Lee Savio Beers, MD

Lately, I have been giving a lot of thought to the important influence fathers can have in a family.

At home, we have just celebrated Father’s Day, and I have been thankful for the great partnership my husband and I have as we juggle our crazy work schedules, school, summer camps, and soccer games. At work, I have been spending a lot of time supporting our program for teen and young adult fathers. These young men face so many challenges in their lives, and still are dedicated to "being there" for their children. No matter what kind of day I am having, when I walk through clinic and see a young father holding his child close, cooing softly to her, it always makes me smile. I suspect I am not alone in this, and yet our health care system is not always friendly to fathers (or "nontraditional" families for that matter) or encouraging of their involvement.

Importantly, every family is made up a little differently – and thus fathers may be involved in different ways. Even two families that look similar on the outside may have different schedules and family arrangements; no two families fit into the same little "box". Watching a movie about family diversity at my daughter’s school earlier this year – which talked about all different types of family structure – the father of one of her classmates turned to me at the end and said, "Well, I hope that wasn’t too confusing for my son, because our family fits into about five of those categories!"

In some families, for a variety of reasons, the father (or the mother) isn’t available to be involved. Respecting the fact that no two families are the same, and so "involvement" looks a little different in every family, it does seem clear that positive father involvement has beneficial effects for children (and also on their partners). The National Fatherhood Initiative is a great resource for information, both for providers and parents.

There is relatively little literature on the topic of involving fathers in their children’s health care, although most agree this is a worthy area of focus. The well-child visit seems an ideal place to encourage this involvement, as it is an opportunity to develop a long-term and trusting relationship with a family. Dr. Craig F. Garfield and his colleagues (Pediatrics 2006;117;e637-45) have a number of recommendations to encourage father involvement in well-child care:

• Provide the father with "relevant and helpful" (perhaps written) information about his child’s health and development.

• When both parents are present, include both in the conversation, and direct questions to both.

• Encourage all main caregivers to be present at well-child visits, in order to facilitate conversation between provider and parent, as well as between parents.

• In families where there is more than one caregiver, and only one is present at a visit, invite them to schedule the next visit at a time when everyone can attend.

• Discuss how parental responsibilities are (and should be!) shared.

• If fathers are unable to attend the visit, invite them to write their questions down and send them in.

• Consider using technology for information exchange and as an engagement tool.

I would also add that it is important to be sure all staff in your office are on the same page with this – fathers should feel as welcomed in the waiting area as they do in the exam room! In my experience, there is great variability among fathers – some are very involved and comfortable with their child’s health care, and others really hold back. Regardless, creating a warm and welcoming environment for fathers is an important first step, and something easily done.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center in Washington. She is a member of the Pediatric News editorial advisory board, a member of the American Academy of Pediatrics Committee on Residency Scholarships, and president-elect of the District of Columbia chapter of the American Academy of Pediatrics. She said she had no relevant financial disclosures.

Lately, I have been giving a lot of thought to the important influence fathers can have in a family.

At home, we have just celebrated Father’s Day, and I have been thankful for the great partnership my husband and I have as we juggle our crazy work schedules, school, summer camps, and soccer games. At work, I have been spending a lot of time supporting our program for teen and young adult fathers. These young men face so many challenges in their lives, and still are dedicated to "being there" for their children. No matter what kind of day I am having, when I walk through clinic and see a young father holding his child close, cooing softly to her, it always makes me smile. I suspect I am not alone in this, and yet our health care system is not always friendly to fathers (or "nontraditional" families for that matter) or encouraging of their involvement.

Importantly, every family is made up a little differently – and thus fathers may be involved in different ways. Even two families that look similar on the outside may have different schedules and family arrangements; no two families fit into the same little "box". Watching a movie about family diversity at my daughter’s school earlier this year – which talked about all different types of family structure – the father of one of her classmates turned to me at the end and said, "Well, I hope that wasn’t too confusing for my son, because our family fits into about five of those categories!"

In some families, for a variety of reasons, the father (or the mother) isn’t available to be involved. Respecting the fact that no two families are the same, and so "involvement" looks a little different in every family, it does seem clear that positive father involvement has beneficial effects for children (and also on their partners). The National Fatherhood Initiative is a great resource for information, both for providers and parents.

There is relatively little literature on the topic of involving fathers in their children’s health care, although most agree this is a worthy area of focus. The well-child visit seems an ideal place to encourage this involvement, as it is an opportunity to develop a long-term and trusting relationship with a family. Dr. Craig F. Garfield and his colleagues (Pediatrics 2006;117;e637-45) have a number of recommendations to encourage father involvement in well-child care:

• Provide the father with "relevant and helpful" (perhaps written) information about his child’s health and development.

• When both parents are present, include both in the conversation, and direct questions to both.

