Yoga for Childre n - Pediatric Nursing · PEDIATRIC NURSING/September-October 2009/Vol.35/No.5 277...

PEDIATRIC NURSING/September-October 2009/Vol. 35/No. 5 277

Yoga for Childre n

From a school principal man-dating yoga for high schoolseniors (Rimer, 2007) to aprincipal of an elementary

school providing yoga to calm stu-dents and handle stress (Eagan,2007), yoga is in the news. Schoolsa re increasingly using this ancientt h e r a p y, including breathing and pos-t u res, to help students manage stre s sand influence well being and behavior.

The increased awareness of thepotential benefits of yoga for childre nhas resulted in school programs thata d d ress stress and anxiety by tre a t i n gthe body and mind. Emphasis on indi-vidual abilities rather than competitionmakes yoga appropriate for all chil-d ren, including those with physicallimitations and lack of involvement ino rganized sports. Obesity and a lackof exercise are recognized as factorsin the health and well being of chil-d ren, and are acknowledged as publichealth concerns (Budd & Hayman,2006). Yoga provides a non-thre a t e n-ing and gentle method to incre a s ephysical fitness and enhance healthand well being.

Encouraging anecdotal re p o rt sdescribe yoga calming childre n ,reducing obesity, reducing disciplinep roblems, decreasing anger and panicattacks, and enhancing imagination,concentration, and academic per-f o rmance (Flisek, 2001). Health pro b-lems, such as headaches, stom-achaches, constipation, back pain,and colds or sinus problems, arere p o rtedly improved with a yoga prac-tice (Luby, 1998), as well as ad e c reased need for medication forc h i l d ren with attention deficit disord e r(Flisek, 2001). There is scant butg rowing empiric support for positivehealth effects of yoga (Galantino,G a l b a v y, & Quinn, 2008; Jensen &K e n n y, 2004; Kuttner et al., 2006;Manjunath & Telles, 2001).

Despite the paucity of re s e a rch, thei n c reasing attention to yoga mayencourage parents to explore yoga fortheir children and request re f e rrals orclarification of the purported eff e c t s .Some children may practice yogawithin physical education classes, andp a rents may express concern re g a rd-ing the perceived religious affiliation ofyoga. What exactly is yoga and shouldc h i l d ren practice it? A description ofthe philosophical basis of yoga, thebasic components of a yoga practice,safety concerns, and how to locateand evaluate a yoga program for chil-d ren will address these questions.

Philosophical FoundationsOf Yoga

The root of the word yoga is “toyoke” or “to harness” (Feuerstein,2003, p. 4). The goal of yoga wasoriginally to provide a guide for whole-

ness, happiness, and well-being(Feuerstein, 2003). Wholeness, in thiscontext, appears to mean the integra-tion of body, mind, and spirit, and con-nection between the self and a divineBeing that leads to self realization oro n e ’s true identity – the authentic self.Yoga helps individuals focus attention.Humans are viewed as conscious-n e s s - e n e rgy (cit-shakti), and thephysical body surrounds this underly-ing existence. Yoga as a traditionalpractice was thought to lead to self-t r a n s f o rmation through transcendenceof the ego (Feuerstein, 2003). Themind and breath are intimately con-nected so that influencing the one willa ffect the other. Yoga consists of spe-cific postures coordinated with bre a t h-ing, meditation, and concentration tofocus and calm the mind (Feuerstein,2003).

The first mention of yoga was doc-umented in ancient Hindu scripture5,000 years ago and influenced byBuddhist philosophy. The traditionalpurpose of yoga was to help transformor transcend the self. The early Hindus c r i p t u res are re p o rted to have beenwritten in 2000 BCE. These early writ-ings of the Vedic peoples who inhabit-ed present-day India were re s p o n s i b l efor the oldest extant literature, theVedas (Feuerstein, 2003). The earlyHindu scriptures included “philosophi-cal texts to epic stories” (Bre u i l l y,O’Brien, & Palmer, 1997).

The early Vedic writings includedfour collections of scripture. The old-est and most popular is the Rig Ve d a ,which is a collection of hymns( B reuilly et al., 1997). These earlytexts concentrated on the pantheon ofgods and divine belief and ritual. The

Objectives and the

CNE posttest can be

found on pages 296-297.

ContinuingNursingEducationSeries

There is an increasing interest in the use of yoga for children to calm the mind and increase health and wellbeing. Despite scant but increasing evidence supporting the efficacy of yoga in children, special yoga pro-grams within schools are being developed for children and adolescents. This increasing popularity of thepotential benefits of yoga may encourage parents to consider yoga for their children and request referralsor clarification of the purported effects. A description of the philosophical basis of yoga, the basic compo-nents of a yoga practice, safety concerns, and how to locate and evaluate a yoga program for children willbe addressed.

Laura Santangelo White

Laura Santangelo White, MS, RN, is aDoctoral Student, Connell School ofNursing, Boston College, Chestnut Hill, MA.Statement of Disclosure: The authorre p o rted no actual or potential conflict ofi n t e rest in relation to this continuing nursingeducation art i c l e .

