In both settings, the pain management team is committed to improving patients’ quality of life by offering them the tools to manage and overcome their pain. They provide treatment options tailored to meet the patients’ goals, such as medication management, interventional pain procedures, physical therapy, cognitive behavior therapy, relaxation therapy, guided imagery, aromatherapy, medical acupuncture, massage therapy, yoga therapy and more. The team also provides education on how to manage pain through lifestyle modifications like paced physical activity, diet and improved sleep hygiene.

Watch the videos below to learn more about the aromatherapy, massage therapy and yoga therapy services at Cook Children’s.

A couple months ago, Pediatric Yoga Therapists Gina Shelton and Stacy Bush joined the Cook Children’s Pain Management team to lead yoga therapy classes and individual consults throughout the medical center, Inpatient Psychiatry Unit and Partial Hospitalization Program.

While yoga is a general term of practice, “yoga therapy is the process of empowering individuals to progress toward improved health and well-being through the application of the teachings and practice of yoga,” according to the International Association of Yoga Therapists.

Our yoga therapists are here to help alleviate physical and mental health conditions by cultivating the mind-body connection. 

“The main thing we teach is that your breath can change how you feel, then movement calms your nervous system. Our modern culture often forgets that our bodies are made to move, not sit still all day,” Shelton said. “And we also talk to them about their brains and how they work. So they get a little more awareness of themselves and how their brain, emotions, and body are interconnected.”

Cook Children's yoga therapy sessions consist of breathing exercises, postures, meditation and relaxation techniques. Conditions addressed may include stress, anxiety, depression, PTSD, ADHD, Musculoskeletal problems, autoimmune diseases, Insomnia, IBS, Cancer, and others. 

“Through these classes we have an opportunity to come in and teach the kids through experience,” Bush said. “When they feel it, it is easier to learn it and implement it as a coping skill. That’s the great thing about the focus we have on breath work. Your breath is always with you, no matter where you are. You don’t have to change what you’re doing – you just stop and breathe and have a moment to connect back.”

Each session is built around integrative learning approaches aimed at being more like play than therapy. The goal is to meet the patient where they are most comfortable and to implement techniques so that the patient engages willingly and in a joyful manner.

“Kids are going to have lots of energy and all kinds of different things going on, so we have to meet them where they are,” Shelton said. “In our classes, we pay attention to how we’re feeling and that brings us back to our bodies and connects mind, body and breath.”

Yoga therapy aligns the needs of the patient with the particular practice required. Our therapists are able to work with children of all developmental abilities, allowing them to participate with low back pain or physical disability with very specific yoga from their bed, chair or floor in their own room.

For example, with positions and postures to increase strength, circulation, range of motion, proprioception and balance. Likewise, with anxiety, there are specialized sessions to raise self-awareness and regulate the central nervous system.  

By developing a positive relationship with their body, the patient is more likely to have a beneficial outcome from other prescribed therapies that are part of their medical treatment.   

“We teach them to take a moment and take a breath to calm back down,” Bush said. “With this awareness, we can help them start to shift the way they think about themselves, the way they view the world and the way they move in the world. I think that’s a pretty powerful thing.”

These are common problems in the lives of a child.

But thanks to cyberbullying, the pressure to make it into college and a desperate need to fit in, anxiety has reached near epidemic proportions.

More than 40 million Americans suffer from Anxiety. According to the annual national survey by the American College Health Association, one in six college students has been treated for or diagnosed with anxiety in the past year.

For many of the kids at Cook Children’s, chronic pain only adds to that sense of stress and anxiety.

“Chronic pain affects every relationship in a child’s life. There’s a lot of bullying that can take place. They lose a lot. They lose their ability to play soccer or stay on the football team or they find themselves not being able to go to school regularly and some of our kids can’t go to school at all due to pain,” said Barbara Deleon, Pain Management Services coordinator at Cook Children’s. “So then they lose some of their friends. They lose those relationships that are important to children.”