• Encourage all main caregivers to be present at well-child visits, in order to facilitate conversation between provider and parent, as well as between parents.

• In families where there is more than one caregiver, and only one is present at a visit, invite them to schedule the next visit at a time when everyone can attend.

• Discuss how parental responsibilities are (and should be!) shared.

• If fathers are unable to attend the visit, invite them to write their questions down and send them in.

• Consider using technology for information exchange and as an engagement tool.

I would also add that it is important to be sure all staff in your office are on the same page with this – fathers should feel as welcomed in the waiting area as they do in the exam room! In my experience, there is great variability among fathers – some are very involved and comfortable with their child’s health care, and others really hold back. Regardless, creating a warm and welcoming environment for fathers is an important first step, and something easily done.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center in Washington. She is a member of the Pediatric News editorial advisory board, a member of the American Academy of Pediatrics Committee on Residency Scholarships, and president-elect of the District of Columbia chapter of the American Academy of Pediatrics. She said she had no relevant financial disclosures.

Lately, I have been giving a lot of thought to the important influence fathers can have in a family.

At home, we have just celebrated Father’s Day, and I have been thankful for the great partnership my husband and I have as we juggle our crazy work schedules, school, summer camps, and soccer games. At work, I have been spending a lot of time supporting our program for teen and young adult fathers. These young men face so many challenges in their lives, and still are dedicated to "being there" for their children. No matter what kind of day I am having, when I walk through clinic and see a young father holding his child close, cooing softly to her, it always makes me smile. I suspect I am not alone in this, and yet our health care system is not always friendly to fathers (or "nontraditional" families for that matter) or encouraging of their involvement.

Importantly, every family is made up a little differently – and thus fathers may be involved in different ways. Even two families that look similar on the outside may have different schedules and family arrangements; no two families fit into the same little "box". Watching a movie about family diversity at my daughter’s school earlier this year – which talked about all different types of family structure – the father of one of her classmates turned to me at the end and said, "Well, I hope that wasn’t too confusing for my son, because our family fits into about five of those categories!"

In some families, for a variety of reasons, the father (or the mother) isn’t available to be involved. Respecting the fact that no two families are the same, and so "involvement" looks a little different in every family, it does seem clear that positive father involvement has beneficial effects for children (and also on their partners). The National Fatherhood Initiative is a great resource for information, both for providers and parents.

There is relatively little literature on the topic of involving fathers in their children’s health care, although most agree this is a worthy area of focus. The well-child visit seems an ideal place to encourage this involvement, as it is an opportunity to develop a long-term and trusting relationship with a family. Dr. Craig F. Garfield and his colleagues (Pediatrics 2006;117;e637-45) have a number of recommendations to encourage father involvement in well-child care:

• Provide the father with "relevant and helpful" (perhaps written) information about his child’s health and development.

• When both parents are present, include both in the conversation, and direct questions to both.

• Encourage all main caregivers to be present at well-child visits, in order to facilitate conversation between provider and parent, as well as between parents.

• In families where there is more than one caregiver, and only one is present at a visit, invite them to schedule the next visit at a time when everyone can attend.

• Discuss how parental responsibilities are (and should be!) shared.

• If fathers are unable to attend the visit, invite them to write their questions down and send them in.

• Consider using technology for information exchange and as an engagement tool.

I would also add that it is important to be sure all staff in your office are on the same page with this – fathers should feel as welcomed in the waiting area as they do in the exam room! In my experience, there is great variability among fathers – some are very involved and comfortable with their child’s health care, and others really hold back. Regardless, creating a warm and welcoming environment for fathers is an important first step, and something easily done.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center in Washington. She is a member of the Pediatric News editorial advisory board, a member of the American Academy of Pediatrics Committee on Residency Scholarships, and president-elect of the District of Columbia chapter of the American Academy of Pediatrics. She said she had no relevant financial disclosures.

With summer in full force, the public focusing more and more on childhood obesity and efforts in my local community to get kids out and about, it seems as if I am increasingly being asked by families for suggestions on how to increase their children’s activity level.

Appropriate and regular physical activity has many health benefits for children and adolescents. Studies have shown that regular physical activity can help aid in weight reduction, strengthen and increase bone density in healthy children, reduce the morbidity associated with obesity, improve classroom performance, and improve mental health, as was summed up in an American Academy of Pediatrics policy statement on prevention of childhood obesity through increased physical activity (Pediatrics 2006;117:1834-42). However, just as it is hard for adults to change a sedentary lifestyle, increasing physical activity can be difficult for families and children.