278 PEDIATRIC NURSING/September-October 2009/Vol. 35/No. 5

Upanishads presented a more ab-stract philosophy, which reflected adecline in the emphasis on rituals andp resented more of a personal, intern a lreligious practice. The concept of re i n-c a rnation was presented as an impor-tant part of life described as a perpet-ual cycle of birth, suffering, death, andre b i rth. Individuals sought a way toescape this cycle. The further evolu-tion of Hindu scriptures moved fro mthe abstract to the concept of devotionto a personal God (Breuilly et al.,1997).

The most famous Hindu writing isthe Bhagavad-Gita, a part of thew o r l d ’s oldest poem, M a h a b h a r a t a.The Bhagavad-Gita describes a moralconflict resulting in the realization thatthe love between God and humanity isof utmost importance in life (Bre u i l l yet al., 1997).

The yoga was originally associatedwith the early rituals of Hindu spiritual-ity (Feuerstein, 2003). The posture s(ãsanas) are meant to increase flexi-bility and strength, and improve bodi-ly functions, such as the endocrinesystem, gastrointestinal and immunefunctioning, sleep, eye-hand coord i-nation, and balance. The practice ofthe ãsanas may also lead to psycho-logical findings of increasing somatica w a reness, attention, memory, learn-ing, and mood (Feuerstein, 2003).

Prãnãyãma is the coordination ofb reathing and postures (ãsanas) toc o n t rol the concentration of the mind.The breath plays a very important ro l ein yoga and is considered energ yp resent in all animate beings. Theearly yoga practitioners, yogi (male)or yogini (female), noticed that ifsomeone was upset, the breath wasrapid and shallow. At times of re l a x-ation and calm, the breath was slowand even. Because the breath and themind are intricately related, it wasbelieved that deliberately contro l l i n gand slowing the breath would slow andcalm the mind (Feuerstein, 2003).E v e n t u a l l y, yoga was codified byPatanjali into Yoga Sutras in appro x i-mately 200 CE.

Classical Yoga

The philosophical system of classi-cal yoga was written as the Yo g aSutras by Patanjali. Yoga is pre s e n t e das an eight-limb path of guidance toactions, thoughts, and morality(Feuerstein, 2003). The Yoga Su t r a sdefined important yoga conceptst h rough the compilation of 195 apho-risms or maxims (Sutras) (Feuerstein,2003). The practice of yoga pro v i d e dguidance on moral restraints (yamas)and moral observances (niyamas)

c u rrent health interests, such as fit-ness, stress management, and therecognition of psychosomatization, aswell as the re p o rted decline of institu-tionalized religion (DeMichelis, 2004).Within a secularized West, yoga beganto be associated with emerging alter-native medicine and personal innerprivate religious practice. By the1970s, yoga was related to healingand personal growth (DeMichelis,2004). The practice of yoga in theWest is described as reductionistic andmay only concentrate on the ãsanasto the neglect of prãnãyãma, mentaldiscipline, or spiritual development(Feuerstein, 2003).

The individual yoga practicedepends on the needs and abilities ofthe yoga student and the qualifica-tions of the yoga teacher. When prac-ticing yoga at fitness gyms, theemphasis is likely to concentrate onits physical benefits. Yoga studios withteachers who may see yoga as a wayof life rather than an exercise mayinclude the higher practices of yogabeyond postures and breathing andm e d i t a t i o n .

Styles of Yoga T h e re are 40 re p o rted styles of

Hindu yoga, which reflect diff e re n ta p p roaches and techniques of train-ing. For example, one style may focuson meditation (Dhyãma-yoga) andanother focus on repetitive sounds(Mantra-yoga) (Feuerstein, 2003).Hatha yoga is a major branch of yogadeveloped in 1000 CE that focuses onphysical aspects and breath contro land cleansing. Hatha yoga was thestyle that entered the West by practi-tioners in the 1920s. After underg o i n gmany adaptations for the needs ofWe s t e rn students, Hatha yoga is themost widely practiced style of yoga inthe West (Feuerstein, 2003). Practi-tioners tend to be primarily intere s t e din health and fitness and less intere s t-ed in self-transform a t i o n .

The goals of Hatha yoga are health,v i t a l i t y, and longevity of life. The lifef o rce (prana) travels through channelsin the body called nadi and can bec o n t rolled by the breath to lead to selfc o n t rol of the mind (Feuerstein,2003). There are many types of yogawithin the hatha style (see Table 1).The most common types are a)I y e n g a r, b) Ashtanga, c) Bikram, d)Integral, e) Kripalu, f) Viniyoga, g)Sivananda, h) Ananda, i) Kundalini, j)Hidden Language, and k) Somaticyoga. The underlying concept ofcalming the mind through posture sand breath are similar, but the envi-

t h rough postures (ãsanas), mindfulb reathing (prãnãyãma), and medita-tion (Dhyana), eventually experienc-ing the union of the self with theobjects of meditation (Samadhi)(Gates, 2002). Moral teachings withinyoga include the guidance of theyamas, niyamas, the four aims of life,and the five moral afflictions.

