Two-Generation Pediatric Care: A Modest Proposal

To reduce inequities in child health, we need to reduce the gap between what we know and what we do. We must challenge our practices and traditions, develop new solutions and have the strength and courage to change how we practice. Based on my experience that the best way to help children is to help their parents, and the best way to reach parents is through their children, I propose a new frame of a 2-generation approach that focuses not only on the child but also on the parents and their relationship to guide our innovation and target improvements. Pediatricians' knowledge and empathy for families is a special base to use new strategies to test ideas on a small number of families with minimal time and cost. Examples from our work includes the following: (1) identify and refer parents with mental health conditions and lack of effective contraception, (2) develop more effective approaches to explain illness and disease to parents, and (3) educate parents about the impact of social relations from infancy on; love can amplify and stress can impair brain and child development. I encourage clinicians to think about what should be changed and more importantly to be excited and brave enough to take the first steps to design and test an idea.