Skip to main content

Advertising Disclaimer »

Main menu

  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors/Reviewers
    • Submit Manuscript
    • Author Guidelines
    • Reviewer Guidelines
    • Open Access
    • Editorial Policies
  • Content
    • Current Issue
    • Online First
    • Archive
    • Blogs
    • Topic/Program Collections
    • AAP Meeting Abstracts
  • Pediatric Collections
    • COVID-19
    • Racism and Its Effects on Pediatric Health
    • More Collections...
  • AAP Policy
  • Supplements
    • Supplements
    • Publish Supplement
  • Multimedia
    • Video Abstracts
    • Pediatrics On Call Podcast
  • Subscribe
  • Alerts
  • Careers
  • Other Publications
    • American Academy of Pediatrics

User menu

  • Log in
  • My Cart

Search

  • Advanced search
American Academy of Pediatrics

AAP Gateway

Advanced Search

AAP Logo

  • Log in
  • My Cart
  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors/Reviewers
    • Submit Manuscript
    • Author Guidelines
    • Reviewer Guidelines
    • Open Access
    • Editorial Policies
  • Content
    • Current Issue
    • Online First
    • Archive
    • Blogs
    • Topic/Program Collections
    • AAP Meeting Abstracts
  • Pediatric Collections
    • COVID-19
    • Racism and Its Effects on Pediatric Health
    • More Collections...
  • AAP Policy
  • Supplements
    • Supplements
    • Publish Supplement
  • Multimedia
    • Video Abstracts
    • Pediatrics On Call Podcast
  • Subscribe
  • Alerts
  • Careers

Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Commentary

Toward Better Understanding of How Fathers Contribute to Their Offspring’s Health

Craig F. Garfield
Pediatrics January 2018, 141 (1) e20173461; DOI: https://doi.org/10.1542/peds.2017-3461
Craig F. Garfield
Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois; and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • Comments
Loading
Download PDF
  • Abbreviations:
    ADHD —
    attention-deficit/hyperactivity disorder
    SSRI —
    selective serotonin reuptake inhibitor
  • Fathers’ time spent involved in child-rearing activities has more than doubled since 1965,1 necessitating researchers, policy makers, and clinicians to better understand the unique ways in which fathers contribute to child health. Research in the past 2 decades has found that fathers contribute to child health in a variety of ways that have an impact not just on the father but on his partner and child as well. For example, there is evidence that father involvement increases the likelihood of the mother receiving appropriate prenatal care,2 reduces infant mortality,3 and improves breastfeeding rates.4 Biologically, paternal age has been associated with a number of child health outcomes, including autism and bipolar disease, although the exact mechanism is not known.5 These examples raise the question of how fathers might contribute to their offspring’s health before the children are even born and what preconception or prenatal effects fathers might have.

    In this issue of Pediatrics, Yang et al6 sought to examine the association between fathers’ use of selective serotonin reuptake inhibitors (SSRIs) during the 3 months preconception, a vulnerable exposure window for spermatogenesis, and the future risk of attention-deficit/hyperactivity disorder (ADHD) in their offspring. By using data from the remarkably comprehensive Danish Medical Birth Registry of 781 470 linked-birth cohorts from 1996 to 2008, the authors examined children who were born to fathers who filled a prescription for an SSRI during the exposure window and the >12 000 children diagnosed with ADHD. The authors also creatively separated the effects of SSRI use from underlying paternal conditions by extending the exposure window to 1 year before conception but not during the 3-month susceptibility window. Because spermatogenesis occurs during the 3 months before conception, these former users reflect the effects of the underlying indication for SSRI use but not the drug itself. On the basis of these results, the authors concluded that although there is some increased risk among SSRI users, the underlying paternal mental health disease may itself be a risk factor for ADHD in offspring.

    These findings highlight a number of clinical and public health implications for fathers and families, foremost among them being the notion of preconception health. Preconception health originally focused on women and led to important initiatives to improve maternal physical and mental health, oral health, and health care access, all of which did double duty by improving the health of women and their children. As an acknowledgment of the role men play in healthy pregnancies and offspring, the concept of preconception health has now expanded to encompass men. Clinical content for preconception care has been outlined and includes aspects that contribute to the father’s health in its own right as well as ways in which his health might benefit his partner’s pregnancy and their offspring.7 Examples include a reproductive life plan, current and past health risk assessments, opportunities for health promotion, and clinical and psychosocial interventions designed to optimize adolescent and young men’s health. More recent work has outlined a research agenda designed to foster growth in this underdeveloped area.8 Specifically, calls have been made in support of a more mature knowledge base around men’s preconception health, ranging from basic science to epidemiologic studies, evaluation of social strategies and interventions designed to support men’s health, and policies that outline the financial, professional, and legal resources that can benefit men’s health during the transition to parenthood.

