American families have changed. More mothers are working, and more young children are being cared for outside the home. The stresses inherent in this sociologic change are great.
Pediatric practice has also changed. Increasingly, pediatricians are involved not only in the medical care of the child, but in the ecologic system in which the child exists. The pediatrician has traditionally worked with parents and children to promote healthy functioning, which encompasses the physical, emotional, cognitive, and social health of the growing and developing child. Now, the pediatrician must expand this role to include working with significant other adults who interact closely with the child who spends much of the day away from home. In this way, the pediatrician will contribute to the promotion of the child's general wellbeing, and some maladaptive behaviors will be prevented.
Parents and adults whom parents delegate to provide child care on a regular basis have the greatest responsibility for children. With increasing numbers of single-parent families and families in which both parents work, there is a greater use of the variety of alternative care-giving arrangements involving adults who are neither parents nor relatives of the child. Effective communication among the child's pediatrician and regular care givers is more difficult to achieve than in the past when parents provided most of the child's care. When developmental irregularities or a chronic illness are a concern, it is particularly important for pediatricians to communicate to the person(s) providing child care the unique features of the child and family. Thus the care giver will be better able to prepare an individualized program that enhances the child's development, increases self-esteem, and supports the parents' child-caring capacity.
- Copyright © 1984 by the American Academy of Pediatrics