 5 1/2 pounds, to accommodate the implantable device. Taking time for the baby to grow while being otherwise treated is strongly preferred for this situation. With this patient, however, the traditional plan was not working.

“In this instance, the patient was not of the optimal size and medical/conservative management was unsuccessful, so a specially modified pediatric-sized pacemaker also known as an implantable pulse generator (IPG) created by Medtronic was used,” Dasgupta said.

Dasgupta and his colleague, Christopher L. Johnsrude, M.D., director of pediatric and adult congenital electrophysiology at Norton and UofL associate professor of pediatric cardiology, reviewed the relevant preclinical data from a procedure where a similar tiny pediatric IPG had been implanted in an adult Yucatan miniature pig, an animal with a heart that resembles a child’s heart.

Once it was determined the pediatric IPG was potentially compatible with the patient at Norton Children’s, Dasgupta worked with Norton Children’s Research Institute, affiliated with the UofL School of Medicine, and the manufacturer, to obtain local Institutional Review Board approval and emergency authorization from the U.S. Food and Drug Administration. 

The procedure to place the implant was completed over the course of a two-hour open-heart surgery. The tiny device measures 1.16 by 0.65 by 0.38 inches and weighs 0.18 ounces.

“While the operative steps might be comparable to the usual pacemaker implantation surgery, this surgery was especially delicate due to the very small size of the baby,” said Bahaaldin Alsoufi, M.D., chief of pediatric cardiothoracic surgery, co-director of Norton Children’s Heart Institute, and UofL professor of cardiothoracic surgery. “This tiny pacemaker generator was positioned in the abdominal wall on the right side and was connected to the usual leads that were attached to the heart.

"This novel device will provide the necessary support that the baby currently needs. At time of repair of the patient’s congenital heart defect in the future, we will be able to utilize these same leads and likely connect them then to a traditional larger pacemaker generator.”

To date, the patient is doing well and continues to be cared for by cardiac and neonatal specialists across Norton Children’s Heart Institute.

For the past 25 years, Greg Barnes has worked with thousands of families to help diagnose, adapt to and overcome autism. Autism is personal to Barnes, whose son, Joshua, was diagnosed with the condition as a young child.

It was clear to Barnes, a pediatric neurologist with the UofL School of Medicine who is director of the UofL Autism Center, affiliated with the Norton Children's Autism Center, and his wife, Kay, that something was off when Joshua was a baby.

“He did not sleep at all, so he already had a sleeping disorder, which occurs in 60% of patients with autism,” Barnes said. “Secondly, very early on, besides speech delay, in the speech that he did have, he manifested what’s called a restricted interest.”

Restricted interest is a characteristic symptom where the child gets fixated on something they can’t shake.

Joshua was diagnosed with autism at age 4, when Barnes was in Massachusetts as a physician resident at Boston Children’s Hospital and Harvard Medical School in 1997. At the time, he was completing a fellowship for advanced training in epilepsy.

“When I was in medical school, I’d never even heard of the term 'autism spectrum disorders,'” he said. “There was so little information then.”

“The only thing you knew of autism was ‘Rain Man’ with Dustin Hoffman,” Kay said, in reference to the 1988 film. “It was extremely hard because it’s a world in which the normal learning process is nonexistent. Your child doesn’t play with other children — they might just hit them, or push them away, or take something away from them. Having a child with autism feels very isolating.”

Using personal experience to help patients

As time went on, Barnes found himself seeing autism patients in addition to epilepsy cases. His personal journey allowed him to connect to the families. Before he knew it, Barnes was treating more autism cases than anything else. He was then asked to serve as a member of the Autism Speaks Autism Treatment Network.

“From a professional standpoint, I saw this as an opportunity to use my knowledge to contribute to the disease that my son had,” he said.

For the past seven years, Barnes has treated autism patients through Norton Children’s and the University of Louisville School of Medicine. He said his ability to relate to his patients and their families is very beneficial.

“You can look a family right in the eye, no matter whether you’re in the clinic or when you’re on Zoom, and say, ‘I have a 27-year-old son with autism.’ Then all of a sudden there’s this huge sigh of relief, sometimes audible, but certainly it’s on their face, of, ‘You know what I’ve been through,’” he said.

It also helps him develop a plan for care.