The Yamas include the practice offive moral restraints: non-violence(ahimsa), truthfulness (satya), non-stealing (asteya), moderation (brah-m a c a rya), and non-hoarding (apari-graha). The Niyamas include fiveo b s e rvances: purity (sauca), content-ment (santosa), austerity or zeal(tapas), self-study (svadhyaya), andthe devotion to a higher power(isvara-pranidhana).

The four aims of life include theo b s e rvation of a spiritual discipline( d h a rma), the creation of a balancedlife (artha), the enjoyment of the pro-duction from one’s work (kama), andthe freedom from the cycle of suff e r-ing (moksa). The five moral aff l i c t i o n swithin yoga are spiritual ignorance(avidya), pride (asmita), desire(raga), aversion (dvesa), and fear ofdeath (abhinivesa) (Gates, 2002). Ingeneral, classical yoga follows theYoga Sutras of Patanjali (Feuerstein.2003). However, the major compo-nent of We s t e rn yoga practice is therelationship between the ãsanas (pos-t u res) and prãnãyãma (mindfulb reathing).

Modern Western Yoga

M o d e rn yoga refers to certain typesof yoga that evolved primarily fro mthe interaction of We s t e rn individualsi n t e rested in yoga over the last 250years (DeMichelis, 2004). Prior to1849, yoga was not considered anoption of practice, but rather, an intere s t-i n g E a s t e rn phenomenon (DeMichelis,2004). In 1893, Swami Vi v e k a n a n d aattended the Chicago Parliament ofReligions and presented Hinduism andyoga to the West. The Swami is cre d-ited for “reshaping” the yoga tradition(DeMichelis, 2004, p. 3). In 1966,B.K.S. Iyengar presented yoga withinthe framework of We s t e rn anatomyand physiology and self-help. Theãsanas were related to We s t e rn ill-nesses and conditions, and addre s s e dspecific body parts.

The dissemination of yoga to theWest modified facets of the practice toc o n f o rm to the needs and sensibilitiesof We s t e rn students (Feuerstein,2003). The modern practice of yoga isv e ry diff e rent from the classical Hindupractice that was grounded in spiritualdevelopment. Modern yoga re f l e c t s


ronment, emphasis on breathing orp o s t u res, and methods differ by style(Feuerstein, 2003).

Yoga for ChildrenThe yoga teacher brings his or her

philosophy and style to the class, andshould adapt the style to child devel-opmental and physical needs. Thefocus in childhood is less on the per-fection of postures than the cultivationof compassion, non-judgment, con-nection between breath and posture s ,and forging the foundations of a life-long practice. However, certain stylesof yoga may not be appropriate forc h i l d ren. For example, Bikram andAshtanga styles of yoga re q u i re thepractitioner to be in excellent physical

Meyers, Sternlieb, & Zeltzer, 2004),i m p roves hypertension (Gupta et al.,2002; Sivasankaran et al., 2006), andreduces coro n a ry art e ry disease(Gupta et al., 2002), stress (Brown &G e r b a rg, 2005; Granath, Ingvarsson,von Thiele, & Lundberg, 2006;Michalsen et al., 2005), depre s s i o n(Butler et al., 2008; Michalsen et al,2005; Wo o l e ry et al., 2004), and pain(daSilva, Lorenzi-Filho, & Lage,2007).

A review of 24 articles of yoga forc h i l d ren revealed a large variety ofoutcomes and measures, lack ofadverse re p o rting, small sample sizes,and low power (Galantino et al.,2008). The paucity of high qualitystudies of yoga in children limits theusefulness and generalizability of thefindings. However, evidence suggeststhat yoga is associated with impro v e dc a rdiovascular status, physical func-tioning, and behavior (Galantino et al.,2 0 0 8 ) .

Yoga may improve attention andemotional control. Jensen and Kenny(2004) studied 19 boys with attentiondeficit hyperactivity disorder (ADHD).Despite low power, varied attendance,and lack of determination of qualityand duration of home practice, therewas a re p o rted reduction of moodswings, temper outbursts, and cry i n gfits on the Conners Global EmotionalLiability Index for the 11 boys in thei n t e rvention group compared to the 8boys in the control group. This is con-sistent with a paper by Nardo andReynolds (2002) (as cited in Peck,Kehle, Bray, & Theodore, 2005) p re-sented at the annual meeting of theNational Association of SchoolPsychologists described by Peck et al.(2005), who re p o rted that yoga pro-motes self-control, attention, concen-tration, self-eff i c a c y, body aware n e s s ,and stress reduction.

Yoga may play a role in the man-agement of chronic illness. In a studyo f 25 participants ranging in age fro m11 to 18 years (20 girls and 5 boys)with irritable bowel syndrome practic-ing yoga daily for four weeks, subjectsre p o rted less functional disability,d e c reased emotion-focused avoid-ance, and decreased anxiety com-p a red with a wait list control gro u p(Kuttner et al., 2006). The mechanismof action of yoga remains unclear.