    From a clinical perspective, this study reinforces the importance of identifying mental health disorders among men transitioning to fatherhood and among current fathers. Fathers frequently experience depression, particularly in the early years. Of fathers, >20% will have experienced depression by the time their children are 12 years old.9 Fathers coresiding with their offspring have reported a 68% increase in their depressive symptoms in the first 5 years of fatherhood, which are key developmental years for children.10 Several studies have found associations between paternal mental health and behavioral issues in offspring. A meta-analysis of fathers’ mental health and child psychopathology found that paternal depression was significantly correlated with child and adolescent internalizing behaviors.11 The Avon Longitudinal Study of Parents and Children showed that paternal depression in the postpartum period was associated with an increase in child conduct problems at ages 3 to 5 years.12 Once at-risk fathers are identified, they can and should be treated for their underlying disorders. It may be welcome news for practitioners and (prospective) parents who may be wary of using SSRIs before conception for the management of paternal psychopathology to learn from this study that SSRIs taken around conception are unlikely to increase offspring’s risk of ADHD. In fact, providing treatment of fathers’ underlying mental health disorders may improve fathers’ and families’ functioning, ultimately improving their children’s outcomes.

    Finally, from an epidemiologic perspective, Yang et al’s study6 points to the value of collecting comprehensive data in large, linkable data sets that span the life course to rigorously study the health of the public, especially at the interface of men’s health and fatherhood. Models like the Danish Medical Birth Registry currently do not exist in the United States. Piecemeal data sets are available and serve as important primary sources for collecting large samples to address public health concerns. The Pregnancy Risk Assessment Monitoring System, for example, is a surveillance project of the Centers for Disease Control and Prevention and state health departments and collects state-specific, population-based data on attitudes and experiences before, during, and shortly after pregnancy but for mothers only. Researchers in other studies strive to include fathers (ie, the Fragile Families and Child Wellbeing Study and the National Survey of Family Growth) yet capture minimal preconception data. No existing data set is dedicated to fathers in the perinatal period, and few comprehensively follow fathers over time. Even a less ambitious survey of men’s health during the transition to fatherhood would be a useful start to further understand the unique contributions of fathers to families and children and build a case for a more complete, longitudinal study of both parents and their transitions to parenthood.

    As father involvement continues to increase so must our understanding of its unique benefits and challenges. Sustaining a vision of father involvement that starts in the preconception period is likely to result in the most comprehensive, applicable, and actionable approach to maximizing father, family, and child outcomes.

    Footnotes

      • Accepted October 18, 2017.
    • Address correspondence to Craig F. Garfield, MD, MAPP, Department of Pediatrics, Northwestern University Feinberg School of Medicine, 633 St Clair, Suite 19-059, Chicago, IL 60611. E-mail: c-garfield{at}northwestern.edu
    • Opinions expressed in these commentaries are those of the author and not necessarily those of the American Academy of Pediatrics or its Committees.

    • FINANCIAL DISCLOSURE: The author has indicated he has no financial relationships relevant to this article to disclose.

    • FUNDING: No external funding.

    • POTENTIAL CONFLICT OF INTEREST: The author has indicated he has no potential conflicts of interest to disclose.

    • COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2017-1081.