Assuming a family is motivated to change their habits (and this is a big assumption, I know, but many families are!), what can we advise them as their pediatricians? First, young children should participate in active, safe, and unstructured play on a daily basis. School-age children should "participate daily in 60 minutes or more of moderate to vigorous physical activity that is developmentally appropriate, enjoyable, and involves a variety of activities," Dr. William B. Strong and his associates suggested after doing a literature review to develop recommendation for physical activity for youth ( J. Pediatr. 2005;146:732-7). This 60 minutes does not need to be continuous, but can be cumulative throughout the day. Organized sports or activities deserve a special mention: These can be positive and motivating activities for youth as long as they are safe, led by qualified staff who tailor the program to the developmental age and abilities of the participating children, and enjoyable. Pediatricians can assist families in determining if a potential program would meet the needs of their child by helping them assess what their child is physically and emotionally ready for. The American Academy of Pediatrics has also published a policy statement on "Strength Training in Children and Adolescents." This is an area that many feel less comfortable giving advice in, so these guidelines are a very helpful resource (Pediatrics 2008;121:835-40).

Within my practice (and my own family!), I have developed a number of tips to help promote increased physical activity, including the following:

• Make it fun. Think about things that your child likes to do, whether it is dance, play basketball, or run around the park, and then incorporate them into your daily routines.

• Make it simple. Elaborate plans for exercise are likely to break down, leaving families frustrated. Think about things that can happen near the house, during or after school, or as a part of a usual activity. Many of the families I care for live in unsafe neighborhoods and aren’t comfortable spending a lot of time outside near their home. I often suggest that they just turn on their favorite music and dance for 20 minutes in the living room. It is a fun, active, and simple way to get moving.

• Turn off the screen. If you are sitting and looking at a TV, computer, or handheld game, you are not moving.

• Involve the whole family. Our family likes to go for runs or bike rides on the weekend; I’m sure we are quite a sight rolling down the sidewalk with two adults, two kids in the double jog stroller, and the dog trailing behind us, but we all have fun, we get outside, and the kids see that physical exercise is a part of the routine. After our run is over (and my husband gets an extra hard workout pushing the kids), we stop at a park for our children to get their chance to run, climb, and play. My daughter just learned to ride her bike without training wheels, and she told us she wants to ride her bike next time we go out instead of riding in the stroller.

As pediatricians, we can play a trusted role in helping families to successfully increase their levels of physical activity in a safe and enjoyable way.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center in Washington. She also is a member of the Pediatric News editorial advisory board, a member of the American Academy of Pediatrics Committee on Residency Scholarships, and president-elect of the District of Columbia chapter of the American Academy of Pediatrics. Dr. Beers said she had no relevant financial disclosures. E-mail Dr. Beers at [email protected]. This column, "Practical Parenting," appears regularly in Pediatric News, a publication of Elsevier.

With summer in full force, the public focusing more and more on childhood obesity and efforts in my local community to get kids out and about, it seems as if I am increasingly being asked by families for suggestions on how to increase their children’s activity level.

Appropriate and regular physical activity has many health benefits for children and adolescents. Studies have shown that regular physical activity can help aid in weight reduction, strengthen and increase bone density in healthy children, reduce the morbidity associated with obesity, improve classroom performance, and improve mental health, as was summed up in an American Academy of Pediatrics policy statement on prevention of childhood obesity through increased physical activity (Pediatrics 2006;117:1834-42). However, just as it is hard for adults to change a sedentary lifestyle, increasing physical activity can be difficult for families and children.

Assuming a family is motivated to change their habits (and this is a big assumption, I know, but many families are!), what can we advise them as their pediatricians? First, young children should participate in active, safe, and unstructured play on a daily basis. School-age children should "participate daily in 60 minutes or more of moderate to vigorous physical activity that is developmentally appropriate, enjoyable, and involves a variety of activities," Dr. William B. Strong and his associates suggested after doing a literature review to develop recommendation for physical activity for youth ( J. Pediatr. 2005;146:732-7). This 60 minutes does not need to be continuous, but can be cumulative throughout the day. Organized sports or activities deserve a special mention: These can be positive and motivating activities for youth as long as they are safe, led by qualified staff who tailor the program to the developmental age and abilities of the participating children, and enjoyable. Pediatricians can assist families in determining if a potential program would meet the needs of their child by helping them assess what their child is physically and emotionally ready for. The American Academy of Pediatrics has also published a policy statement on "Strength Training in Children and Adolescents." This is an area that many feel less comfortable giving advice in, so these guidelines are a very helpful resource (Pediatrics 2008;121:835-40).

Within my practice (and my own family!), I have developed a number of tips to help promote increased physical activity, including the following:

• Make it fun. Think about things that your child likes to do, whether it is dance, play basketball, or run around the park, and then incorporate them into your daily routines.

• Make it simple. Elaborate plans for exercise are likely to break down, leaving families frustrated. Think about things that can happen near the house, during or after school, or as a part of a usual activity. Many of the families I care for live in unsafe neighborhoods and aren’t comfortable spending a lot of time outside near their home. I often suggest that they just turn on their favorite music and dance for 20 minutes in the living room. It is a fun, active, and simple way to get moving.