Yoga may affect the functioning ofthe pre - f rontal cortex, including theability to plan and execute complexfunctions. After one month of 75 min-utes of daily yoga, breathing, intern a lcleansing practices, meditation, devo-tional songs, and relaxation, 10 to 13-y e a r-old girls decreased the time

condition. Bikram yoga is practiced inan excessively hot room. Ashtangayoga focuses on strength training andrapid movements.

The effects of yoga in childre nremain unsupported due to smallsample sizes, inconsistent interv e n t i o ndescription, varying outcome meas-u res, and low power. Research withadults is also limited by the lack ofc o n t rol groups and explication of thespecific yoga intervention or duration.H o w e v e r, findings in adults suggestthat yoga improves symptoms of anx-iety (Brown & Gerbarg, 2005; Gupta,Khera, Vempati, Sharma, & Bijlani,2002), enhances relaxation (Smith,Hancock, Blake-Mort i m e r, & Eckert ,2007; Waelde, Thompson, &G a l l a g h e r-Thompson, 2004; Wo o l e ry,

Yoga for Children

Ta ble 1.Styles of Hatha Yo g a

Hatha Yoga Style C h a r a c t e r i s t i c s

I ye n g a r Uses props, such as bl o ck s, stra p s, bags, and cushions, toconnect the body and mind chiefly through careful ãsanas.

Ashtanga (powe r ) The focus is on strength and flexibility tra i n i n g .M ay be fo u n din gyms and health clubs.

B i k ra m Includes vigorous postures in a standard sequence in aroom heated to 100 to 110 degrees F. The practitioner mu s tbe physically fit.

I n t e gra l Po s t u r e s, breathing techniques, relaxation, and meditationwith an emphasis on the function of the practice rather thanexplicit fo rms and techniques.

K ri p a l u Includes three stages created for We s t e rn students.The firststage includes body and breath awa r e n e s s. The secondstage focuses on holding the postures for a longer time.T h ethird stage is referred to a meditation in motion because iti nvo l ves a deeply relaxed mind leading to spontaneousu n s t ructured move m e n t s.

V i n i yo g a Sequence of postures focused on the individual’s phy s i c a land mental capacity with an emphasis on the coordinationof breath and postures.

S i va n a n d a S e ries of 12 postures that include mantra chanting, relax-ation, and breathing exe r c i s e s.

Ananda Gentle move m e n t s, meditation, affirm a t i o n s, and special-i zed energetic breathing exercises called kri ya to conscious-ly direct the life force (prana) to all parts of the body.

Ku n d a l i n i Po s t u r e s, breath control, chanting, and meditation are usedto awa ken the innate energy, considered coiled like a ser-pent within the lower abdomen.

Hidden language E m p h a s i zes physical well being and self-understandingthough the study of the symbolism in the postures.

S o m a t i c - i n t e gra t e d S l ow postures with visualization and conscious breathingwith relaxation between postures joined with principles ofp s y c h o p hysiology to connect body and mind.

S o u rc e : Adapted from Feuerstein, 2003.


re q u i red to execute a mental test(Manjunath & Telles, 2001). Theauthors suggested that yoga in-c reased blood flow to the frontal lobe,which resulted in the rapid re a l i z a t i o nand correction of erro r s .

Yoga may also influence neuro-transmitter function. For example, asignificant 27% increase in brain y-aminobutyric acid (GABA) levels thatmay affect mood was found in 8 expe-rienced adult yoga practitioners com-p a red with 11 non-practicing contro l s .D e c reased GABA is associated withd e p ression and anxiety (Streeter et al.,2 0 0 7 ) .

The postures and breathing mayi m p rove the strength and flexibility ofmuscles while increasing circ u l a t i o n ,uptake of oxygen, and functioning ofh o rmones. The parasympathetic ner-vous system may become more dom-inant and stabilize the autonomicn e rvous system to enhance re s i s t a n c eto the effects of stress (Parshad,2 0 0 4 ) .

Some yoga programs for childre nhave been met with resistance to asystem viewed as Hinduism and amethod of spreading Eastern mysti-cism. To compensate for these con-c e rns, yoga teachers within schoolschange the terminology fro mprãnãyãma to “bunny breathing” ormeditation to “time in.” Pro g r a m sre p o rted in the media, such as the“Power Moves Kids Program for PublicSchools,” include character- b u i l d i n gcomponents, such as quotes byM a rtin Luther King, Jr. (CNN.com,2007).

Components of a YogaPractice for Children

Common components necessarywhen teaching yoga to children oryoung adolescents include the envi-ronment and atmosphere, parts of ayoga session, and re c o m m e n d e dlength of the class. The enviro n m e n tmay be a special location or “space”to help with relaxation and the con-cept of removing oneself from theusual daily hassles. Shoes are usuallyremoved before entering the ro o m( M e t z g e r, 2002, 2003). If the class isin a usual classroom or gym, a nightlight may be used or the lights may bet u rned down with soft music playing.Candles or incense should be avoidedto reduce the risk of fire or allergic re s-p i r a t o ry symptoms in susceptible chil-d ren. The class should be conductedwith a feeling of compassion and non-judgment, and without competition( M e t z g e r, 2003).

