Caring for children by supporting parents

Schuster Supporting ParentsA mother brings her toddler in for a well-child visit. When the pediatrician asks how things are going, and the mother says, everything’s fine. The pediatrician asks whether she’s getting enough support at home, to which she cautiously responds that some days can feel like more than she can handle. 

Delving a little deeper, the pediatrician learns that the mother recently lost her father, is having trouble sleeping and hasn’t been engaging or playing with her child. After the pediatrician determines the mother is not at immediate risk for harming herself or her child, the clinic nurse helps her make an appointment with her primary-care provider.


This scenario — and many others like it — are part of the well-child visit anatomy. Experts say, the traditional 15-to-30-minute appointment is not only an opportunity for pediatric providers to track a child’s growth and development, but also check in with parents and discuss their concerns.

“Pediatric providers play an important role in supporting parents,” says Mark Schuster, MD, PhD, chief of the Boston Children’s Hospital Division of General Pediatrics.

“It’s our job to promote children’s healthy physical, behavioral and emotional development, and doing so often requires working with and supporting parents.”

Pediatric providers are uniquely positioned to promote positive parenting practices and provide support to parents through anticipatory guidance, identification of family or child needs and more. The well-visit scenario mentioned above is described in the new perspective article published in The New England Journal of Medicine entitled, Caring for Children by Supporting Parents. Co-authored by Schuster, who is also the William Berenberg Professor of Pediatrics at Harvard Medical School, and Elena Fuentes-Afflick, MD, MPH, a professor at the University of California, San Francisco School of Medicine, the article describes findings from a recent National Academy of Medicine report on supporting parenting of young children. The report presents the idea that although pediatric providers’ interactions with families are intermittent, the support, education, and counseling that they offer parents can have lasting effects on both the parent and the child.

“Pediatric providers are uniquely positioned to promote positive parenting practices and provide support to parents through anticipatory guidance, identification of family or child needs and more,” he says.

The article cites additional opportunities to provide parental support including:

  • one-on-one interactions
  • education on a wide range of topics such as eating habits, discipline, and firearm safety
  • adopting team-based approaches to care through which nurses, social workers, community health workers and other professionals assist with eliciting parents’ concerns
  • referrals to practice-, clinic- or community-based programs

The challenge

Physicians may find it challenging to expand the amount of counseling they provide to parents during a typical 15-to-30-minute pediatric visit. Schuster says that although well-child visits are an ideal time to offer anticipatory guidance and assess families’ needs, physicians may also provide support during other clinic visits or call on other members of the care team to assist.

“Team-based approaches to care can facilitate efforts to provide counseling to parents and address all of their concerns within the constraints of a typical visit and can also improve care coordination and follow-up,” he advises.

The power of positive parenting practices

Parents have substantial influence on their children during early childhood, but the perspective notes that in some cases, parents may be uncertain, misinformed, overwhelmed or depressed, Schuster adds. The article identifies several parenting practices associated with positive health outcomes for children. These include:

  • ensuring children receive adequate physical activity and nutrition
  • promoting household and vehicle safety
  • monitoring (supervising children’s activities and being aware of where they are and whom they are with)
  • using appropriate discipline
  • establishing routines
  • reading books and talking with children

“Although pediatric providers can work to ensure the healthy development of children, parents typically spend much more time with their child and are a dominant influence on their child’s health and well-being,” says Schuster. “By supporting parents and taking the time to learn about their needs and concerns, clinicians can have an even greater effect on the health of children.”

Read the paper published in The New England Journal of Medicine.