GROW OUTSIDE! Keynote Address to the American Academy of Pediatrics National Conference

About the Author

Richard Louv is Co-Founder and Chairman Emeritus of the Children & Nature Network, an organization supporting the international movement to connect children, their families and their communities to the natural world. He is the author of ten books, including "Last Child in the Woods: Saving Our Children from Nature-Deficit Disorder," "The Nature Principle," and "Vitamin N." His newest book is "Our Wild Calling: How Connecting to Animals Can Transform Our Lives — and Save Theirs." In 2008, he was awarded the Audubon Medal. He speaks frequently around the country and internationally.

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Adapted excerpts from Richard Louv’s plenary keynote address to the American Academy of Pediatrics National Conference, Oct. 2, 2010 in San Francisco. On Oct. 1, Louv made similar remarks at the UCSF Conference, Children First: Promoting Ecological Health for the Whole Child.

More than three decades ago, when Dr. Mary Brown’s children were growing up in Bend, Oregon (she describes it as a city at the base of the Cascade Mountains with a world class fly-fishing river running through it and where the sun shines over 300 days a year), it never occurred to her that much of her practice as a pediatrician would one day be so focused on childhood obesity and depression.

These maladies, as she described them in an e-mail to me a few days ago, are the ones that happen when kids move inside and interact with their video games and computers instead of outside playing with each other and using their imaginations. She continued, Just this week I saw a teenager who attempted suicide, who had no friends, no activities, and no ideas about how to change her life. Her life had been moving from place to place with nothing but a computer for a friend. A month, ago I saw a 13-year-old boy who weighed over 300 pounds who told me if he didn’t have his video games he would have no reason to live. She added, Last weekend it was 75 degrees and sunny and I went for a long walk though several neighborhoods that were safe, with open spaces and endless opportunities for outdoor activities and I was not able to find one child outside looking for lizards, butterflies or playing with other kids.

The disconnect with the outdoors, especially the natural world, is, she says, one of the core reasons for so many of the physical and mental problems that have changed the practice of pediatrics over the last 20 years.

Dr. Brown, a member of the board of directors of the American Academy of Pediatrics, believes that pediatricians can play a vital role in the movement to reconnect children to nature, because they so often see the symptoms of what I’ve called nature-deficit disorder. I introduced that term in Last Child in the Woods. In that book and since, I emphasize that nature-deficit disorder is a societal disorder, and in no way a medical diagnosis — though perhaps someday it should be. Rather, the term gives us a way to consider the price children, and all of us, pay for our growing alienation from the natural world. That disconnect is, many of us believe, a partial explanation for what pediatricians now call the millennial morbidities, which include increases in childhood depression and asthma; a rise in vitamin D deficiency which can cause rickets and lead to osteoporosis; and growing incidences of type-2 diabetes among children — an increase so significant (type 2 now accounts for up to half of the new cases of childhood diabetes) that the term adult-onset diabetes is no longer used.

As Dr. Brown points out, for many pediatricians, the strategic pediatric priorities have changed from infectious disease, immunizations and car seats and helmets to mental health, obesity and early brain development, all of which could be changed by re-connecting our kids to the wonder of nature.

A few years ago, after the publication of Last Child, I suggested a pediatrics Grow Outside! campaign. The idea, as I described it in the updated edition in 2008, was that pediatricians and other health professionals could be powerful voices for that reconnection, by offering prescriptions to go outside, along with posters, pamphlets, and personal persuasion. What some of us had in mind was an effort modeled on the national physical fitness campaign launched by President John F. Kennedy. Since then, we’ve seen some wonderful progress — the First Lady’s campaign, Let’s Move (and its recently added subset, Let’s Move Outside) against child obesity. A number of new campaigns, which I’ll describe a bit later, are enlisting health care providers to encourage independent or close-to-independent play in the natural world.

Along with educators, conservationists, business people and many others, pediatricians are already helping to lead this movement. Pediatricians and other pediatric health providers are particularly effective at this because of  their special, trusted voice. I’m here today to ask you to raise that voice. Please understand what we are not requesting: We are not asking you to consider the nature prescription as a replacement for traditional evidence-based approaches; when appropriate, it should be considered complimentary to traditional therapies. While correlative evidence is rolling in, we still lack sufficient, rigorous longitudinal research. This disparity does not necessarily reflect the relative importance of nature-based therapy versus other modalities, but rather where the funding for research comes from. Nonetheless, the correlative evidence does tend to point in a single, common-sense direction: Getting children outside can be good for their health, and getting them outside in nature may well offer special benefits.