The parts of each yoga class

may be used with younger childre n( M e t z g e r, 2002, 2003). A warm - u pperiod of gentle movements, includings t retching, will pre p a re the body forthe postures. This period may alsoinclude songs or chants for all ages( M e t z g e r, 2002, 2003).

The postures (ãsanas) may beclassified as a) standing, b) seated, c)balance, d) twists, e) supine, f) for-w a rd bends, g) backbends, and h)inversions (Metzger, 2002, 2003). Theinversions include postures in whichthe legs are above the level of theh e a rt. For example, a shoulder standinvolves balancing on the uppershoulders while the legs and back areraised in the air.

The postures may be held to thecount of 10, but the individual’s bodyresponse needs to be the guide, andc h i l d ren need to be reminded that theyshould not force a position or be inpain. If a child is believed to be anx-ious due to stre s s - related symptoms,the pose may be held for one to twominutes, if possible (Luby, 1998).C h i l d ren less than 6 years of age canbe encouraged to hold postures for 20seconds to one minute. Children olderthan 6 years of age may hold posture sfor one and a half minutes (Khalsa,1 9 9 8 ) .

C h i l d ren may be instructed in thep o s t u res in relation to imitating plants,objects, or animals (see Figures 1 and2). Some programs for children pro-vide pictures of the object for the childto imitate. Some animals used as aguide are a pigeon, lion, mouse,mountain, or tree. For example, themountain pose emphasizes feelings t rong and steady. The tree encour-ages balance. Younger children mayneed to look at the pictures and try tomake their bodies look like the pose inthe pictures while following thet e a c h e r ’s instructions (Luby, 1998).

During the postures, children needto be reminded to inhale and exhalethe breath in relation to movement.Each posture should be followed byone to two deep breaths. After pos-t u res that are more strenuous or diff i-cult, a short relaxation period ofa p p roximately 15 seconds on the flooris recommended (Khalsa, 1998).During the movements, the childneeds to breathe slowly and deeplyt h rough the nose. The breath shouldnot be forced or held. The posture smay be in any ord e r, but there needsto be a concentration on balance. Forexample, if the child bends forw a rd ,the next posture should involve bend-ing backward. The postures shouldnot hurt, and children need to bereminded to feel their body during a

include quieting the mind, posture sand breathing, relaxation, and a re a d-justment time to bring the mind andbody back to normal activity. For chil-d ren, these phases may be describedas a warm-up, breathing, posture s ,and relaxation (Schwartz, 2003).

The class may begin by layingdown, sitting cross-legged on the floor,or sitting in a chair. Special objectsmay be used to symbolize a specialtime for relaxation. This may be ayoga mat, pillow used exclusively foryoga and relaxation, special clothing,blanket (DeMichealis, 2004), ors t u ffed animal (Metzger, 2002, 2003).C h i l d ren are encouraged to shut theireyes only if they feel comfort a b l edoing so. Yoga is not competitive andshould not hurt. Children, especially ifused to competition and sports, needto be reminded not to compare them-selves to classmates. Explaining thisto children in the beginning is impor-tant to encourage children to focus onthemselves without concern for beinglaughed at or not keeping up with theclass.

The mental quieting phase focuseson leaving worries behind. For chil-d ren, this may be thinking of one thingthat worries them and mentally imag-ining the worry flying away or thro w-ing it away. For younger children at am o re concrete operational level, thew o rry may be written, then torn up orhung on a tree. The concept is to bringwhat is the most concerning issue forthe child into consciousness and dis-c a rd it from his or her mind.

How well children feel they do yogaone day may change the next sessionand is not as important as doing thebest they can and to concentrate onb reathing. One technique is to focuson the breath and picture a colorf u lballoon in their bodies with the open-ing near the chest and the bottom atthe stomach. As they breathe ind e e p l y, they are instructed to feel theair fill the balloon. When they bre a t h eout slowly, they are to imagine the airmoving back up the balloon to theopening of the balloon at the chest( L u b y, 1998).

Another example is to sit cro s s -legged on the floor with hands togeth-er at the center of the chest. After theeyes are closed, the children arei n s t ructed to feel as if they can seef rom the center of their fore h e a dbetween their eyes. At the same time,they are guided to feel a warm glow intheir heart. Then they are guided tob reathe in and out slowly and deeplyt h rough the nose three times (Khalsa,1998). Special age-appropriate activ-ities, such as songs, chants, or crafts


p o s t u re and only go as far as the bodyfeels comfortable. Practice and slowconcentrated eff o rt can lead to in-c reasing flexibility (Schwartz, 2003).

