COMMENTARY

Back to School: In Praise of the Routine

L. Gregory Lawton, MD

Disclosures

September 26, 2018

It begins as a little whisper on the seventh or eighth day. By the 10th day, it is palpable. Regardless of where we are or what we are doing, I have come to anticipate its appearance and its crescendo toward insistence. The family vacation is over. It is time to return home. Our routine awaits.

Don't get me wrong. I love our family vacations. A vacation is time away from the routine—mentally, physically, and psychologically. As a physician, it is time away from the rat-a-tat-tat of appointments scheduled every 15 minutes, email threads for informatics projects or electronic health record complaints, and spending the last 30 minutes of each day in the clinic scribbling my signature on yet another form.

But, the routine beckons. It is familiar. It is reassuring. It is the totality of how we choose to spend our time—at home, work, school, religious services, exercising, eating, and sleeping. And so we must return to it.

I write this not only as families return from vacation, but also as children return to school and college campuses once again bustle with activity. First-day-of-school photos are posted on Facebook to commemorate and share in the great return to routine (or to document the initiation of a new routine: college). Big changes are afoot. But big changes in families' activities and routines have their origins in the small, seemingly imperceptible folds of our past days and years.

Consider the newborn visit. The parents (especially mom) are beyond exhaustion. They swaddle their newborn, a cherubic being with a mercurial temperament. Their two main jobs, I tell them, is to:

  • One: Grow (feed their baby to insure good weight gain); and

  • Two: Establish a day schedule that is different from a night schedule. The "day schedule" is more eating and less sleeping, and the "night schedule" is less eating and more sleeping. This is important, I say, because their baby has come into this world from a windowless Jacuzzi, with no sense of day or night (beyond the prenatal maternal motions). A routine is important for imprinting as well as for the parents, who crave a predictable pattern almost as much as a desire to love and nurture their baby.

Within the first year, feeding patterns evolve from nursing or bottles to include purees, puffs, and pancakes. Distinct, recognizable meals get folded into the mix—breakfast (at the kitchen counter), lunch (on the patio), and dinner (at the table)—and become regular experiences in our daily and weekly routines. This, I tell folks, is important to establish early, because it conveys for the child, from their earliest memories, the notion that there are these special times (and places) each and every day where a family gathers, eats, talks, reflects, shares, and argues. No television or videos. It's about food, family, and conversation. Moreover, this is not a routine that starts when the child turns 13. It is "as it has always been."

An article penned by family therapist and Harvard Medical School professor Anne Fishel in the Washington Post[1] extols the myriad benefits of regularly eating meals as a family. Fishel notes that toddlers and young children who share meals with their parents have a larger vocabulary of "unusual" words compared with children who share fewer meals. Families that eat together tend to have healthier diets, with consumption of more fruits and vegetables. Finally, as kids become teens and use this time to catch up with their parents and siblings, the family table is linked with lower levels of adolescent anxiety and risky behavior.

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