Observe, assess, intervene

 

On most days when I walk into the exam room for a well-child visit, I find an anxious mom or a fretful father sitting next to a fearless child. I quickly shove aside my unrealistic expectation of finding both parents together holding the child. During the progression of my day, I see a diversity of parents playing their parts in caring for their children. It is sometimes a single mom, strong and robust, surrounded by a firm aura of principles and rules; she is concealing all signs of weakness, to make sure her child doesn’t cross any line that she has so cautiously made. Sometimes it is a single mom who is nervous and scared with a galaxy of fear in her eyes, desperately seeking for reassurance of her parenting. Fathers also come playing many roles, from someone struggling with tears as his child gets immunizations, to someone who has parenting in his bag, and skillfully plays eeny meeny miny moe with the little ones in the waiting room.

They all have one thing in common: the immense love for their children and the pressure of being a single or separated parent. It is indeed a reality that I see in most of the clinic rooms – that 60%-70% of children are not living with both mom and dad in the same house. Please note that these are raw data based entirely on my observation. While I watch each parent struggling as mentioned above, my mind often wanders to how each young child copes with such a situation.

In my observation, infants of course are oblivious and are not forming major memories; they are happily babbling away, sometimes throwing tantrums, while the parent tries to cater to each mood. Preschool children slowly emerge from that oblivion, and most of the time try to make sense of whatever arrangement they find themselves in. They often find discord in the rules and discipline set in two homes, if that is the case, and try to find middle ground in their immature minds. They also may hold themselves responsible for not having both parents. School-age children mostly have adjusted to their surroundings; they are sensible and know how to deal with each parent. Although as they grow older, I often sense some palpable anger, mostly focused toward the parent who is responsible for them.

What is our role as pediatricians as we walk into the exam room, as we encounter these different family dynamics? To simplify it for myself, I divide it into three categories: Observe, assess, and intervene. Most of the time as physicians, our gut feelings and instincts guide us to where help is needed. It is important to anticipate the changes a family might go through as we meet a first-time single mom or a family who has recently been separated. As we anticipate and observe, it also is important to ask specific questions of parents who may not feel comfortable volunteering this information:

• “Are you and your child undergoing any sort of stress?”

• “How do you think your child is coping with the separation?”

• “Do you identify any flaws in how things are going now?”

Of course, we need to ask questions about stress and family dynamics of all parents. We also should maintain a high level of sensitivity as we approach such questions. It is important to identify any changes in a child’s emotional and social development as we see them on every visit. And when we deem the need, to intervene and identify resources for the family. We also can help parents with ideas for communication with the child; anger management; helping parents and children understand changes; and encouraging open discussion when possible, instead of bottling up unsaid feelings and emotions. This is especially true for single-parent families, but two-parent families undergo stresses as well, for which pediatricians should keep an eye out.

While it is extremely important for us on every well-child visit to ensure that a child’s physical health is up to par, it is equally important not to ignore their emotional and social well-being as we walk in the room so we can help them flourish into the best version of themselves.

Dr. Fatima is a first-year pediatric resident at Albert Einstein Medical Center, Philadelphia. Email her at [email protected].

 

On most days when I walk into the exam room for a well-child visit, I find an anxious mom or a fretful father sitting next to a fearless child. I quickly shove aside my unrealistic expectation of finding both parents together holding the child. During the progression of my day, I see a diversity of parents playing their parts in caring for their children. It is sometimes a single mom, strong and robust, surrounded by a firm aura of principles and rules; she is concealing all signs of weakness, to make sure her child doesn’t cross any line that she has so cautiously made. Sometimes it is a single mom who is nervous and scared with a galaxy of fear in her eyes, desperately seeking for reassurance of her parenting. Fathers also come playing many roles, from someone struggling with tears as his child gets immunizations, to someone who has parenting in his bag, and skillfully plays eeny meeny miny moe with the little ones in the waiting room.

They all have one thing in common: the immense love for their children and the pressure of being a single or separated parent. It is indeed a reality that I see in most of the clinic rooms – that 60%-70% of children are not living with both mom and dad in the same house. Please note that these are raw data based entirely on my observation. While I watch each parent struggling as mentioned above, my mind often wanders to how each young child copes with such a situation.

In my observation, infants of course are oblivious and are not forming major memories; they are happily babbling away, sometimes throwing tantrums, while the parent tries to cater to each mood. Preschool children slowly emerge from that oblivion, and most of the time try to make sense of whatever arrangement they find themselves in. They often find discord in the rules and discipline set in two homes, if that is the case, and try to find middle ground in their immature minds. They also may hold themselves responsible for not having both parents. School-age children mostly have adjusted to their surroundings; they are sensible and know how to deal with each parent. Although as they grow older, I often sense some palpable anger, mostly focused toward the parent who is responsible for them.