The relaxation or meditation periodoccurs after the completion of thep o s t u res. This may include laying onthe floor supine with the eyes shut andconcentrating on breathing, a sound,or the repetition of a phrase. A soundor phrase may be repeated to helpc h i l d ren increase their concentrationon breathing. Children may beencouraged to visualize a picture andhold it in their mind (Schwartz, 2003).T h e re may also be a guided visualiza-tion, such as imaging lying on a cloudand floating through the sky. After therelaxation period, there is a slowreawakening to normal activity bys t retching or wiggling fingers and toes.If they are lying down, they will bei n s t ructed to roll over to one sideb e f o re slowly arising (Metzger, 2002,2003). This may last under three min-utes for children between 3 and 6years of age, and longer in older chil-d ren (Luby, 1998). As children geto l d e r, this period will increase, but thisdepends on the individual child.

The frequency of practice is ideallyfour to six times a week to best enjoythe cumulative benefits of yoga, but atleast once a week is re c o m m e n d e d .The length of a yoga class depends onthe attention span and developmentalage of the students. A class for adultsmay last from one to two hours. Forc h i l d ren less than 6 years of age, theclass may be 15 minutes. A class forc h i l d ren between 7 and 9 years of agemay be 25 minutes in length (Khalsa,1998).

Disease Control and Prevention [CDC],2 0 0 9 ) .

Yoga mats are worth purc h a s i n g .Mats range in price from $11 to over$100 depending on size, thickness,material, and decorative features. A1/8-inch thick standard mat is ade-quate ($11 to $16). A small pillowmay increase comfort when sitting onthe floor. Some teachers re c o m m e n da strap or foam block or thick blanketto help with postures if the person isnot flexible enough to reach toes or liftlegs, but this is not necessary( M e t z g e r, 2002, 2003). To pre v e n ti n j u ry, movements must be slow, withconcentration as postures arechanged (Luby, 1998). A water bottlemay be kept near children to sipt h roughout the class. The ro o mshould be heated to a comfort a b l et e m p e r a t u re and the postures shouldnot be strenuous enough to cause pro-fuse sweating.

Yoga should not be perf o rm e dwhen a child is sick, such as with acold, flu, headache, or vomiting.I n v e rted postures (with the legsextended above the heart or head)that put pre s s u re on the head, neck, orshoulders should be avoided. Specificp o s t u res that increase pre s s u re ortwisting motions should be avoided inc e rtain circumstances. For example,c h i l d ren suffering from migraineheadaches or from any condition thatis affected by extra pre s s u re to thehead or neck, such as hypertension orc a rdiac problems or menstrual period,should avoid shoulder stands.C h i l d ren with back pain or pro b l e m sshould also avoid shoulder stands aswell as the boat position (lying on thestomach with arms behind the backholding up bent legs at the ankles)

Safety Guidelines for YogaPractice

P r i m a ry safety issues surro u n d i n gthe practice of yoga involve the safetyof the environment including practicingon level ground, using a clean mat,moving slowly and carefully withoutpushing beyond capabilities, and con-traindications to postures or practice.The yoga practice is best done on anempty stomach because some pos-t u res raise the stomach above thehead, which may cause re g u rgitation ofstomach contents. Before a yoga prac-tice, children should wait 2 to 4 hoursafter a large meal or 1 to 2 hours aftera light meal (Schwartz, 2003). Yo g ashould be practiced on level gro u n dwith as little distractions as possible toencourage focus and concentration.

To practice yoga, a mat is best top revent slipping. If yoga is being doneon a carpet, this is less import a n t ,although dust mites in carpets may bea concern for children with asthma.Scented candles should be avoideddue to the potential exacerbation ofasthma and fire.

The yoga mats need to be cleanedre g u l a r l y. To clean mats, follow them a n u f a c t u re r ’s directions. Some matscan be machine-washed. In general,mats can be washed with 2 cups ofwater mixed with 4 drops of dish soapand wiped with a damp sponge, thenrinsed, dried with a towel, and hung tod ry (Raskin, 2009). Mats at yoga stu-dios and gyms with multiple usersshould be washed with a disinfectantand discarded after 1 year. The label ofthe disinfectant should be re g i s t e re dwith the U.S. Environmental Pro t e c t i o nAgency (EPA), and the label shouldread that it is effective againstStaphylococcus Aureus (Centers for

Yoga for Children

Figure 1.9 - Ye a r-Old Alyssa White in Bow Pose

( D h a nu r a s a n a )

Figure 2.9 - Ye a r-Old Alyssa White in Mouse or Child’s Po s e

( G a r b h a s a n a )


that strains the back. Problems suchas asthma or bronchitis may be exac-erbated by special yoga bre a t h i n gtechniques; there f o re, concentrationmay need to focus only on a simplea w a reness of the breath going in andout at a normal depth and fre q u e n c y.C h i l d ren with any hernia should avoidf o rw a rd bending postures (Schwart z ,2 0 0 3 ) .

C h i l d ren limited to wheelchairs areable to participate in yoga by focusingon the breath and movements of theupper body and head. An experiencedyoga teacher should be able to adaptthe postures for children with specialneeds. If a child cannot do a standings t retch, he or she may be able toadapt it to lying down or sitting( S c h w a rtz, 2003).