To help the children who suffer from chronic pain, Pain Management Services uses many different types of therapies to help their patients including acupuncture, acupressure, aroma therapy, massage therapy and different types of physical therapies.

But yoga has always been at the top of the list to add to their pain management tools.

Two years ago, the Pain Management team wrote a proposal to bring a yoga program to Cook Children’s and they received the funding this year. Then the search was on for the right person to lead and teach yoga to the variety of patients dealing with pain and anxiety at Cook Children’s.

Tatiana Miller was that person. Miller brings with her a ton of expertise with hundreds of hours of yoga instruction, as well as a cognitive behavioral therapy practitioner, a stress management life coach and a health counselor.

She is also a wife and mother of two who lives in Fort Worth. Immediately, she knew this job at Cook Children’s was the one for her.

“When they called me in to meet with the Pain Management department I thought, ‘Oh my gosh this is divine. This is more than meant to be. All the knowledge I’ve gained, all the experience I have was for this moment. It was for this department. We’re taking these children and giving them these tools that they had not been given before. These kids are missing school because of their pain. They aren’t able to catch up on reading or math, but they also can’t catch up with just wanting to have a good life. To get their life back. If you don’t have the tools to cope with this pain, you can’t catch up to feeling depressed or angry or frustrated. Anxiety is paralyzing and these kids that once had normal lives aren’t able to do life anymore because of their pain and the anxiety that comes with it.”

The yoga instruction at Cook Children’s provides tools to make it easier for patients to cope with the challenges they may face, including:

• Anxiety
• Post-traumatic stress disorder
• Chronic headaches
• Sleep disorders
• Pain
• Grief
• Depression

The yoga is designed to accommodate all ages and fitness levels, based on 5 principles:

• Stillness – learn to quiet the mind and body, become self-aware and develop sensitivity, self-control and self-regulation.
• Listening – tune in to what your heart, mind and body have to say.
• Grounding – discover how to be physically present in your body and develop a sense of competence, physical safety and security.
• Strength – develop physical, mental and emotional strength.
• Community – enjoy a fun-loving environment where you can explore yoga through the use of movement, breathing and games.

Miller takes the principles with her to help her patients, but these are kids and no two sessions are the same.

“Part of the yoga therapy approach is meeting patients where they are at,” she said. “So I can’t show up with a plan because I might have a teenager and a toddler in a class or all teenagers for all toddlers. The kids may be very active or very tired. So my approach is to show up and to read them. That’s where I start off. I talk to them to make them feel safe. I try to connect to each participant in a way they can relate.”

For all of her training and expertise, Miller said any progress begins with one simple truth: “They have to like me. Because if they don’t, they aren’t going to participate and they aren’t going to listen to what I have to say.”

Miller walks into a room and scans for body language, where the kids are located in the room and their social cues such as are they looking her in the eye.

From there, she begins to reach into her bag of tricks to hook their attention. She may bring out a focus ball to help the kids with their breathing. She teaches them what breathing should feel like and how to slow down their breath.

“If I can get them to slow down their breathing, their nervous system says things are good. We can calm down,” Miller said. “The first goal is to get them in a happy place in their nervous system.”

From there, depending on age and the physical makeup of the class, students may do as many as 15 yoga poses.

But Miller works on more than just the physical during yoga. She works on their self-esteem. She talks to them about feeling empowered and feeling like a leader.

“The true understanding of yoga is the ability to be still and listen. That’s it. Yoga is not body postures. Yoga is not meditation. Yoga is not breathing. Yoga is the ability to be still and listen and not let external circumstances affect your internal state,” Miller said. “A crisis is any time your internal tools can’t keep up with the external demand. That’s why most teenagers live in crisis, which is anxiety, because they don’t have the internal tools to meet the external demands.

“If you teach them to be in the world but have the capacity to come back into themselves and say, ‘Is this real or is it in my head? My thoughts? My emotions? Can I do this? Is this right for me? That relationship within themselves … That’s the stillness and the listening.”

