Anticipatory guidance for dark times


As a pediatric resident, I have the joy of building relationships with families and watch their children grow while providing them with anticipatory guidance at every visit. From newborn visits to toddler visits to teenager visits, they come, and we all grow together. (They grow chronologically and as a family, I grow in my experience and knowledge.)

The questions come in such a wide, but expected, variety: “When can I introduce solids?”, “How do I make the tantrums stop?”, “My child is not doing well in school, what should I do?”, “How do I make my teenager listen to me?”

And all these questions are fair. And the children ask their rounds of questions too, which make us giggle every time: “I want to be a rocket ship. How do I become one?”, or, “Why do I have brush my teeth every night?”, and my favorite: “My mom told me I have floating ribs. I’m scared they will float away.” Fortunately, our residency programs and all our reading materials help us provide the right answers to guide the parents and the right answers for the children at their understanding level.

But something is changing. The usual questions that we are trained to answer are fading into the background. Much more pressing issues are surfacing to the top: unjust shootings, racial slurs, gang violence, coping with all the social events and its implications in the lives of our children.

The questions I now face from the children include:  “Why was he killed?”, “How do I protect myself and my friends?”, “Should I be scared?”, “Why is everyone so upset?” The questions from the parents include “Should I tell my child about all this violence?” ,“How do I explain all this to them?”, “I’m afraid my child is making the wrong friends because they’re scared, what should I do?” In some areas of our country, these are not new questions. But for a large number of areas, these are new and terrifying questions.

How should I answer these questions? Just last week, a 9-year-old boy was shot and killed in my community while walking with his father, in a shooting thought to be related to gang violence. Throughout residency, most of us have taken care of pediatric gunshot wounds at some point. What initially appeared a distant issue that affected primarily adults has now moved in next door affecting children in our community.

What should or can I say to the parents? What do I say to the school friends of these children when I see them in clinic? How do you explain this crazy world we live into a child who does not understand the idea of discrimination and hatred based on gender, race, ethnicity, occupation, and/or love orientation? I personally don’t think that children should understand these concepts as these concepts should not exist, much less be used to justify anyone’s actions.

We all need to put a stop to all this madness, if not for our sakes, then at least for the sake of our children and the world we are raising them in.

Alexandra Iacob is a pediatrics resident.

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