Locating a Yoga ProgramFor Children

To locate an appropriate yoga classfor children, parents may ask physicaleducation teachers, dance teachers,and sports coaches; talk to peoplea l ready practicing yoga; refer tobooks or yoga magazines (Schwart z ,2003); and ask at mothers’ groups orthe local YMCA (Metzger, 2002,2003). Yoga studios can be found inlocal phone books and Intern e tre s o u rces, such as those listed inTable 2.

C e rtification may be inconsistent,and a minimum of a weekend orweek-long training in yoga for childre nis suggested. Some reputable trainingin yoga for children is also listed inTable 2. The teacher should practiceyoga regularly and have basic knowl-edge of yoga, safety, benefits of yoga,and contraindications of postures (M.M e t z g e r, personal communication,J a n u a ry 22, 2009).

Specific questions to ask theteacher depend on the age and specialneeds of the child, and pare n t a l

activities, such as singing, chanting,crafts, or make believe play, may benoted in classes for younger childre n .The atmosphere should feel peaceful,s u p p o rtive, calm, warm, spacious,level, and uncluttered. Music is usual-ly playing. There should not be anycandles burning. The teacher shoulddemonstrate the posture first and notfocus on perfection (Metzger, 2002,2003).

The age range of the children in theclass and the number of children per

expectations from yoga. The pare n tneeds to notify the teacher about anyhealth problems and concerns, andassess the experience of the teacherwith these issues. Additional questionsto consider are listed in Table 3.

P a rents may observe the classprior to registration to determine whattypes of activities are perf o rmed, thet e a c h e r ’s manner, and the enviro n-ment. The children should appear tobe having fun and receive kind atten-tion from the teacher. Age-appro p r i a t e

Ta ble 2.R e s o u rces to Find Yoga Pro g r a m s

Web Site D e s c r i p t i o n

w w w. yo g a a l l i a n c e. o r g P r ovides info rmation regarding certified programs and teachers.

w w w. c o l o rm eyo g a . c o m P r ovides trainings and classes specializing in yoga for children.

w w w. yo g a j o u rn a l . c o m P r ovides basic info rmation about yoga issues.

w w w. yo g a f i n d e r. c o m Assists in locating yoga programs intern a t i o n a l l y.

w w w. s p e c i a l yo g a . c o m P r ovides info rmation and trainings for children with special needs.

w w w. yo g a s e e ke r. c o m Lists teachers and yoga schools.

w w w. yo g a . c o m Finds classes and studios.

w w w. c h i l d r e n s yo g a . c o m P r ovides trainings and classes specializing in yoga for children.

w w w. yo g a k i d s. c o m P r ovides trainings and classes specializing in yoga for children.

Ta ble 3.Questions to Consider When Assessing a Yoga Pro g r a m

Te a cher Characteristics

What is the teacher’s ex p e rience with this age gr o u p ?

For how many years has the teacher practiced yo g a ?

Where did the teacher train and what certification does he or she have ?

What special needs training and ex p e rience has he or she had?

What should the child expect to learn ?

What are the benefits of the class?

Po l i cy

What is the policy for behavior and discipline?

What are the policies regarding fe e s, cancellations, and make-up classes? Is there liability insura n c e ?

Are guardians expected to stay ?

For toddlers, are diapers allowe d ?

Logistics and Routine

H ow many children are in the class? What is the age range of the students?

H ow many teachers are in one class? Are there any assistants?

H ow long is the class?

What is the routine of the class?

What does the child need for the class?

Is a snack prov i d e d ?

Is a bathroom on site and what supervision is ava i l a ble for bathroom use?

S o u rc e : M . M e t z g e r, personal communication, Ja nu a ry 23, 2009.


class may vary by the availability ofclasses. In areas where there aremany classes, single-age classes maybe off e red. Other locations with lessi n t e rest or yoga classes may only off e rclasses with mixed ages. According toa pediatric yoga expert (M. Metzger),it is recommended that toddlers, aswell as children younger than 5 yearsof age, have their own class. Childre nbetween 5 and 11 years of age may betaught together, but 10 to 11-year- o l dc h i l d ren may not want to share a classwith younger children. By 11 years ofage, children may also desire singlegender classes. The ideal number ofc h i l d ren per class is 6 to 10. Over 10c h i l d ren may necessitate a secondteacher (M. Metzger, personal com-munication, January 22, 2009).

Once having attended classes andl e a rned basic postures, children maypractice yoga at home with the samesafety re q u i rements. An area in thehome may be designated as a specialplace for calmness and yoga practice.Despite practice at home, form a lclasses are recommended to periodi-cally check proper postures andb reathing (Schwartz, 2003).

Nursing Implications C h i l d ren use complementary and

a l t e rnative medicine (CAM), includingyoga. There f o re, nurses need toe n s u re child safety and assessp a rental knowledge re g a rding expec-tations and interactions. A recent sur-vey of 281 families in general pedi-atrics and specialty care re p o rted ahigh percentage of children usingCAM therapies. The survey re p o rt e dthat 61.9% of children with epilepsy,59% of children with cancer, 50.7% ofc h i l d ren with asthma, 47.4% of chil-d ren with sickle sell disease, and 36%of general pediatric patients used aCAM therapy (Post-White, Fitzgerald,Hageness, & Sencer, 2009). Despitethis re p o rted use, many patients donot re p o rt their use of CAM to healthc a re providers (Shakeel, Little, Bru c e ,& Ah-See, 2007).

