Supporting families to improve child healthPositive parenting in a primary care setting

Dr. Andrea Feller
Associate Medical Officer of Health, Niagara Region Public Health
Member, CPS Early Years Task Force

You can hear the family out in the waiting room. It's almost always the same when they come. One of the children starts yelling, another child starts crying, and you can hear the tension in the parent's voice in response. By the time you get in the room to see them, you find yourself hoping that the visit goes okay, and that there's something tangible you can do to help improve things for this family.

At least, that's been my experience.

Over the years I have come to realize that when parents bring children in for seemingly minor issues over and over, there is usually something else going on. And when someone seems excessively concerned about bedwetting or otherwise age-typical behaviors, I wonder about parental coping. Fortunately, we now know more than ever about the impacts of parenting behaviours – and there is something tangible we can do to help families.

In the last decade, the science and knowledge-base around children's neurodevelopment and their relational development has grown astronomically. We understand the health risks from adverse childhood experiences, including behavioural impacts; and we now understand how critical, and how protective, positive parenting behaviours are in mitigating those risks.

We are well on our way to incorporating more direct questions about and supports for parenting behaviours into standard paediatric care. Many physicians, paediatricians and others have been leading the way in this work – and now the Canadian Paediatric Society is releasing a position statement to help clinicians incorporate positive parenting guidance in their practice.

Those of us who have started to have these brief discussions have seen profound and positive responses from our patients. So many of our patients are struggling to cope with stress. Parents are consistently relieved when I ask questions, acknowledge their stress, show that this is a safe place to be honest, and share information about brain wiring and behaviours as communication. I tell them that there is no magic pill, but that small changes in approach can bring relief for both parents and children, and ultimately, enjoyment of family-relationships that matches the amount of love already there.

The Early Years Task Force behind the parenting statement is a cross-sectoral group of committed practitioners--including a family doctor, pediatricians, and child psychiatrists-- working to bring the best possible support and guidance to primary care providers. We understand that it can feel like an uphill climb to start incorporating supports for positive parenting into your practice. It helps to recognize that this is squarely within the wheelhouse of anticipatory guidance. The guidelines in this statement provide some practical advice, great examples, and point to community-based resources for further support. The CPS understands that we need more and is committed to doing more, as reflected in our 2017-22 strategic framework.

Yours in the care of children,

Andrea

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