The statement directs pediatricians to consider their own practices from this perspective. “It’s not just the academy telling other people what to do, but examining ourselves,” Dr. Trent said. Pediatricians and others involved in children’s health need to be aware of the effects of racism on children’s development, starting in the womb, she said.
Pediatric clinical settings need to make everyone feel explicitly welcome, with images of diverse families up on the wall and with the capacity to provide care in different languages. Those efforts can also include the reception families get at the front desk — and who is staffing that front desk — as well as who is seeing patients in the exam rooms.
“The toys you have in your waiting room should be multicultural,” said Dr. Adiaha I.A. Spinks-Franklin, an associate professor of pediatrics at Baylor College of Medicine. “Bring in multicultural dolls, multicultural figurines, books, videos.”
And the pediatric office needs to be a “safe space” to talk about anything that is worrying the child or the parents, such as whether a child is being bullied, or is bullying.
The statement calls on pediatricians to improve their own practices, but also to get involved in their communities. “Many of us work in education settings and then also justice settings — the goal is really community change,” Dr. Trent said, citing collaborations with emergency medical workers, for example, or advocacy for clean and safe water for the children of Flint, Mich.
“I think there are times where racism is super explicit: Somebody called my kid a name, wrote something on a wall, said something at school,” said Dr. Heard-Garris, who heads an A.A.P. group working on minority health, equity and inclusion. But children may also face more insidious bias in terms of lowered expectations from teachers.
Dr. Spinks-Franklin, a developmental-behavioral pediatrician, said that racial awareness in children follows a set of milestones. By the time children are 3, she said, they begin to recognize normal human variations, including skin color, but without assigning value to them. “A 4-year-old recognizes basic racial stereotypes,” she said. Parents need to be aware of what their children are watching, and provide diverse books and stories with strong positive models.