• Turn off the screen. If you are sitting and looking at a TV, computer, or handheld game, you are not moving.

• Involve the whole family. Our family likes to go for runs or bike rides on the weekend; I’m sure we are quite a sight rolling down the sidewalk with two adults, two kids in the double jog stroller, and the dog trailing behind us, but we all have fun, we get outside, and the kids see that physical exercise is a part of the routine. After our run is over (and my husband gets an extra hard workout pushing the kids), we stop at a park for our children to get their chance to run, climb, and play. My daughter just learned to ride her bike without training wheels, and she told us she wants to ride her bike next time we go out instead of riding in the stroller.

As pediatricians, we can play a trusted role in helping families to successfully increase their levels of physical activity in a safe and enjoyable way.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center in Washington. She also is a member of the Pediatric News editorial advisory board, a member of the American Academy of Pediatrics Committee on Residency Scholarships, and president-elect of the District of Columbia chapter of the American Academy of Pediatrics. Dr. Beers said she had no relevant financial disclosures. E-mail Dr. Beers at [email protected]. This column, "Practical Parenting," appears regularly in Pediatric News, a publication of Elsevier.

With summer in full force, the public focusing more and more on childhood obesity and efforts in my local community to get kids out and about, it seems as if I am increasingly being asked by families for suggestions on how to increase their children’s activity level.

Appropriate and regular physical activity has many health benefits for children and adolescents. Studies have shown that regular physical activity can help aid in weight reduction, strengthen and increase bone density in healthy children, reduce the morbidity associated with obesity, improve classroom performance, and improve mental health, as was summed up in an American Academy of Pediatrics policy statement on prevention of childhood obesity through increased physical activity (Pediatrics 2006;117:1834-42). However, just as it is hard for adults to change a sedentary lifestyle, increasing physical activity can be difficult for families and children.

Assuming a family is motivated to change their habits (and this is a big assumption, I know, but many families are!), what can we advise them as their pediatricians? First, young children should participate in active, safe, and unstructured play on a daily basis. School-age children should "participate daily in 60 minutes or more of moderate to vigorous physical activity that is developmentally appropriate, enjoyable, and involves a variety of activities," Dr. William B. Strong and his associates suggested after doing a literature review to develop recommendation for physical activity for youth ( J. Pediatr. 2005;146:732-7). This 60 minutes does not need to be continuous, but can be cumulative throughout the day. Organized sports or activities deserve a special mention: These can be positive and motivating activities for youth as long as they are safe, led by qualified staff who tailor the program to the developmental age and abilities of the participating children, and enjoyable. Pediatricians can assist families in determining if a potential program would meet the needs of their child by helping them assess what their child is physically and emotionally ready for. The American Academy of Pediatrics has also published a policy statement on "Strength Training in Children and Adolescents." This is an area that many feel less comfortable giving advice in, so these guidelines are a very helpful resource (Pediatrics 2008;121:835-40).

Within my practice (and my own family!), I have developed a number of tips to help promote increased physical activity, including the following:

• Make it fun. Think about things that your child likes to do, whether it is dance, play basketball, or run around the park, and then incorporate them into your daily routines.

• Make it simple. Elaborate plans for exercise are likely to break down, leaving families frustrated. Think about things that can happen near the house, during or after school, or as a part of a usual activity. Many of the families I care for live in unsafe neighborhoods and aren’t comfortable spending a lot of time outside near their home. I often suggest that they just turn on their favorite music and dance for 20 minutes in the living room. It is a fun, active, and simple way to get moving.

• Turn off the screen. If you are sitting and looking at a TV, computer, or handheld game, you are not moving.

• Involve the whole family. Our family likes to go for runs or bike rides on the weekend; I’m sure we are quite a sight rolling down the sidewalk with two adults, two kids in the double jog stroller, and the dog trailing behind us, but we all have fun, we get outside, and the kids see that physical exercise is a part of the routine. After our run is over (and my husband gets an extra hard workout pushing the kids), we stop at a park for our children to get their chance to run, climb, and play. My daughter just learned to ride her bike without training wheels, and she told us she wants to ride her bike next time we go out instead of riding in the stroller.

As pediatricians, we can play a trusted role in helping families to successfully increase their levels of physical activity in a safe and enjoyable way.

Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center in Washington. She also is a member of the Pediatric News editorial advisory board, a member of the American Academy of Pediatrics Committee on Residency Scholarships, and president-elect of the District of Columbia chapter of the American Academy of Pediatrics. Dr. Beers said she had no relevant financial disclosures. E-mail Dr. Beers at [email protected]. This column, "Practical Parenting," appears regularly in Pediatric News, a publication of Elsevier.