I have been in pediatrics since 1976. Add in medical genetics and the breadth of my career has covered both children and adults. And now in retirement, I find myself engaged as a consultant for children and families suffering from various forms of trauma—and how to ameliorate those effects and to build resilience going forward.
One of the general statements that I heard early in my career from some of my adult medical colleagues (general and specialists) was that children were just small adults. My vehement objections were usually just greeted with a smile and a chuckle. I am now smiling and chuckling at the naïveté of their observations. I hope now that they realize the significant misunderstanding they have about pediatric medicine and its impact throughout the lifespan of their adult patients.
Fast forward from 1976 to 2018 and I shared the distinct pleasure of co-authoring a book with Dr. Andy Garner, published by the American Academy of Pediatrics – Thinking Developmentally: Nurturing Wellness in Childhood to Promote Lifelong Health. In this book, Dr. Garner and I discussed how so much of what happens in early childhood extends far beyond childhood, well into adulthood.
Dr. Garner is particularly fond of noting what he calls “The Pediatric Way” – what sets pediatricians apart from other health care professionals is the recognition that their patients are still developing—physically, emotionally intellectually, and socially. As a consequence, pediatricians must have fundamental appreciation for the wide array of influences (e.g., genetic, nutritional, environmental, social) that affect the unfolding of the developmental process. Pediatricians recognize the current and future well-being is not just about the child but the developmental milieu: the family, neighborhood, and cultural context in which that development is occurring…The pediatric way requires pediatricians to translate this developmental science into practice and policy, [and this understanding] must become the North Star for all who hope to nurture childhood wellness and promote lifelong health.”1
Let’s unpack this briefly –
- Pediatrics is an all-encompassing medical specialty. It is incumbent upon pediatricians to have a broad understanding of science and related environmental factors that can affect the children and their families.
- The unfolding of dramatic advances in developmental science have revealed that brain development [the growth and connections] occurs very early yet is potentially alterable with the right positive influences.
- These changes are embedded in the growing child and subsequent adult and sometimes in subsequent generations via genetic-related factors.
- We now know that these embedded changes are responsible for many so-called adult diseases such as hypertension, diabetes, cancer, substance abuse and others.
- What medicine in general calls adult-onset diseases (hypertension, diabetes, obesity, heart disease, and the like) are actually ADULT-MANIFEST diseases; that is, so much of illness and medical expenses that occur in adulthood actually have their roots in childhood.
- Preventive measures (addressing nurturing and relational factors) can substantially affect early development.
If we follow the line of reasoning above, we would agree that we should direct far more attention to what happens in childhood and that “what happens in childhood does not necessarily stay in childhood.” Yet that clearly is not what our society has chosen to do.2
We have consistently undervalued the health and well-being of our children, all of our children. We have taken an approach that chooses to let poverty be too pervasive in our society.3 During the COVID-19 epidemic, we concentrated on its effect on the elderly. This was appropriate but its effect on children was diminished too much and not enough measures were taken to protect our children (belittling the protective effects of masks and subsequent underpromotion of vaccines). We underfund Medicaid by either not expanding the eligibility or providing fewer reimbursed services for children as compared to adults. Mental health services are underfunded but, more critically, are undermanned. And we have consistently underestimated the effect of early childhood adversity. We think that childhood adversity is similar to adversity of adulthood, and nothing could be farther from the truth.
We have the opportunity to make substantial differences for our children and families exposed to significant adversity. One thing should be emphasized. Significant adversity might be very subtle and should never be underestimated. Adverse childhood experiences call out for help but first need appropriate recognition.
We all have a role in being a part of the Pediatric Way. Parents, teachers, educators, policy makers, communities, and fellow citizens all have a responsibility. To deny our role in the nurturing of all is to deny our common humanity and purpose in life.4,5,6 And selfishly, adults that deny the importance of such are destined to spend more money on adult-manifest diseases and endure more health burden. That is not a wise choice.
Several months ago, I was playing a round of golf with a couple. I asked if they had any children. They did not, and the husband noted that they did not seek an adoption (especially an international adoption) because “only the dregs are left over.” I was aghast and literally speechless that someone would consider vulnerable children suffering from environmental deprivation through no fault of their own to be the “dregs” (the residue or remains) and not worthy of their possible adoption.
I am proud to be part of a movement that sees the importance of treating all children as our valuable resources to be nurtured and cherished, as our valued humans that often face unrecognized adversity and are deserving of attention, and as our young citizens that will transition to adulthood and be worthy of lifelong health and emotional well-being.
The Pediatric Way is highlighted here as way for pediatric health professionals to be tangible activists for children. But realistically, all of us should be practicing the Pediatric Way. In the words of the song Bui Doi from the musical Miss Saigon, “we can’t forget, we must not forget, that they are all our children too.”5 The Pediatric Way should be the North Star for all of us.
- Garner AS, Saul RA. Thinking Developmentally: Nurturing Wellness in Childhood to Promote Lifelong Health. American Academy of Pediatrics, 2018, 175pp. (page xii)