“I have always told people that having Joshua gives me an enormous advantage,” Barnes said. “I know the questions to ask. Also, parents aren’t afraid to tell me what’s really going on, so I get a better, more accurate history. Being able to take what I’ve learned from my own situation has been an enormous contribution to the care of my autism families.”

Advancements in autism treatment

When Joshua first was diagnosed, there were few therapies and services for autism. Fortunately, those options are growing.

“We’re looking at using machine learning and artificial intelligence to be able to diagnose autism,” Barnes said, “mainly to diagnose autism from a MRI scan, but also to be able to develop better treatment options from both behavioral data as well as genetic data.”

According to Barnes, treating autism also requires an approach that brings in specialist providers from many fields.

“Every single case of autism is different,” he said. “I think the major thing that’s in the future for treatment is using combination therapies. That includes trying to figure out the right combination of medications, behavioral therapy interventions or occupational therapy interventions, and speech therapy interventions.”

Hope for the future

Joshua continues to seek treatment for his autism, but he’s come a long way. He has a job through a UPS program for people with cognitive mental disabilities and spends his spare time playing video games, reading his Bible, and talking on the phone or Skype. He’s also learning some important life skills, like cooking and cleaning.

“Our dreams are the same as many autism families,” Barnes said. “We want our son to do well and be happy. It’s a daily challenge, but we see progress all the time. My goal is to help Joshua and all my patients live the best lives they can.”

Kay agreed.

“We hope that at some point Joshua will be able to live on his own, with support,” she said. “It’s important for us to know that he’ll be OK when we’re not around anymore.”

Current year’s support of over $1 million continues funding for children’s health

A relationship begun nearly 40 years ago is still going strong.

Since 1982, Kosair Charities has been a solidly dependable supporter of children’s health programs at the University of Louisville. This year, total donations have reached more than $50.4 million.

Moving the total past the $50 million mark this year is over $1 million in funding from the charity – the largest in Kentuckiana – to support programs in pediatric forensic medicine, neuro-recovery and cancer research along with the Center for Women & Infants at UofL Hospital.

“Kosair Charities has made immeasurable contributions to the University of Louisville, this community and beyond. I believe what makes a partnership great is a shared vision. And that is certainly the case with Kosair Charities and UofL,” said UofL President Neeli Bendapudi. “Kosair Charities has given to so many areas across the University of Louisville, and the impact can be felt far and wide throughout our community, region and beyond.”

“Louisville is my home, UofL my school, and Kosair Charities is my passion. It is special to be able to pull it all together to help children move forward,” said Keith Inman, president of Kosair Charities. “For almost 100 years Kosair Charities has had one mission, one focus, and that is for children to overcome their obstacles and reach their full potential. For 38 of those years, the University of Louisville has been an important partner, as we have invested in research, programs, facilities and people at the university who can make that vision, that mission a reality.”

The support is as important to UofL for its consistency as much the dollars donated, said UofL Vice President for Advancement Jasmine Farrier. “All philanthropic gifts are impactful, but this level of extraordinary support given consistently over decades is truly transformational,” Farrier said. “We are so fortunate to have Kosair Charities’ commitment to our children’s health programs.”

Recent gifts made by Kosair Charities to the university have helped fund:

• UofL Kosair Charities Division of Pediatric Forensic Medicine: Led by Dr. Melissa Currie, the first board-certified child abuse pediatrician in Kentucky, this division focuses on physical, mental and sexual abuse and neglect in children.
• Kosair Charities Center for Pediatric NeuroRecovery: The gift from Kosair Charities targets paralysis in children with acute flaccid myelitis (AFM), a disease that affects the area of the spinal cord called gray matter, causing the muscles and reflexes in the body to become weak. Although occurrences are relatively rare, cases of AFM have been on a steady increase since 2014.
• Kosair Charities UofL Brown Cancer Center Pediatric Cancer Research: Drawing upon the strengths of researchers and physicians in the UofL Health – Brown Cancer Center, this program applies immunotherapy – the use of the patient’s own immune system – to fight children’s cancer.
• UofL Hospital’s Center for Women & Infants: Kosair Charities funding enables the center to purchase upgraded infant warmers for its cutting-edge Neonatal Intensive Care Unit that cares for the tiniest and most vulnerable newborns.

