Setting and Pursuing Goals to Improve Parenting

Edward L. Schor, MD How can child health care providers best help parents with childrearing? If we are to improve children’s health, development, and well-being, we need to lift our eyes from our focus on children and pay more attention to their parents’ circumstances and behaviors. As a report from the AAP’s Task Force on the Family notes, “The health and well-being of children are inextricably linked to their parents’ physical, emotional and social health, social circumstances, and child-rearing practices.” Although a great deal of attention has recently been brought to the topic of social determinants of children’s health and to the biology of intergenerational transmission of the effects of stressful life events and experiences, the basic fact remains that children learn from their parents. Nearly everything that children experience, especially early in life, comes from their parents or other primary caregivers or is filtered through them. Later development builds on the scaffolding of this early experience. A pediatric encounter is typically a dyad—the child and parent(s) are both our patients. After child health care professionals do their work—histories and physical examinations, measuring and screening, assessing, diagnosing, prescribing, and recommending—the effectiveness of care almost always depends on subsequent actions by parents. Thus, shaping parents’ behaviors should be considered an essential process and, importantly, a primary outcome of ambulatory pediatric care. This axiom applies to basic activities—such as teaching parents to administer acetaminophen or to raise a typically developing child—and to much more difficult topics, such as teaching a family to care for a child with a complex health condition. Yet, the health care system, from training to reimbursement, fails to support this fundamental role of pediatricians.