Here is a sample of what the research suggests, and what pediatrics professionals can do:

• Contact with the natural world appears to significantly reduce symptoms of attention deficit disorder in children as young as five.

• Nearby nature, and even a view of nature from a bedroom window, can reduce stress in children

• Older children who spent more time outside were generally more physically active and had a lower prevalence of overweight than children who spent less time outside. (Less is known about the impact on very young children.)

• Children in greener neighborhoods appear to have lower body weight changes.

• Spending time outdoors may help prevent myopia.

• Play in natural environments is associated with young children’s improved motor abilities and increased creativity.

• Access to nature nurtures self-discipline and self-confidence among children, including children with disabilities.

• Natural environments, such as parks, foster recovery from mental fatigue and may help children learn.

• Green exercise may offer added benefits when compared to equal exertion in indoor gyms.

• In hospitals, clinics and medical offices, incorporate nature into the design to help children, and their families, reduce stress and heal.

• The concept of play, including play in nature, is more compelling and inviting to most adult caregivers, parents and guardians than exercise.

An additional benefit of nature experience has received scant attention, yet it is one of the most stirring: family bonding. Research has not looked specifically at a link between outdoor experience and quality of parent-child attachment, and certainly parents can be sensitive and responsive to their babies and young children indoors or out, says Martha Farrell Erickson, Ph.D., a developmental psychologist and a past children’s health advisor to the White House. But, in many ways, the natural world seems to invite and facilitate parent-child connection and sensitive interactions. What better way to escape the constant, interrupting beeping of modern life, and actually have a chance to spend concentrated time with your child, than with a walk in the woods?

How pediatricians, nurses and other pediatric health professionals can help

In 2009, Janet Ady of the U.S. Fish and Wildlife Service stood before a crowd of grassroots leaders gathered by the Children & Nature Network. She held up an outsized pharmacy bottle. Within the bottle was a physician’s prescription—one that would be as appropriate for adults as it would be for children. The contents of the medicine bottle included a variety of information, including a Web address to National Wildlife Refuges, a guide to animal tracks, Leave No Trace tips, a link to information on planting native vegetation to help bring back butterfly and bird migration routes, a Power Bar, and other items—including a temporary tattoo of migratory birds.

The label read: Directions: Use daily, outdoors in nature. Go on a nature walk, watch birds, and observe trees. Practice respectful outdoor behavior in solitude or take with friends and family. Refill: Unlimited. Expires: Never.

In your practices, in every community, at every economic level, please consider suggesting to parents that they get their children and themselves into nature. The AAP has long dedicated itself to improving health by prescribing healthier habits and environments. The Academy is doing our part by calling on every pediatrician to calculate body mass index (BMI) for every child over the age of two at every well-child visit,” according to Dr. Judith Palfreey, AAP president. “We are encouraging our 60,000 pediatricians to give out official child-friendly prescriptions for healthy, active living—good nutrition and physical activity—at every well-child visit. Using these ‘prescriptions,’ pediatricians will work with families to set goals for good eating habits and physical activity. What else can pediatricians and pediatric health providers do, perhaps more specific to the nature connection?

• Learn more about the research on the restorative power of nature, and pass this information on to parents and other caregivers.

• Informally recommend green exercise in nearby nature to your patients and their families.

• Offer written information (C&NN can help with this) about the health benefits of outdoor play.

• Educate families about the powers of nature for stress reduction for children and parents.

• Recommend nature time for parent-child family bonding, including infants.

• Provide information on where parents, grandparents and other caregivers can get outdoors.

• Provide safety information about nature: how to avoid ticks and noxious plants, for example.

• Hand out C&NN’s family nature club toolkits, encouraging multiple families to head outside together.

• Get involved with or help start a regional campaign. (Over 80 already exist in North America; these groups are your nearby allies.)

• Use biophilic design principles in your office, clinic or hospital.

• When a family first comes to you, give them a Grow Outside! picnic or gardening basket filled with pamphlets, maps, a compass, a trowel.

