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PEDIATRICS Vol. 107 No. 1 January 2001, pp. 195-197
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ABSTRACT |
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Children's brain growth, general health, and development are directly influenced by emotional relationships during early childhood. Contemporary American life challenges families' abilities to promote successful developmental outcomes and emotional health for their children. Pediatricians are positioned to serve as family advisors and community partners in supporting the well-being of children and families. This statement recommends opportunities for pediatricians to develop their expertise in assessing the strengths and stresses in families, in counseling families about strategies and resources, and in collaborating with others in their communities to support family relationships.
The health and welfare of children depend on the ability of
families and their community support systems to foster positive emotional and physical development. Recent scientific research confirms
that brain growth and neurophysiologic development during the first
years of life respond directly to the influence of early emotional
relationships. The neurologic pathways produced then have profound
effects on the behaviors of children and adolescents and affect their
interactions within their families and extended society.
Contemporary American life challenges families' efforts to promote
successful developmental and emotional outcomes for their children.
Longer hours away from their children, disconnection from close
extended family support, and disintegration of traditional community
interdependence all reduce the time, energy, and external supports
available for rearing healthy children. Pediatricians play a unique
role as family health advisors during the formative period of a
child's development and during crucial developmental stages throughout
childhood and adolescence. Pediatricians need expertise in assessing
family needs, strengths, and situations, along with counseling skills
to offer strategies and resources to families.
The structure of families and patterns of family life in the
United States have changed profoundly in the past quarter century. Five
percent of all births in 1960 were to unmarried women; this figure
increased to 32% by 1995.1 Since 1960, the divorce rate
has more than doubled,2-4 and it is estimated that 25%
of children growing up in this decade will experience the consequences
of divorce.5 Although remarriage rates are high, more than
a third of remarried couples are divorced again.6 As a
consequence, approximately 8% fewer children are living with 2 parents
(74.8% in 1989 vs 83.1% in 1971),7,8 and only 61% live
with both biological parents.9 Another change in family
life is that approximately 65% of all mothers with preschool-aged
children are in the labor force, reflecting a twofold increase since
1970.10 A decline in the purchasing power of family
income, the lack of comparable wages for women, and significant rates
of homelessness have all added to the stress on families. Social
disparities have also contributed to the growing percentage of children
who live in poverty. Adolescents present the pediatrician with
particular challenges for assessment and counseling. High-risk
families, including adolescent parents (single or married) also require increased attention for problem prevention and assistance. Finally, residential mobility has separated many families from the natural support systems provided by their extended families. This may leave
parents feeling socially isolated and prevents the intergenerational transmission of cultural and community-specific advice and support.
These social changes have strained the ability of families to provide
for their children's needs. Economic and social inequalities have led
to increasingly impoverished neighborhoods, more working families
living in or near poverty, and weakening of community ties. As a
result, the health, development, and well-being of children have been
jeopardized. Rising rates of child abuse and neglect, and high rates of
adolescent problems such as teenage pregnancy, drug use, dropping out
of school, delinquency, homicide, and suicide reflect the weakened
capacity of many communities to meet the needs of children and
families.
Social institutions have begun to offer various family support
services to help parents carry out essential functions on behalf of
their children. Some schools are providing after-school programs for
children whose parents cannot be at home when classes end; others are
providing school-based or associated health services to ensure that
children receive timely health care and counseling. School curricula
have expanded to include topics such as conflict resolution, sex
education, and community service. Some employers offer family-oriented
benefits such as flexible work hours, shared jobs, and child care.
Religious congregations in some communities have developed a full array
of social services and supports. The Family and Medical Leave Act of
1993 is an example of government acting in support of families, as are
more established programs such as the Supplemental Nutrition Program
for Women, Infants, and Children and Temporary Assistance for Needy
Families.
Many comprehensive, community-based family support programs have been
established around the country. These programs aim to support family
relationships and promote parental competencies and behaviors that
contribute to parental and infant/child/adolescent health and
development. The best programs offer a spectrum of services that
involve informal and structured provider groups. Topics may include
information on child development, personal growth and family
relationships, peer support groups, parent-child activities, home
visits, drop-in programs, early developmental screening, outreach,
community referral and follow-up, job skills training, and/or adult
education, especially language and literacy education.11
Services should be provided to all families regardless of their economic or ethnic background. Families participate in such programs because of 1) a need or desire for specific services; 2) difficulties encountered in using existing services, such as expense, logistics, or
red tape; and 3) the simple need to belong to a group of people with
similar concerns.12 The programs operate on the premise
that no family is entirely self-sufficient and most can benefit from
some external support.13,14 Pediatricians should search
for, become familiar with, and refer families to high-quality family
support services in their communities.
Many pediatricians are already familiar with some types of family
support programs such as home visitor programs for families with
newborn infants, family preservation programs for abused and/or
neglected children at risk for foster care placement, parent education
groups, play groups for preschool children, drop-in centers for parents
of young children, comprehensive early childhood education programs
(eg, Early Head Start, Head Start), early screening and referral
programs, crisis care programs, parent support groups, early reading
and parental literacy, early intervention programs for children with
special needs (eg, Individuals with Disabilities Education Act, Part
C), and others.
High-quality programs operate on the following principles:
CHANGES IN FAMILIES
TYPES OF COMMUNITY SUPPORT PROGRAMS
PRINCIPLES OF FAMILY SUPPORT PROGRAMS
Family support programs play an important and, in some instances, essential role in promoting the positive functioning of families and ensuring the well-being of children. Their effectiveness, at least with low-income families, is well-documented.15 All families need knowledge, skills, and support to raise their children and to foster normal growth, development, and learning. Supportive programs, however, cannot substitute for unsupportive relationships. Ultimately, even the best professional programs cannot substitute for community, nor can social services replace kindness and caring expressed within the family and by primary caregivers. The American Academy of Pediatrics encourages public policies, professional practices, and personal behavior that support the caregiving role of families, advocate comprehensive approaches to child health, and encourage prevention and early intervention strategies oriented toward the family.
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RECOMMENDATIONS |
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Abstract
Recommendation
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Committee on Early Childhood, Adoption, and Dependent Care, 2000-2001
Peter A. Gorski, MD, MPA, Chairperson
Deborah Ann Borchers, MD
Danette Glassy, MD
Pamela High, MD
Chet D. Johnson, MD
Susan E. Levitzky, MD
S. Donald Palmer, MD
Judith Romano, MD
Liaisons
Nancy Hablutzel, PhD, JD
National Council of Juvenile and
Family Court Judges
Moniquin Huggins
Child Care Bureau
Mireille B. Kanda, MD, MPH
Head Start Bureau
Pat Spahr
National Association for the Education of Young Children
Phyllis Stubbs-Wynn, MD, MPH
Maternal and Child Health Bureau
Ada K. White
Child Welfare League of America, Inc
Staff
Eileen Casey, MS
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FOOTNOTES |
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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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REFERENCES |
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