Miller is just beginning the program, but it is catching on throughout the medical center. She has taught children in Pain Management, Rehabilitation, Psychiatry and more is planned, including going to individual rooms for yoga therapy.

Yoga is a way to help the patients at Cook Children’s feel better about themselves. It’s one way to help kids who have lost control either physically or emotional to gain some control back.

“Pain is very physical and yoga can be physical,” Deleon said. “With pain, there is a mind, body connection and in yoga there is a mind, body connection. So the relationship between yoga and helping with their pain is very beneficial to our patients.”

I am shocked at the number of patients we see where bad posture plays a role in their pain and physical limitations. Whether it be sports injuries, overuse injuries or postural dysfunction, the trend is younger patients are starting to report more injuries. I see technology driving our kids to be more active in an online space than it does in a physical space.

So I would like to take a minute to address how to get our kids active again, but not just any activity. I want to talk about core activity.

What is the core?

The core is a muscular system that works synergistically to provide support and power generation to the body in all positions and with every activity. Think of a soda can to explain the core. The can has a front (deep abdominals), back (multifidi muscles), top (diaphragm muscle) and bottom (pelvic floor muscles). And just like the can, as long as no one pokes a hole in it, it is very strong. As soon as someone creates a weak spot in the can/core, it can easily be crushed.

When do you use your core?

The core should be used during all of life’s daily tasks, but we lose this ability as children when no one teaches us how to use the core during modern-day tasks such as playing on your Ipad or texting your friends.

How do I train the core of a child?

Return to the basics. Too often we see young athletes who have been given formal instruction in how to pitch a ball or perform a round-off back handspring, but little or no training on what it means to use their core functionally. Schools have our kids doing pushups before teaching how to plank. Physical therapy can definitely help patients of all ages with core training, but there are also some things you can do at home. For really young children (3-6yrs) this can mean returning to games that require you to hold positions, such as Twister or Untying the Knot. For slightly older children (7-12yrs), yoga or even just plank holds (3 positions) help build core strength and endurance. For our teens and young adults more formalized training for power generation and power transfer using the core can be very beneficial.

What does a strong core mean?

For your child a strong core means improved performance in their activities whether that is football, dance or band. It can mean no pain when sitting in class or when trying to be active with peers.

For parents, a strong core means fewer complaints from your child, better posture, and less risk of injury while your child is performing their activities.

If you or your child would like help with core training, please contact your physician and seek a referral to Cook Children’s Physical Therapy Department.

More SPORTS resources related to this topic:

• Top 10 questions parents have about sport injuries
• Young athlete's injury prevention guide

The incidence of anxiety and depression in pediatrics is due in part to overscheduled children and families. Here are some suggestions on how to slow down and find some down time with your family.

1. Gardening: My children’s happiest moments have been picking tomatoes and digging out potatoes in their grandparent’s garden. In describing her experiences in the garden, their grandmother, Jean Mangham writes “I love to get outside to feel the sun, smell the dirt and hear the birds sing. My garden provides me with a place to see the miracle of life. Put a small seed into the dirt and with just a little nurturing, you produce a fruit or a flower. Gardening also provides me with a great sense of pride, and how important that is to pass along to my grandchildren.”
2. Kathleen Wayland, a music teacher, writes, “Relaxation is a learned behavior. A child’s day, even one spent at home, can be very stimulating, offering a little, unstructured quiet time. Having some quiet time with your child provides an opportunity for you to model relaxation for your child and let them know they can relax, even when it’s not naptime or bedtime. This is also a wonderful opportunity for some bonding time to deepen your connection with your child. Holding, rocking, singing and cuddling are all ways to have a quiet, bonding time that will relax both of you. Children need time to be stimulated and engaged, and they also need time to be at leisure. This down time is physically necessary for the brain to process the learning that occurs during structured activities and interaction.”
3. One of my yoga instructors once said, “If you can breathe, you can do yoga.” The practice of yoga and meditation promotes physical and mental wellness. Heidi McGall, a trained yoga instructor teaches kids relaxation: “I have kids close their eyes and imagine a balloon in a big empty blue sky. Imagine anything that is bothering them – schoolwork, family life, things that are nagging them. Imagine tying all those troubles to the balloon. Then they set the balloon free. It floats off into the blue sky out of their vision and they are left with the perfect blue cloudless sky. Then take a big inhale and exhale and open their eyes.”
4. Take your children outside. Being near trees and under a blue sky are inherently relaxing. Go for a walk, take a bike ride, plan a camping trip. Read the book, “Last Child in the Woods” by Richard Louvs. He describes why being in nature is important for children. He lists nature activities for kids and families. Have you and your kids seen the movie The Lorax? You should. It is a thoughtful look at the value of nature in the lives of our children.