    References

    1. ↵
      1. Parker K,
      2. Wang W
      . Modern parenthood: roles of moms and dads converge as they balance work and family. 2013. Available at: www.pewsocialtrends.org/2013/03/14/modern-parenthood-roles-of-moms-and-dads-converge-as-they-balance-work-and-family/. Accessed October 15, 2017
    2. ↵
      1. Teitler JO
      . Father involvement, child health and maternal health behavior. Child Youth Serv Rev. 2001;23(4–5):403–425
      OpenUrlCrossRef
    3. ↵
      1. Alio AP,
      2. Mbah AK,
      3. Kornosky JL,
      4. Wathington D,
      5. Marty PJ,
      6. Salihu HM
      . Assessing the impact of paternal involvement on racial/ethnic disparities in infant mortality rates. J Community Health. 2011;36(1):63–68pmid:20512407
      OpenUrlCrossRefPubMed
    4. ↵
      1. Mitchell-Box KM,
      2. Braun KL
      . Impact of male-partner-focused interventions on breastfeeding initiation, exclusivity, and continuation. J Hum Lact. 2013;29(4):473–479pmid:23792369
      OpenUrlCrossRefPubMed
    5. ↵
      1. D’Onofrio BM,
      2. Rickert ME,
      3. Frans E, et al
      . Paternal age at childbearing and offspring psychiatric and academic morbidity. JAMA Psychiatry. 2014;71(4):432–438pmid:24577047
      OpenUrlCrossRefPubMed
    6. ↵
      1. Yang F,
      2. Liang H,
      3. Chen J, et al
      . Prenatal paternal selective serotonin inhibitors use and risk of ADHD in offspring. Pediatrics. 2017;141(1):e20171081
      OpenUrl
    7. ↵
      1. Frey KA,
      2. Navarro SM,
      3. Kotelchuck M,
      4. Lu MC
      . The clinical content of preconception care: preconception care for men. Am J Obstet Gynecol. 2008;199(6, suppl 2):S389–S395pmid:19081435
      OpenUrlCrossRefPubMed
    8. ↵
      1. Kotelchuck M,
      2. Lu M
      . Father’s role in preconception health. Matern Child Health J. 2017;21(11):2025–2039pmid:28983715
      OpenUrlPubMed
    9. ↵
      1. Davé S,
      2. Petersen I,
      3. Sherr L,
      4. Nazareth I
      . Incidence of maternal and paternal depression in primary care: a cohort study using a primary care database. Arch Pediatr Adolesc Med. 2010;164(11):1038–1044pmid:20819960
      OpenUrlCrossRefPubMed
    10. ↵
      1. Garfield CF,
      2. Duncan G,
      3. Rutsohn J, et al
      . A longitudinal study of paternal mental health during transition to fatherhood as young adults. Pediatrics. 2014;133(5):836–843pmid:24733877
      OpenUrlAbstract/FREE Full Text
    11. ↵
      1. Kane P,
      2. Garber J
      . The relations among depression in fathers, children’s psychopathology, and father-child conflict: a meta-analysis. Clin Psychol Rev. 2004;24(3):339–360pmid:15245835
      OpenUrlCrossRefPubMed
    12. ↵
      1. Ramchandani P,
      2. Stein A,
      3. Evans J,
      4. O’Connor TG; Avon Longitudinal Study of Parents and Children Study Team
      . Paternal depression in the postnatal period and child development: a prospective population study. Lancet. 2005;365(9478):2201–2205pmid:15978928
      OpenUrlCrossRefPubMed
    • Copyright © 2018 by the American Academy of Pediatrics
    PreviousNext
    Back to top

    Advertising Disclaimer »

    In this issue

    Pediatrics
    Vol. 141, Issue 1
    1 Jan 2018
    • Table of Contents
    • Index by author
    View this article with LENS
    PreviousNext
    Email Article

    Thank you for your interest in spreading the word on American Academy of Pediatrics.

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    Toward Better Understanding of How Fathers Contribute to Their Offspring’s Health
    (Your Name) has sent you a message from American Academy of Pediatrics
    (Your Name) thought you would like to see the American Academy of Pediatrics web site.
    CAPTCHA
    This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
    Request Permissions
    Article Alerts
    Log in
    You will be redirected to aap.org to login or to create your account.
    Or Sign In to Email Alerts with your Email Address
    Citation Tools
    Toward Better Understanding of How Fathers Contribute to Their Offspring’s Health
    Craig F. Garfield
    Pediatrics Jan 2018, 141 (1) e20173461; DOI: 10.1542/peds.2017-3461

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
    Share
    Toward Better Understanding of How Fathers Contribute to Their Offspring’s Health
    Craig F. Garfield
    Pediatrics Jan 2018, 141 (1) e20173461; DOI: 10.1542/peds.2017-3461
    del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
    Print
    Download PDF
    Insight Alerts
    • Table of Contents

    Jump to section

    • Article
      • Footnotes
      • References
    • Info & Metrics
    • Comments

    Related Articles

    • No related articles found.
    • PubMed
    • Google Scholar

    Cited By...

    • No citing articles found.
    • Google Scholar

    More in this TOC Section

    • Safety of Breastfeeding by Mothers With COVID-19: New Evidence From Israel
    • Advocating for Minority Inclusion in Clinical Trials: A Call for Representation and Justice
    • Pediatric Enteric Diagnostic Stewardship: The Right Test in the Right Context
    Show more Commentary

    Similar Articles

    Subjects

    • Public Health
      • Public Health
    • Journal Info
    • Editorial Board
    • Editorial Policies
    • Overview
    • Licensing Information
    • Authors/Reviewers
    • Author Guidelines
    • Submit My Manuscript
    • Open Access
    • Reviewer Guidelines
    • Librarians
    • Institutional Subscriptions
    • Usage Stats
    • Support
    • Contact Us
    • Subscribe
    • Resources
    • Media Kit
    • About
    • International Access
    • Terms of Use
    • Privacy Statement
    • FAQ
    • AAP.org
    • shopAAP
    • Follow American Academy of Pediatrics on Instagram
    • Visit American Academy of Pediatrics on Facebook
    • Follow American Academy of Pediatrics on Twitter
    • Follow American Academy of Pediatrics on Youtube
    • RSS
    American Academy of Pediatrics

    © 2021 American Academy of Pediatrics