• Attend one of the Nature Champion training sessions offered by the National Environmental Education Foundation (NEEF).

• Take a hike yourself; be restored in nature.

Pediatricians, pediatric nurse practitioners, and other health care professionals can also help by pushing for more research funding. But as Howard Frumkin, Dean of the University of Washington School of Public Health, often says, yes, we need more research, but we know enough to act.

Grow Outside! How to get started

To get started, log on to the Children & Nature Network, which offers a Grow Outside! Start Guide with links to C&NN’s own extensive research pages, blogs, the regional or state campaigns in or near your community, family nature club tool kits (in English and Spanish), and Nature Rocks for fast and easy actions parents can take.

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The guide, which also offers sample prescription forms for nature, will also lead you to the good works, related to pediatrics, of many organizations, including AAP, the National Wildlife Federation, Audubon, and NEEF, which has recently launched its ambitious Children and Nature Initiative.

NEEF’s program is designed to educate pediatricians and other pediatric health care providers about health benefits of spending time outdoors in nature, and connect them to local nature sites, so that they can refer families to safe and easily accessible outdoor areas. NEEF is holding a series of train-the-trainer workshops to prepare pediatric health care providers to serve as Nature Champions. NEEF offers adaptable nature prescription pads, patient brochures and pediatric environmental history forms, a training presentation, and a fact sheet highlighting key scientific studies. The Initiative is guided by an advisory committee of experts from major medical institutions, including AAP.

Directly related to C&NN’s work, in Holland, Michigan, Dr. Paul Dykema changed his pediatrics clinic waiting area to include posters about reconnecting children and nature, for their health and well-being. He provides a waiting room video about the benefits to children and families from nature-based experiences; incorporates recommendations for nature-based time outdoors in all the regular family wellness meetings for parents and children from birth and older; and has a special instruction pad for children prescribing an hour a day of outdoor play in nature, and 20 minutes of reading a day. And in Ohio, Dr. Wendy Anderson is taking the lead with the medical community, as part of the Leave No Child Inside Central Ohio Collaborative — one example of how regional campaigns can build public support.

The nature prescription isn’t for everyone, and it’s no panacea. The experience must take place in a larger context of healthy relationships, diet and environment. But based on the emerging evidence, the restorative power of nature can help many children.

Within the health professions, interest in the nature prescription is already growing. Healing

gardens on hospital grounds are now popular. Dr. Daphne Miller, a general practitioner in Noe Valley, California, envisions nature prescriptions as part of the burgeoning field of integrated medicine. Nature is another tool in our toolbox, says Miller, who, in addition to her medical practice, is associate clinical professor in the Department of Family and Community Medicine, University of California, San Francisco. She also believes that park rangers can, in effect, become health providers. So can whole park districts.

Santa Fe, New Mexico, in an effort to fight the high rate of diabetes there, launched its Prescription Trails program, which is partially funded by the Centers for Disease Control and Prevention. Besides trail time, physicians can refer their patients to a trail guide. In 2010, a pilot program in Portland, Oregon, began pairing physicians with park professionals, who will record whether the outdoor prescriptions are fulfilled; the park prescription program will be part of a longitudinal study to measure the effect on health.

Any parent whose child has ever been sick — which means all of us — has deep respect, even love, for the pediatricians and other pediatric health providers in their lives. It’s one thing to put our trust for our own lives in a doctor’s hands; it’s quite another thing when the lives at stake are our children’s. The gift you give us is much more than your technical knowledge. You give us your kindness and wisdom. You calm our fears. So I’m here today to ask your help in the movement to reconnect our children and future generations to the natural world. I ask this for their physical and psychological health, their ability to learn, their capacity for wonder — for their ability to feel fully alive in a very real world.


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Richard Louv is chairman of the Children and Nature Network. He is the author of “Last Child in the Woods: Saving Our Children from Nature-Deficit Disorder” and “The Nature Principle,” Spring, 2011.


  1. We don’t need no “Waiting for ‘Superman'”. We just need to move and MOVE outside! Nature is the best medicine for sure.

  2. This paper identifies many of the reasons why we need to get kids and adults outside. Although the focus here is on the children, adults experience the same mental and physical health benefits.