What is our role as pediatricians as we walk into the exam room, as we encounter these different family dynamics? To simplify it for myself, I divide it into three categories: Observe, assess, and intervene. Most of the time as physicians, our gut feelings and instincts guide us to where help is needed. It is important to anticipate the changes a family might go through as we meet a first-time single mom or a family who has recently been separated. As we anticipate and observe, it also is important to ask specific questions of parents who may not feel comfortable volunteering this information:

• “Are you and your child undergoing any sort of stress?”

• “How do you think your child is coping with the separation?”

• “Do you identify any flaws in how things are going now?”

Of course, we need to ask questions about stress and family dynamics of all parents. We also should maintain a high level of sensitivity as we approach such questions. It is important to identify any changes in a child’s emotional and social development as we see them on every visit. And when we deem the need, to intervene and identify resources for the family. We also can help parents with ideas for communication with the child; anger management; helping parents and children understand changes; and encouraging open discussion when possible, instead of bottling up unsaid feelings and emotions. This is especially true for single-parent families, but two-parent families undergo stresses as well, for which pediatricians should keep an eye out.

While it is extremely important for us on every well-child visit to ensure that a child’s physical health is up to par, it is equally important not to ignore their emotional and social well-being as we walk in the room so we can help them flourish into the best version of themselves.

Dr. Fatima is a first-year pediatric resident at Albert Einstein Medical Center, Philadelphia. Email her at [email protected].

 

On most days when I walk into the exam room for a well-child visit, I find an anxious mom or a fretful father sitting next to a fearless child. I quickly shove aside my unrealistic expectation of finding both parents together holding the child. During the progression of my day, I see a diversity of parents playing their parts in caring for their children. It is sometimes a single mom, strong and robust, surrounded by a firm aura of principles and rules; she is concealing all signs of weakness, to make sure her child doesn’t cross any line that she has so cautiously made. Sometimes it is a single mom who is nervous and scared with a galaxy of fear in her eyes, desperately seeking for reassurance of her parenting. Fathers also come playing many roles, from someone struggling with tears as his child gets immunizations, to someone who has parenting in his bag, and skillfully plays eeny meeny miny moe with the little ones in the waiting room.

They all have one thing in common: the immense love for their children and the pressure of being a single or separated parent. It is indeed a reality that I see in most of the clinic rooms – that 60%-70% of children are not living with both mom and dad in the same house. Please note that these are raw data based entirely on my observation. While I watch each parent struggling as mentioned above, my mind often wanders to how each young child copes with such a situation.

In my observation, infants of course are oblivious and are not forming major memories; they are happily babbling away, sometimes throwing tantrums, while the parent tries to cater to each mood. Preschool children slowly emerge from that oblivion, and most of the time try to make sense of whatever arrangement they find themselves in. They often find discord in the rules and discipline set in two homes, if that is the case, and try to find middle ground in their immature minds. They also may hold themselves responsible for not having both parents. School-age children mostly have adjusted to their surroundings; they are sensible and know how to deal with each parent. Although as they grow older, I often sense some palpable anger, mostly focused toward the parent who is responsible for them.

What is our role as pediatricians as we walk into the exam room, as we encounter these different family dynamics? To simplify it for myself, I divide it into three categories: Observe, assess, and intervene. Most of the time as physicians, our gut feelings and instincts guide us to where help is needed. It is important to anticipate the changes a family might go through as we meet a first-time single mom or a family who has recently been separated. As we anticipate and observe, it also is important to ask specific questions of parents who may not feel comfortable volunteering this information:

• “Are you and your child undergoing any sort of stress?”

• “How do you think your child is coping with the separation?”

• “Do you identify any flaws in how things are going now?”

Of course, we need to ask questions about stress and family dynamics of all parents. We also should maintain a high level of sensitivity as we approach such questions. It is important to identify any changes in a child’s emotional and social development as we see them on every visit. And when we deem the need, to intervene and identify resources for the family. We also can help parents with ideas for communication with the child; anger management; helping parents and children understand changes; and encouraging open discussion when possible, instead of bottling up unsaid feelings and emotions. This is especially true for single-parent families, but two-parent families undergo stresses as well, for which pediatricians should keep an eye out.

While it is extremely important for us on every well-child visit to ensure that a child’s physical health is up to par, it is equally important not to ignore their emotional and social well-being as we walk in the room so we can help them flourish into the best version of themselves.

Dr. Fatima is a first-year pediatric resident at Albert Einstein Medical Center, Philadelphia. Email her at [email protected].