Almost everyone asks me about side effects when I prescribe a medication, which is very smart of everyone. But not everyone asks the very brilliant follow-up:
“I assumed there were side effects, but can you tell me how to minimize them?”
The concept of ‘side effect’ is layered with an unreasonable fear and mystery when patients and doctors speak it, but should be straightforward. Everything has side effects. Gardening gives you splinters. Basketball gives you floor burns. Cooking gives you those little oval burn marks where the back of your hand bumps the upper oven rack.
Some of the best things have the most side effects. Great parents take pride in how much outdoor play they provide their children. It’s a good thing the FDA hasn’t studied the side effects of outdoor play. Imagine the press release:
The FDA has approved Outdoor Play for use by children ages 0-18.
Indications for the use of Outdoor Play include: cabin fever, hyperactivity, anxiety, animosity, boredom, sibling rivalry, inattention, fidgeting, uncontained exuberance and parental frustration overload. Even in the absence of specific indication, Outdoor Play may be used as a supplement to food and shelter, although should not be administered simultaneously with meals or sleep.
Usual dosage: Outdoor Play should be administered daily. Doses as small as 5 minutes have shown statistically significant benefits in clinical studies, while doses ranging to 4 hours show proportionately larger symptom reduction. No dose-related toxicity has been documented. Doses as high as 24 hours, linked sequentially, have been studied in campsites and remote hiking trails with no loss of incremental benefit.
Side effects: The most common side effects include scrapes, falls and stuff that’s NOT FAIR!!
Serious or potentially fatal adverse events: accidental collisions, heatstroke, drowning, lightning strikes, shark bites, traumatic cataracts, West Nile virus. Myocardial infarction, fatal ventricular arrhythmias and unexplained sudden death are fortunately rare, but occur more commonly during active play than sedentary activities.
Side effects occurring in more than 1% of children are listed by body system:
Body-as-a-whole: excessive sweating, exhaustion, frostbite.
Neurologic: concussion, headache
Dermatologic: sunburn, actual dirt in skin folds, skinned knees/elbows/hands, cuts, splinters, bruises, insect and spider bites, dog bites, cat bites, kid bites, poison ivy, campfire burns.
Immunologic: allergic rhinitis, ocular allergies, wheezing, cough, hives.
Eyes: sand or dirt thrown in eyes, conjunctivitis, foreign bodies, sub-conjunctival hematoma.
Head/ears/nose/throat: broken or bloody nose, chipped teeth, accidentally swallowing gum, insects flying into ear canal or up nose
Cardiovascular: heart racing, palpitations, broken hearts, fainting.
Gastro-intestinal: stomach ache from getting punched, stomach ache from eating green apples or wild berries, stomach ache from waiting too long to go inside to the bathroom
Genito-urinary: blood in urine when guys on YouTube crash-land on their crotch
Orthopedic: breaks, sprains, strains, displacements, tears, ruptures, dislocations. Also everything that happens on trampolines.
The side effects of outdoor play can be divided into two basic categories: a) the things we survived in childhood and now view with a perverse pride, and b) the things we haven’t experienced that make our knees go weak when we imagine them happening to the children we love.
Some people say we should avoid medication because of side effects. I recently heard two licensed professionals advising parents against the use of medication while promoting “the treatment that’s free of any side effects—outdoor play.”
You wonder what kind of weeny fun they call ‘play’. Candy Land on a screened porch?
The majority of my childhood memories are outdoor: free-play, camping, fishing, hunting tadpoles, baseball, football, swimming, bicycling and pretending we didn’t hear the call to come inside for supper. Injuries occurred daily. My friends and I encountered ‘side effects’ every day.
Even now, I can get pretty banged up on weekends from surf kayaking, dinghy sailing, body surfing, running, skiing, gardening and outdoor chores. I’ve got dents in my ski helmet and scrapes on my road bike. I spent 18 months rehabbing a crashed shoulder and 2 years pulling sea urchin spines out of my foot. The last time I fell out of an apple tree was a few months ago. (Sometimes you just need to know you haven’t lost it. The tree and I both recovered quickly.)
Outdoor play has more side effects and less therapeutic effect than ADHD medications, but it’s so important that we can’t give it up. Parents and kids working together can lower the “side effect” rates substantially with supervision, proper techniques and protective gear. Doctors, likewise, have numerous techniques that can prevent or diminish side effects if we remember to ask instead of just giving up.
Side effects aren’t a reason to avoid things, but rather to be prudent in how we do them.