#WeAreUofL

About Kosair Charities: Since 1923, Kosair Charities has helped children reach their potential while overcoming obstacles. Kosair Charities enhances the health and well-being of children by delivering financial support for health care, research, education, social services  and child advocacy. We envision a world in which children in need live life to the fullest. For more information, please visit kosair.org.

Department of Pediatrics' academic researchers Kyle Brothers, MD, PhD, Deborah Winders-Davis, PhD, and Margaret Calvery, PhD will join Department of Neurological Surgery colleague Andrea Behrman, PhD to host Reeves Summit panel session titled "Recovery of Children with SCI through Interview with Caregivers"  Apriul 27 - 29, 2021.

Kyle Brothers, MD, PhD
Division Chief, Pediatrics Clinical and Translational Research

Margaret Calvery, PhD
Associate Professor, Developmental and Behavioral Pediatrics

Deborah Winders Davis, PhD
Director, Child & Adolescent Health Research Design and Support Unit

As e-cigarette use increases among teenagers, it’s important for parents and caregivers to know the associated risks and what they can do to foster healthy habits in their children.

Although the liquid used in e-cigarettes does not include tobacco, it contains nicotine, which is highly addictive and poses dangers to children, said Heather Felton, M.D., medical director of the UofL Pediatrics – Sam Swope Kosair Charities Centre.

“Nicotine raises blood pressure and spikes adrenaline, thus increasing heart rate and the likelihood of having a heart attack,” Felton said. “It also can harm a child’s developing brain and parts of the brain that control attention, learning, mood and impulse control.”

The amount of nicotine in vaping liquids can vary among brands, but many contain more nicotine than a traditional cigarette. For instance, a single JUUL pod contains as much nicotine as a pack of 20 regular cigarettes, Felton said. The liquid can be a poison when swallowed or absorbed through skin or eyes. Also, vaping often leads to traditional tobacco product use.

What parents can do:

• Set a good example by being tobacco-free.
• Talk to your child about vaping and the risks of use.
• Seek help from your child’s physician to explain to your child the health risks of vaping.
• Encourage teachers and administrators at your child’s school to enforce tobacco-free policies.

The three UofL Physicians – General Pediatrics clinics have earned Patient-Centered Medical Home (PCMH) designation by the National Committee for Quality Assurance.

PCMH recognizes primary care practices with a team-based health care delivery model that provide comprehensive care to patients and are dedicated to continuous quality improvement for health outcomes. Designated practices put patients at the forefront and create strong relationships between patients and their clinical care teams.

Research shows that PCMHs improve quality, the patient experience and staff satisfaction while reducing health care costs, according to the National Committee for Quality Assurance.

“We’ve changed policies, procedures and day-to-day functioning to accommodate patients in every way we can,” said Melissa Hancock, M.D., UofL division director of general pediatrics. “All of our providers and staff are invested in our patients’ primary care. This is where they’re going to get their comprehensive health care needs met.”

UofL Physicians – General Pediatrics has clinics at the Novak Center for Children’s Health in downtown, Sam Swope Kosair Charities Centre on Eastern Parkway and on Stonestreet Road in southwest Louisville.

The University of Louisville School of Medicine, UofL Physicians – Pediatrics and Norton Healthcare today announced they have signed a non-binding Letter of Intent (LOI) to create a new pediatric affiliation. 

The LOI allows the organizations to explore a more meaningful partnership as the organizations work toward a definitive agreement later this summer if approved by the UofL Board of Trustees.

The goal is to further align strategic, operational and financial interests to support pediatric care, teaching and research.

“We want to ensure we continue to promote healthy children and communities while maintaining our strong academic training programs and research, which translate into better care for children,” said UofL President Neeli Bendapudi, Ph.D. “We’ll do that by leveraging the strengths of the UofL School of Medicine, ULP – Pediatrics and Norton Healthcare.” 

“For many years, Norton Healthcare and Norton Children’s Hospital have worked closely with the University of Louisville through our academic affiliation,” said Russell F. Cox, president and chief executive officer of Norton Healthcare. “Each day, dedicated providers from both organizations work together to deliver quality care that children and their families need. Together we have grown specialty services for children in the important areas of heart, diabetes and cancer care. With this new initiative, we expect this type of growth to continue, and we are committed to identifying even better ways to meet the health care needs of children and families.”