And to quote another wise sage, “Life moves pretty fast. If you don't stop and look around once in a while, you could miss it.” – Ferris Bueller.

The answer is complicated.

Yes, it's very important for toddlers ages 1-3 to interact with other kids their age and challenge their balance, strength and coordination. Sports are a great way to promote these skills and literature shows that athletes who play sports at a younger age are more likely to be active adults than their peers who don't participate in sports.

However, organized sports  may not be the best solution for children 3 and under, and aren't the only way to teach our children these skills. The list below describes activities for toddlers and some benefits of these activities for their development.

Swimming: Helps strengthen the arms and legs, as well as improve coordination since the child has to use both arms and both legs at the same time. Learning swimming at an early age helps promote good water safety habits later in life. You can practice swimming in a "parent and me" swimming class. 

Dance: Improves balance, coordination, strength and flexibility. You can practice in a class setting or by having a "dance party" or playing a game of "freeze dance" at home.

Biking: Between ages 2 and 3, kids should be able to begin riding a tricycle. For young kids, there are tricycles that offer a parent guide bar to help kids move and steer. You can practice biking in your neighborhood or on trails.

Soccer: Most teams start between ages 3-5; however, kicking a ball in the backyard with your toddler is a great way to help them learn to run, develop core strength and balance on one foot for a short period of time.

Basketball: Helps kids develop hand-eye coordination when dribbling and shooting and improve running and jumping skills, as well. You can play with an adjustable hoop in the driveway, or sing up for a community team (which will generally begin between ages 3-5).

T-Ball: Teaches running, balll skills and coordination skills. Using larger balls for young children will help them be successful with catching and throwing.

Yoga: Helps improve flexibility, which is very important since toddlers are growing quickly and develop tight musles quickly. Yoga can also improve strength (especially in the core muscles) and balance. Several toddler yoga videos can be found online, and classes are available throught out the DFW area.

Gymnastics: Another way to gain strength, balance and flexibility, gymnastics is a sport that children can begin learning as early as 18 months old. Many gyms have special toddler and preschool classes, as well as "parent and me" classes.

Yard games: The old staples of "tag" and "hide and seek" are great for teaching turn taking and problem solving, as well as practicing and running and climbing. Taking your child to a local playground also offers a wide variety of ways to practice climbing stairs, running, swinging, balance, etc. 

With all of these, safety is a primary concern. Toddlers are at high risk of injury when practicing new things. Contact your pediatrician if you feel like your child is having difficulty learning new skills and they may refer you for evaluation by a physical therapist to evaluate your child and help them learn these new skills.

About the author

Jodi Burgett PT, DPT, CPST, is the clinical coordinator of Neurodevelopmental Physical Therapy at Cook Children's. Physical therapy at Cook Children's focuses on large motor and functional skils to enhance development, restore function and prevent disability from pediatric conditions, illness or injury. Cook Children's has Rehabilition Services in locations in Fort Worth, Hurst and most recently in Mansfield.