Tindle, Davis, Phillips, andE i s e n b e rg (2005) re p o rted that yogais one CAM therapy that has incre a s e din use between 1997 and 2002. Whenasked which CAM therapies theywould be most willing to use, adoles-cents with chronic pain re p o rted awillingness to try yoga (Ts a o ,M e l d rum, Kim, Jacob, & Zeltzer,2007).

Nurses need to be knowledgeableabout evidence-based practices, pa-tient safety, and all methods of carethat may enhance health and healing.

Fow l e r, S., & Newton, L. ( 2 0 0 6 ) . C o m p l e-m e n t a ry and altern a t i ve thera p i e s : T h enu r s e ’s role. J o u rnal of NeuroscienceNursing, 38(4), 261-264.

G a l a n t i n o, M., Galbav y, R., & Quinn, L.( 2 0 0 8 ) . T h e rapeutic effects of yoga fo rc h i l d r e n : A systematic rev i ew of the liter-a t u r e. Pe d i a t ric Physical T h e ra py, 20( 1 ) ,6 6 - 8 0 .

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CAM practices incorporating mindand body are consistent with nursingt h e o ry and practice, which focus onwholeness and healing (Fowler &Newton, 2006). Yoga may be a pro m-ising nursing intervention to enhancewell being for children of many agesand capabilities.

R e s e a rch is greatly needed to eval-uate the purported health claims ofyoga in children and provide evidencefor the best styles and practices forc h i l d ren at specific ages and healthneeds. For children, yoga should be afun way to learn how to relax theirminds and exercise their bodies. Thepractice of yoga may serve as a foun-dation for the nurturing of innerre s o u rces and strengths to facilitatelifelong health and well being.

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Yoga for Children

continued on page 295


S c h wa rt z . E . ( 2 0 0 3 ) . I love yo g a. P l a t t s bu r g h ,N Y: Tu n d ra Books.

S h a keel, M., Little, S., Bru c e, J., & Ah-See, K.( 2 0 0 7 ) . Use of complementary anda l t e rn a t i ve medicine in pediatric oto-l a ryngology patients attending a tert i a ryhospital in the UK. I n t e rnational Journ a lof Pe d i a t ric Otorhinolary n g o l o g y,7 1(11), 1725-1730.

S i va s a n k a ran, S., Po l l a r d - Q u i n t n e r, S. ,S a c h d eva, R., Pugeda, J., Hoq, S. M., &Z a rich, S.W. ( 2 0 0 6 ) .The effects of a six-week program of yoga and meditationof brachial art e ry reactivity: Do psy-chosocial interventions affect va s c u l a rtone? Clinical Cardiology, 29(9), 393-3 9 8 .

Smith, C., Hancock, H., Blake - M o rt i m e r, J., &E cke rt, K. ( 2 0 0 7 ) . A ra n d o m i zed com-p a ra t i ve trial of yoga and relaxation to re-duce stress and anxiety. C o m p l e m e n t a ryT h e ra p i e s, 15(2), 77-83.

S t r e e t e r, C., Jensen, E., Pe rl mu t t e r, R.,C a b ral, H., Tian, H., Te r h u n e, D., et al.( 2 0 0 7 ) . Yoga asana sessions increaseb rain GABA leve l s : A pilot study. T h eJ o u rnal of Altern a t i ve and ComplementaryM e d i c i n e, 13(4), 419-426.

T i n d l e, H., Dav i s, R., Phillips, R., &Eisenberg, D. ( 2 0 0 5 ) . Trends in use ofc o m p l e m e n t a ry and altern a t i ve medi-cine by U. S. a d u l t s : 1 9 9 7 - 2 0 0 2 .A l t e rn a t i ve T h e ra p i e s, 11(1), 42-49.

T s a o, J., Meldrum, M., Kim, S., Ja c o b, M., &Z e l t ze r, L. ( 2 0 0 7 ) . Treatment prefe r-ences for CAM in children with chronicp a i n . Evidence-Based Complementaryand Altern a t i ve Medicine, 4(3), 367-3 7 4 .

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Wo o l e ry, A., Mye r s, H., Stern l i e b, B., &Z e l t ze r, L. ( 2 0 0 4 ) . Yoga intervention fo ryoung adults with elevated symptoms ofd e p r e s s i o n . A l t e rn a t i ve T h e rapies inHealth and Medicine, 10(2), 60-63.

A dditional ReadingR o d g e r s, B., & Yen, W- J. ( 2 0 0 2 ) . R e - t h i n k i n g

nursing science through the under-standing of Buddhism. Nursing Philosophy,3(3), 213-221.

Yoga for Childrencontinued from page 283

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