The roughly 120,000 children adopted in the United States every year have high risk for physical, developmental and mental health issues, conditions that may have been unknown before joining their new families.

A clinical report published online recently by the American Academy of Pediatrics offers guidance for pediatricians on the initial comprehensive medical evaluation of newly adopted children. The evaluation helps parents fully address their child’s physical and mental health and developmental needs, said V. Faye Jones, M.D., Ph.D., M.S.P.H., professor of pediatrics at the University of Louisville School of Medicine, and lead author of the report.

“The physician can help families prepare and work through expected questions and concerns during an early visit, even if they have limited information about the child’s past,” Jones said. “We know that many adopted children have previous chronic illnesses or are at risk for developing physical or mental health problems.”

Children awaiting adoption are at high risk of having been exposed prenatally to illegal drugs and/or alcohol as well as physical, emotional and sexual abuse, according to the report. Other early childhood factors that impact the health of adopted children include poverty and inadequate developmental stimulation. Common health issues these children face include growth failure, asthma, obesity, vision impairment, hearing loss, neurologic problems and sexually transmitted infections.

Soon after a child’s adoption, a pediatrician should conduct a comprehensive medical evaluation to confirm and clarify existing medical diagnoses, assess for previously unknown issues, discuss developmental, mental and behavioral concerns with parents and make referrals. The evaluation should include a thorough review of the child’s medical history, a complete physical examination and necessary diagnostic testing, according to the report.

More than 40 percent of all eye injuries are related to sports or recreational activities, accounting for more than 100,000 physician visits a year and costing more than $175 million. The American Academy of Ophthalmology recommends that everyone, even people who do not require optical correction, use protective eyewear during sports.

“Ninety percent of sports-related eye injuries in school-aged children can be avoided with protective eyewear,” said Kara Tison, O.D., optometrist with UofL Physicians–Pediatric Eye Specialists. “Regular prescription glasses do not provide adequate protection, and if a trauma occurs, can cause more damage.”

It is important to choose protection that has been tested and meets standards from the American Society for Testing and Materials (ASTM), which establishes the guideline of recommended sports eye protection for children.

Sports eye protection needs to have an ASTM label and fit the athlete comfortably and properly. Health care professionals can suggest appropriate eyewear for young athletes.

If an eye injury occurs, it should be evaluated by a health care provider. While most ocular injuries are painful, some are painless and can cause permanent vision loss.

For treatment of a sports-related eye injury or more information on protective eyewear, call UofL Physicians–Eye Specialists at 502-588-0550 for an appointment.

Kentucky has the highest child abuse rate in the United States, according to federal data released in 2019 that shine a light on the issue and ways caregivers can curb abuse. April is National Child Abuse Prevention Month.

In 2017, Kentucky reported 22,410 child abuse victims, equating to about 22 out of every 1,000 children, which is more than double the national average, according to the U.S. Department of Health & Human Services Children’s Bureau Child Maltreatment 2017 report. The state’s number has increased 27 percent since 2013.

Nationally, 78 percent of child abuse perpetrators were parents, according to the report.

“Many factors go into child abuse, but it’s always 100 percent preventable,” said Kelly L. Dauk, M.D., pediatrician with UofL Physicians - Pediatric Hospital Medicine. “There are many resources available for parents, caregivers, babysitters and bystanders to keep children out of these dangerous situations.”

According to Face It, a movement to end child abuse, there are simple ways parents and caregivers can make a lifesaving difference:

• Crying is normal. If you feel frustrated with your child, it’s OK to leave the baby in a crib or safe place while you take some deep breaths and calm down.
• Hitting and yelling don’t work and are shown to be harmful. Scolding, if used frequently, can reinforce negative behavior and cause attention-seeking.
• Potty training takes patience. Be patient and understanding with your child. Research shows physical punishment and shaming are not effective ways to help your child learn to use the potty. Instead, praise your child when she or he is successful. On average, potty training is an 18-month process.
• Make sure your child knows the difference between “okay” and “not okay” touches.

For more information, visit faceitabuse.org.

