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doors (Mayo Clinic: Diseases and Conditions – Depression and anxiety: Exercise eases symptoms, 2014). Because children with CD often display some of the symptoms above such as overwhelming feelings of sadness, numbness, and frustration, it is very likely that the children struggle socially. Recess helps improve the social skills of all children, including children with disabilities, in many ways. In addition to helping with creativity, it improves leadership skills, negotiation tech niques, and conflict resolution as well (Kovar, et. al, 2011). These are all core skills that children who are able to go to school on a consistent basis have more opportunity to learn. Playtime, if run correctly, including with proper supervision and modifications helps children to make more friends at school, which improves mental health and, in turn, academic performance. Recess Activity Accommodations for Children with Crohn’s Disease Accommodations to assist in making the recess setting more accessible, enjoyable, and allow for other positive effects of re cess for children with CD should be implemented by school per sonnel. Because of intestinal characteristics, procedures should be implemented to allow for students that need quick and easy access to bathrooms. It might be helpful to appoint a designat ed staff member who is ready to take children with CD to the restroom promptly. School personnel should encourage low to moderate intensity exercises. Low intensity exercises may in clude slow walking, light yoga, or tossing and catching a soft ball. Moderate intensity exercises may include jogging slowly for a short distance, jogging a “route” before catching a football, and shooting a basketball in a game of horse. As noted, tossing balls is a good activity, however staff should be mindful if their students have a stoma bag. If students have a stoma bag, shorter and softer tosses, with a soft ball should be stressed and extra supplies should be on hand in the nurse’s office to change the bag if needed. Cycling is beneficial for children with CD. The avail ability and use of a stationary bike is recommended (Crohn’s and Colitis Foundation, Exercise, n.d.). Activities that should be avoided include ones which are more likely to bruise students, as children with CD take longer to heal from injuries due to malnu trition. Similarly, activities that increase the likelihood of fractur ing a bone should be avoided. If a student suffers from cramps or gets uncomfortable during exercise, staff should encourage them to lightly stretch their body. As with all students, modifications can benefit them during the day. Conclusion In conclusion, recess provides significant emotional, physi cal, and social benefits for students with CD. Teachers and other school staff should know the definition, symptoms, and preva

lence, and recess accommodations for students with CD. Teach ers should monitor their student’s wellbeing during recess and throughout each day and be aware of the particular CD symp toms displayed by their student with CD. References Bilski, J., Brzozowski, B., Mauer-Bialy, A., Sliwowski, Z., Brzo zowski, B. (2014). The role of physical exercise in inflamma tory Bowel Disease. BioMed Research International, (2014), 1-14. Retrieved April 21, 2022 from https://www.hindawi. com/journals/bmri/2014/429031 Cao, Q., Huang, Y.-H., Jiang, M., & Dai, C. (2019). The preva lence and risk factors of psychological disorders, malnutrition and quality of life in IBD patients. Scandinavian Journal of Gastroenterology , 54 (12), 1-9. Retrieved February 28, 2022, from https://pubmed.ncbi.nlm.nih.gov/31791216/ Crohn's and Colitis Foundation: Causes of Crohn's disease . (n.d.). Retrieved February 28, 2022, from https://www.crohn scolitisfoundation.org/what-is-crohns-disease/causes Crohn's and Colitis Foundation: Exercise (n.d.). Retrieved Febru ary 28, 2022, from https://www.crohnscolitisfoundation.org/ campus-connection/navigating-college/exercise Everhov, Å. H., Kalman, T. D., Söderling, J., Nordenvall, C., Halfvarson, J., Ekbom, A., Ludvigsson, J. F., Olén, O., & Myrelid, P. (2021). Probability of stoma in incident patients with crohn's disease in Sweden 2003-2019: A population based study. Inflammatory Bowel Diseases , 28 (8), 1160 1168. Retrieved April 20, 2022, from https://pubmed.ncbi. nlm.nih.gov/34618020/ Kovar, S., Combs, C., Campbell, K., Napper-Owen, G., & Wor rell, V. (2011). Elementary Classroom Teachers as Movement Educators . Mcgraw Hill: New York, NY. Lucas, M.D. (2015). Students with depression in recess. The Vir ginia Journal , 36 (1), 8-9. Mayo Clinic: Diseases and Conditions – Depression (major depressive disorder) (2014). Retrieved April 21, 2022 from https://www.mayoclinic.orgg,diseases-conditions/depression/ symptoms-causes/syc-20356007 Ng, V., Millard, W., Lebrun, C., & Howard, J. (2006). Exer cise and Crohn’s disease: Speculations on potential benefits. Canadian Journal of Gastroenterology, 10 (1), 657–660. Ploeger, H., Obeid, J., Nguyen, T., Takken, T., Issenman, R., de Greef, M., & Timmons, B. (2012). Exercise and inflammation in pediatric Crohn's disease. International Journal of Sports Medicine , 33 (8), 671-691. Retrieved February 28, 2022, from https://pubmed.ncbi.nlm.nih.gov/22562735/ U.S. National Library of Medicine. (2021). Crohn's disease. MedlinePlus . Retrieved February 28, 2022, from https://med lineplus.gov/crohnsdisease.html

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