    Environmental benefits of re-connecting people of all ages with the natural world, come from greater understanding of and respect for the environment. To make that connection meaningful requires personal experience. We are familiar with ‘armchair travel’ documentaries and have watched as wildlide photographers take us down the Zambesi River. What we miss with the virtual experience is the smell of the earth, the taste of the fresh berries, the feel of the sun warming our back.

    People value special places, care for them and in so doing care for themselves and those around them. When we re-connect with Nature we re-connect our communities, get active, get healthy and we all benefit. With pressing environmental concerns adding to phsycial and mental health issues I agree: it’s time to re-connect, build the linkages, value our varied skills and work together. Health practitioners need to work with landscape professionals, who in turn must work to support the efforts and initiatives of educators, environmentalists, academics, local communities and their representitives.

    The problems and possible solutions described in Richard Louv’s paper are not unique to one state or territory. They are problems now spread across the world. There has never been a better time to think global, act local. The challenge is to do it with shrinking funding. That’s where the benefits of connecting professionals and budgets become tangible. My measley budget added to your measley budget makes a bigger budget. Together we can achieve more, avoid doubling up of services, capture a wider ‘market’ to provide the natural connection opportunities sustainable communities need.

    Sustainablity is about more than just the planet’s resources, the community of birds and the trees; it’s also about the health of the people who live there and their hopes for the future. The web of life connects us all. When we destroy a part of the web we destroy a part of ourselves, whether through depression, rickets, obesity or disease. Let’s work together to make a difference.

  3. Great speech, I am heartened to see the medical community opening up to nature connection!!!!

  4. I just want to know why there hasn’t been any connection between Waiting for Superman and No Child Left Inside. All of the all of the problems are the same, but no connection as to how the outdoors can be part of the solution has been mentioned.

    Low science scores: nature=critical thinking. Low math scores: nature=problem solving skills. Low self-esteem: nature=increase in self confidence. The proof is there, the research supports it, yet no one at the national level…not even the President who’s wife created the “Let’s Move” campaign…has uttered one word in connection to the nature movement.

    It’s not rocket science. What are we waiting for? Let’s bridge that gap!

    • Richard Louv

      Alison, thanks. As you probably know, C&NN (as well as “Last Child in the Woods”) has made many connections to education. Please take a look at our research section, including the paper assembled by Dr. Cheryl Charles on education benefits of nature. Also, we’ve created the Natural Teachers Network to move ahead on this front without waiting; please take a look at that link on the C&NN site. Also, there are many stories on the site about progress in the development of nature-focused preschools and other schools. Much is going on. Not nearly enough, yet, but action on that front is growing. We agree that this deserves much more attention on the national level. Thanks again for your comment.

  5. As Gayle states above, this indeed is an issue that require global thinking and local action. I find the greatest barrier to people getting out is their image of that that means. So often I speak to people who have an image of ‘getting in touch with nature’ as a hike in the deep woods and they feel uneasy about their ability to do it. If the parents feel inadequate, they certainly won’t allow their children to play outside.

    Perhaps rather than encouraging a generalized connection with nature, a series of specific low barrier programs could be developed that would introduce families to the outdoors. Here are a few of my ideas:
    * Give out bird feeders with a guide to local birds
    * Organize a series of walks to introduce local wild spaces
    * Free fishing days on local waters
    * Wildflower walks in local parks

    Anyone else have some ideas?

  6. Mr. Louv, are you the author of “Web of Life” ??? Which was dedicated to Lucy Hollembeak?

  7. Yes! This country is all about money, money , money. As you quote the program director of the Active Living Research Program for the Robert Wood Johnson Foundation, James Sallis, we just “ follow the money” in our society. I really appreciate the time you spent in putting together many thoughts and researches available to make our kids more active and value nature. For us, parents, it is an alert to take a step back and appreciate more the environment and forget a little bit about money.

  8. Oops. I just forgot to cite the name of the book. Here you have the entire posting with the name of the book included.

    Yes! This country is all about money, money, money. As you quoted in your book Last Child in the Woods the program director of the Active Living Research Program for the Robert Wood Johnson Foundation, James Sallis, we just “follow the money” in our society. I really appreciate the time you spent in putting together many thoughts and researches available to make our kids more active and value nature. For us, parents, it is an alert to take a step back and appreciate more the environment and forget a little bit about money.