In Kentucky, to report suspected child abuse call 1-877-KYSAFE1 (597-2331). The National Child Abuse Hotline, 1-800-4-A-CHILD (422-4453), offers professional crisis counselors who can provide intervention, information and referrals to emergency, social service and support resources. Calls are confidential.

A new public health campaign is highlighting the need for education and awareness on antibiotic overuse in Kentucky, the state with the highest rate of antibiotic use in the United States.

Although antibiotics are important life-saving drugs that treat bacterial infections – including strep throat and urinary tract infections – their overuse can lead to drug resistance, which occurs when antibiotics no longer cure infections that they should treat, said Bethany Wattles, Pharm.D., clinical pharmacist in the Department of Pediatrics at the University of Louisville School of Medicine.

Kentucky Antibiotic Awareness (KAA), a statewide campaign to reduce inappropriate antibiotic use, is led by health professional researchers at the UofL Department of Pediatrics Antimicrobial Stewardship Program with collaboration and financial support from the Kentucky Cabinet for Health and Family Services Department of Medicaid Services. The campaign provides education and resources to Kentucky health care providers and the public.

“If we continue to overuse antibiotics, even minor infections will become untreatable. This is a serious public health threat,” Wattles said. “To combat the spread of antibiotic resistance, we must use antibiotics only when necessary.”

Examining antibiotic prescriptions for Kentucky children on Medicaid, researchers found that the rate of antibiotic use has been especially high in Eastern Kentucky. In some areas, children are receiving three-times more antibiotic prescriptions than the national average, Wattles said.

Antibiotics are most frequently used for upper respiratory infections, many of which are caused by viruses that antibiotics do not kill.

The majority of antibiotic prescribing is done in outpatient settings, which include medical offices, urgent care facilities, retail clinics and emergency departments. An estimated 30 to 50 percent of this antibiotic use is considered inappropriate, Wattles said.

When antibiotics are prescribed, it is important to take them as instructed; do not share the medicine with others or save for later use.

To learn more, visit the KAA website and follow the campaign on Facebook and Twitter. Health care providers are encouraged to join the KAA Listserv for newsletter updates, or email KYAntibx@louisville.edu with questions and suggestions.

###

This project was supported by the following: Kentucky Cabinet for Health and Family Services: Department for Medicaid Services under the State University Partnership contract titled “Improving Care Quality for Children Receiving Kentucky Medicaid”, Norton Children’s Hospital, and the University of Louisville School of Medicine, Department of Pediatrics; School of Public Health and Information Sciences. This content is solely the responsibility of the authors and does not necessarily represent the official views of the Cabinet for Health and Family Services, Department for Medicaid Services.

It’s time to shake it for a good cause. The University of Louisville student group raiseRED kicks off its 18-hour dance marathon Feb. 22 to fight pediatric cancer and blood disorders.

About 1,000 dancers will try to raise more than $601,000, the record-breaking amount collected last year.   

The dance marathon starts at 6 p.m. Feb. 22 in the Swain Student Activities Center. The night is a mix of dancing, patient testimonials and special guests to keep the dancers energized and focused on how their participation makes a difference. There also will be a kid talent show in which children from the pediatric cancer clinic get to show off their special talents.

The public is invited to take part Feb. 23 in the 10:30 a.m.-noon Community Celebration, which culminates in the grand reveal of the total number of dollars raised.

All funds from raiseRED go to research and patient care at the UofL Division of Pediatric Hematology and Oncology.

Student dancers have been split into teams, and each member collects pledges of support. In addition, the dance marathon is supported by Papa John’s, Kosair Charities, UPS and Churchill Downs.

Learn more at raisered.org. To make a donation, go to raisered.org/donate.

UofL medical students will shave their heads Feb. 12 as part of the raiseRED initiative. The money they raise will be used to support the UofL Physicians-Pediatric Cancer & Blood Disorders clinical practice and researchers developing pediatric cancer treatment therapies. Some participants will donate their hair to create wigs for children who have lost their hair from chemotherapy. RaiseRED Shaved Heads is noon-1:30 p.m. in the auditorium of the Kornhauser Health Sciences Library, 500 S. Preston St. 

The number of influenza cases is on the rise in Louisville and across the country. The illness can be especially dangerous for young children.

