Doctor talking to parents and child

In our ever-changing world, children are not shielded from the realities of racial injustice and discrimination. As a health professional and a mother, I have encountered numerous instances where the impact of racism on children’s health and well-being could not be ignored.

As my coauthors and I shared in an American Academy of Pediatrics policy statement:

The impact of racism has been linked to birth disparities and mental health problems in children and adolescents. The biological mechanism that emerges from chronic stress leads to increased and prolonged levels of exposure to stress hormones and oxidative stress at the cellular level. Prolonged exposure to stress hormones, such as cortisol, leads to inflammatory reactions that predispose individuals to chronic disease.

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In short, research has found that racism harms children’s physical health, as well as their mental health. As health providers, we cannot avoid discussions of race and racism. When we identify a risk factor for a disease, our job as health providers is to educate our patients about how to prevent or decrease their exposure to the risk, like talking to new parents about sleep-related infant deaths.

Race and racism is another risk factor that we should discuss with our patients in our role to improve their health and well-being. These discussions play a crucial part in combating the harmful effects of racism and providing families with the support that they need.

How children learn about race

Children learn about race and racial bias early. As early as six months of age, children notice differences in skin color. As children get older, they learn about race based on what they see and hear from their loved ones and the world they live in. They see that people are treated differently based on characteristics such as skin color, hair texture, hair color, language, gender, and ability. They often have questions about why they look different from other friends or why their friends look different. Children can develop biases based on these experiences.

Children can also experience the effects of racism individually and through the places they learn, live, play, and grow. Children experience the effects of racism through individual acts of discrimination or bias; as bystanders watching others experience racism; and additionally through unequal access and distribution of resources, limited economic opportunity, and unequal enforcement of rights.

Trusted adults in children’s lives, such as parents, caregivers, educators, and health providers, can help children understand their racial and ethnic identity and learn about others. Starting conversations early about race is essential to help children understand differences, get answers to their questions, deal with racial bias, and stand up to racial bias and discrimination. It also normalizes these conversations. 

It is important to include white families and their children in conversations about race, too. Unfortunately, white children are frequently excluded from discussion about race. White children, like children of color, are part of the racial and ethnic diversity spectrum and experience the impacts of racial bias and discrimination.

Talking with families about race

Having conversations about race and racism can be uncomfortable. The strategies below provide ways that health providers can begin to engage with families about the topics of race and racism. By fostering open dialogue, we can empower families to address these sensitive topics and work toward building a more just and equitable society for all children.

Create a culturally safe, supportive, and welcoming environment for patients and their families. This is essential when addressing the topic of race and racism with families. Here are some ways to do this from our American Academy of Pediatrics policy statement:

  • Train your organization’s leadership and staff in culturally competent care, diversity, equity, and inclusion
  • Ensure leadership and staff reflect the cultural and language diversity of the community
  • Allow patients and their families to identify their racial and ethnic identity each time they visit
  • Provide treatment in patients’ preferred languages
  • Provide educational materials, signage, and resources in patients’ preferred languages

Listen and validate experiences. Racism affects individuals differently, and children may have encountered instances of mistreatment or witnessed racism firsthand. Ask families if they want to engage in conversations about race and racism; if a family declines, let them know that you respect their decision and that you are available for future conversations.

For families who want to engage in conversations, encourage them to share their experiences, actively listen, and validate their feelings. By doing so, health professionals demonstrate empathy and provide a platform for families to express themselves. This validation also helps families recognize that their experiences are real and important. I experienced this firsthand when a parent asked for recommendations for mental health providers that reflected their family’s racial background. The family appreciated being heard and receiving information that was best for them.

Educate yourself about race and racism, and share resources. To effectively address race-related issues, health professionals must continually educate themselves about racial disparities, historical contexts, and the impact of racism on health. See the sidebar for examples of educational resources for providers and families, including books, websites, and articles, that provide additional information about the topics of race and racism.

For me, one discussion about race occurred during a well visit with a family of color. After discussing sun safety, the mom asked me if I could recommend a sunscreen that wouldn’t leave a white cast on darker skin. This encounter made me examine how I talked to families and provided guidance on sun safety. During and after this encounter, I researched sunscreen brands for darker skin tones and developed a resource list that I could share with families and colleagues. This discussion matters because skin cancer is preventable and research finds that patients of color are less likely to be counseled about sunscreen use and doctors are less likely to discuss skin type in making recommendations.

Support families in talking to their children about race and racism. Encourage families to engage in critical thinking and reflection by discussing racial stereotypes, biases, and the importance of challenging them. Help them explore ways to foster empathy and understanding toward individuals from diverse racial and ethnic backgrounds. Encourage families to actively seek out opportunities for their children to learn about different cultures, traditions, and histories, such as taking a trip to a cultural museum.

To help with this, you can share resources with families to empower them with knowledge and equip them to have informed conversations with their children. Books, articles, documentaries, and websites can serve as valuable tools in initiating discussions and promoting racial literacy.

Engaging in conversations about race helps children develop empathy, challenge stereotypes, and embrace diversity.

Empower families to take action. Guide families in identifying ways they can actively contribute to dismantling racism and promoting racial equity. Encourage them to engage in advocacy, both at the individual and community levels. Families can participate in community events, join organizations working toward racial justice, and support policies that promote equality.

Emphasize the importance of modeling anti-racist behavior within the family and creating a nurturing environment that fosters inclusivity and respect. In addition, as health professionals, we can help empower families through our own engagement in advocacy for more equitable and just policies and practices that will lead to better health for our families.

Addressing the topic of race and racism with families is vital for promoting children’s health and well-being. The strategies provided are meant to help health professionals so that they can offer families the tools and knowledge to engage in meaningful conversations about race. As health professionals, we have a unique opportunity to make a positive impact by fostering open dialogue, fostering racial understanding, and working toward a more equitable future for all children.

This essay was adapted from Reflections on Children’s Racial Learning 2023, published by EmbraceRace, an organization that aims to help parents and educators raise a generation that is thoughtful, brave, and informed about race.

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