  9. Nature is becoming one with humanity again partly thanks to you. From my experience what you said in the blog is all true and it shocks me to see it all pointed right in front of me when I read your book. If anything I must admit that things need to change, especially the fear part of nature. I’m now 18 and I still don’t how to interact with the nature around me. It’s left me feeling totally shallow inside and I would like to amend that. Your book inspired very much and I hope to follow a path that is set with a green scenery. I too want to set an example for those who follow, namely the children left behind.

  10. First, it is very encouraging to hear that the pediatricians are becoming more aware of the healing benefits of nature. In the blog you mentioned a number of things that the research suggests including: “Green exercise may offer added benefits when compared to equal exertion in indoor gyms.” From my experience exercising outdoors does offer many benefits compared to working out at the gym. For example, I can enjoy the green environment while exercising, especially fresh air and the sunlight. I am able to exercise longer and feel better than when I go to the gym. Thank you for all your work on raising awareness about the health benefits of nature.

  11. I am all for the GROW OUTSIDE! campaign. I too have experienced the sight of many obese children in today’s society. Not only do I see it when I go out in public, but I see it in my relatives as well. My 11 year old cousin unfortunately is diagnosed with diabetes. Diabetes runs in the family, but there is no record of it occuring to someone in my family at that young of an age. Not only will this help children become more physically and mentally healthy, but it may build a stronger bond between the parents and the children.

  12. What a great prescription!

    “How pediatricians, nurses and other pediatric health professionals can help

    In 2009, Janet Ady of the U.S. Fish and Wildlife Service stood before a crowd of grassroots leaders gathered by the Children & Nature Network. She held up an outsized pharmacy bottle. Within the bottle was a physician’s “prescription” — one that would be as appropriate for adults as it would be for children. The contents of the medicine bottle included a variety of information, including a Web address to National Wildlife Refuges, a guide to animal tracks, Leave No Trace tips, a link to information on planting native vegetation to help bring back butterfly and bird migration routes, a Power Bar, and other items — including a temporary tattoo of migratory birds.

    The label read: “Directions: Use daily, outdoors in nature. Go on a nature walk, watch birds, and observe trees. Practice respectful outdoor behavior in solitude or take with friends and family. Refill: Unlimited. Expires: Never.”” (Louv)

    I think the world owes Richard Louv a great debt of gratitude for all of your research and the books you have written. At this point I have only read “Last Child in the Woods: Saving Our Children From Nature-Deficit Disorder” but I plan on reading more. All who read this book should share it and the information they have learned with everyone they know. We should make it a point to get ourselves, our children and grandchildren back outside into the great outdoors. It certainly cannot hurt and will probably do great things for everyone who does get back to outdoor play and all of the people they come in contact with.

    Thank you for the memories you shared and all of the research you have done. Your stories reminded me of a lot of great times I had as a child and later with my own children and most recently with my grandson. Last weekend my wife and I took our grandson to Yosemite to play in the snow, sledding and having a snowball fight. He also counted 18 deer, 1 owl, and on the way home 460 head of cattle. To see him smile and exclaim “how cute” when he saw the deer was great. You could see and feel the love he had for being free to play as he chose outside. The sledding and snowball fight were his ideas and he was able to carry each one out as he led his grandmother and me through what he chose to do. Getting to see the deer and other animals was an incredible bonus to him. You could just see him completely relax and not even think about his school work or other things that would normally occupy his mind. He is nine years old. Thank you again as it was your book that inspired the trip last weekend.

    Louv, Richard. “Grow Outside! Keynote Address to the American Academy of Pediatrics National Conference.” Field Notes from the Future: Tracking the Movement to Connect People and Nature. Children and Nature Network. 4 Oct 2010. Web. 1 Dec 2010.

  13. It is hard to change the life style of the children of this generation. Seeing how video games console are no longer just a machine to play on, but a tool to explore a community on the other side of the monitor with people that have the same interest. There does not seem to be a reason of desire to really go step outside the door for excitement. Knowing that the outdoors is somewhat a necessity toward a balance human growth, it seems necessary to force some of that knowledge to the indoor gaming children of this era. Knowing there are campaigns and events that provide exciting outdoor play, even if the children are heading towards are world of indoor gaming with company from miles away, there are still many people with the heart to help kids experience the wonderful nature. The hope to steer children back to a balance lifestyle is never going to disappear.



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