“The Centers for Disease Control and Prevention estimates that between 6,000 and 26,000 children younger than 5 have been hospitalized each year in the United States because of influenza,” said Navjyot Vidwan, M.D., UofL Physicians-Pediatric Infectious Diseases. “These young children are also at a greater risk of death from the flu.”

“Having your child vaccinated for the flu is a safe way to provide the best protection against the flu,” Vidwan said. “Washing hands often and well definitely helps keep flu at bay, too.”

Children with the flu may have one or many of the following symptoms:

• Fever
• Cough
• Sore throat
• Runny or stuffy nose
• Feeling weak or extremely tired
• Headache
• Chills
• Body aches

If your child gets sick, call your pediatrician and let him or her know early on if you are worried about your child’s illness. This is especially important for children younger than 5 years old who have long-term health problems, including asthma, diabetes and disorders of the brain or nervous system. Make sure your child gets plenty of rest and drinks enough fluids, especially if he or she is coughing and blowing his or her nose.

The flu can become very serious. Get emergency medical care for your child if he or she shows any of the following signs:

• Fast or troubled breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Serious or constant vomiting
• Not waking up or interacting
• Extreme irritability
• Flu-like symptoms that improve, but then return with a fever and worse cough

Also, it is important to get emergency medical care for an infant who is unable to eat, cries without tears or does not produce a wet diaper with normal frequency.

Children should stay home from school or day care until their temperature is less than 100 degrees without the use of medication for 24 hours. This will prevent spreading flu to others.

Since the 1980s, we’ve known to protect our children from tobacco’s effects by having a minimum legal age of consumption, but we have failed to protect them from tobacco smoke while they attend public schools or ride a school bus in the state of Kentucky.

About 50 percent of the roughly 650,000 public school students in Kentucky currently attend school in districts that have become smoke free, but the state as a whole has not passed legislation to make our public school facilities smoke free.

While half of the states in this country have enacted laws to keep our children safe from second-hand smoke at school facilities, Kentucky is still working out the kinks of a bill that will pass through the House.

Just a quick search on the CDC website shows what the health care field has known for decades: the countless side effects from second-hand smoke such as asthma attacks requiring admission to the pediatric intensive care unit.  Children who are exposed to smoking are also more likely to smoke themselves, which can lead to breathing problems, increased general health risks and even lung cancer. 

In the emergency department, it is quite common to see children presenting with a severe asthma attack triggered by tobacco smoke.  Seeing the fear in a child’s face, just once, when they can’t get sufficient oxygen, is enough to know something has to be done at a health policy level.  Even those who generally support smaller government and fewer regulations should recognize that protecting vulnerable children is an appropriate role of government.  And while some parents can rest easy knowing their child isn’t exposed to smoke at home, they should have the same level of comfort when their child goes to school or simply rides the school bus.  

As a pediatrician, I have seen far too many cases of second-hand smoke being detrimental to children’s health. I urge you to contact your State Representative and State Senator during this current legislative session, from January to March, to help keep your children out of the hospital, to save money and time for all. 

This pediatrician will be advocating for your children throughout this legislative session and many years to come.

The Novak Center for Children’s Health, an $80-million center that opened in downtown Louisville this summer, has been cited among the seven facilities and programs that represent the future of Louisville, according to Insider Louisville.

Children should have play time every day, according to the American Academy of Pediatrics, which is now urging physicians to talk with families about getting children to play.

“Playing is crucial for learning, stress relief, and brain and skill development,” said Heather Felton, M.D., medical director of the UofL Pediatrics - Sam Swope Kosair Charities Centre. “Developmentally appropriate play with parents and peers is an opportunity to promote social-emotional, cognitive, language and self-regulation skills. It also can be good exercise and supports formation of safe, stable and nurturing relationships.”

Types of play include:

• Object play (playing with an object and learning about it)
• Physical, locomotor or rough-and-tumble play
• Outdoor
  • Social or pretend

How should play be encouraged?

• It is so important that doctors may even write an actual prescription for play.
• Doctors should discuss playing, including smiling back at infants and playing peak-a-boo, at every appointment until a child turns 2.
• Schools should allow for unstructured playtime, as opposed to purely formal teaching, and include daily recess periods.
• Avoid electronic devices because they encourage passivity and the consumption of others’ creativity rather than active learning and socially interactive play. Plus, they distract from real play.