Mindfulness in Practice

Lenna Liu, MD, MPH, FAAP
Odessa Brown Children’s Clinic

As pediatric practice has evolved and new evidence has emerged on the impact of significant stressors or trauma in childhood (Adverse Childhood Experiences, or ACES), we find ourselves trying to support children and teens with a myriad of behavioral and mental health conditions, particularly anxiety. Furthermore, as someone who has been working in the field of childhood obesity for over 20 years, I know that when a child has a significant and/or ongoing change in their growth trajectory (either gaining or losing weight) it is often associated with what is going on in the family’s life. Instead of asking about what foods a family is eating, we should be asking (as in trauma-informed care), “What is happening in your life?” We know as pediatricians that the well-being of a child is linked to the parents’ well-being.

Given this evolution in the understanding of stress and trauma and their impact on health, Odessa Brown Children’s Clinic (OBCC) is building a mindfulness program. Starting in the 1970s, Jon Kabat-Zinn, PhD developed Mindfulness-Based Stress Reduction (MBSR), the most well-studied mindfulness intervention. Many mindfulness programs have developed from or alongside MBSR including Mindfulness-Based Cognitive Therapy (used in depression relapse) and Mindful Self-Compassion (MSC). There is robust evidence showing reductions in stress, anxiety, and depression following participation in these programs.

At OBCC, we formed a team of parents and health-care professionals to adapt a version of the MSC course tailored for parents of children with chronic conditions who are also facing poverty and other adversity. Called “Finding Strength for the Long Haul,” this 5-week class is taught and facilitated by parents with mindfulness training alongside a facilitator with mindfulness and/or mental health expertise. The classes introduce mindfulness and compassion practices in a group setting and allow parents to share their experiences applying these practices to their own lives.  We have found that participants begin to see that they are not alone, find strength within themselves, learn to identify their inner critical voice, and practice self-compassion.

In the words of parent Shayla Collins who participated in the first class and then became a facilitator, “The class taught me that it’s okay to feel something, but rather than immediately react, I need to give myself time to pause and figure out how – or if – I want to respond. I started to notice that after each class, as I was more able to control my reactions and bring down my tone, my kids were doing the same. When I responded to them differently, they responded to me differently.”

We have adapted the curriculum for Spanish-speaking parents and have also developed a subsequent class to deepen mindfulness practice for parents who are eager to learn more and/or become a parent facilitator.   We hope to continue to build the program and adapt the classes for other cultures and in other languages as well.  We are also exploring other avenues of mindfulness.  We have piloted classes teaching mindful eating (mindfulness applied to eating and feeding children) to parents while simultaneously offering a cooking class to their kids. We are grateful for the generous support of the Maritz Family Foundation, the Nesholm Foundation, Thrive Washington, the Center for Child and Family Well-being and Seattle Children’s Hospital to support the design and implementation of these classes, as well as research studies evaluating our pilot programs.

Mindfulness is not just for parents. We also see how it can support our staff and trainees. Some of our staff have taken mindfulness training in order to be a part of our mindfulness team. We also are leading meditation or mindfulness sessions before some staff meetings.  We hold monthly reflection rounds for pediatric residents to allow for teaching on self-care, to allow time to discuss and reflect on challenging social cases, to talk about the art of medicine and how to keep meaning in our work. Our program continues to grow and evolve, but we intend to allow mindfulness practices to support both our families and our staff.  We are all integral to each other’s health and well-being.

In medicine, we are accustomed to action and doing. But so much of life is about enduring what is difficult or challenging. Mindfulness is a practice that cultivates compassionate and non-judgmental awareness of ourselves and what is happening in our lives. It is a balance and complement to the doing. It is an opening to our whole selves and building the capacity to be with whatever comes our way with more space and freedom to breathe.