Nurturing wellness in children

^{Coverage is proud to publish columns featuring the perspectives of Black women physicians who belong to the Diva Docs network in Greater Boston. Today, Dr. Jeanette Adele Callahan, pediatrician at Cambridge Health Alliance, co-founder of The Wellness Collaborative and medical director of the Northeast Region Health Services of the Justice Resource Institute, shares her thoughts with Dr. Philomena Asante, leader of Diva Docs Boston and creator of the Digital Health Award-winning Diva Docs series for Coverage.}

My journey to becoming a physician began when I was 9 years old, when my mother was in labor on our couch with my baby brother. I sat by her, holding her hand and comforting her and saying, “Breathe, Mommy. Breathe.” I felt so comfortable in that healing space. I knew then that I wanted to be a physician.

I didn’t take a straight path to medicine. I went to college, married young and had four children. I always wanted to help people, so I did a lot of volunteer work in my community around children, food insecurity and nutrition, but lacked the confidence to pursue a career in medicine.

I spent a lot of time working through my own self-doubt and fear of failure. When my children were between the age of 9 and 14, I found myself thinking, I never want to say that I didn’t do something because I was afraid I’d fail at it. It was a realization that time will run out, and I could one day be looking back on my life with a list of regrets. I was 14 years older than most of my fellow students when I entered Harvard Medical School.

I had done that as a mom for years when my children were sick or scared from a nightmare. I knew that I could be totally myself. And I was inspired by my patient population, ranging from newborn to 21 years old. I believed they would be more open to influences that help them change their behaviors in ways that most adults are not.

Racial disparities among children

As pediatricians, we see racial disparities in many aspects of our practice. Fewer Black teens seek treatment for depression and mental health issues than their white counterparts, for instance, and suicide is now the second-leading cause of death among Black youth aged 10 to 19. Race is a social concept not based in genetics or biology, so race in and of itself does not make anyone more likely to develop any illness, mental or physical. But social factors are important.

Mental health support

For example, I have found in my practice that in many families of color, mental illness is stigmatized. Young people often receive the message, “If you pray, you’ll be okay. If you live right, you’ll be okay. Depression is a crutch. You have a good family that loves you, and that should be enough.”

We have not normalized the simple fact that everyone feels sad at times, and that falling into depression is a common occurrence. Many view depression as a sign of weakness or a lack of spiritual strength or faith in God. The fact is these episodes are commonplace. Having a system of prevention and intervention early in life is key. In the same way that we provide vaccinations beginning early in infancy, awareness of mental health and access to therapy should be part of every child’s life before their parents might even think that there is an issue.

Many parents feel the pressure to be perfect. I see this particularly in families of color that have immigrated here. And that pressure can be passed on to children. “We’ve come to the United States for you. Don’t waste this opportunity. You have more stuff than your family members living in other countries. What is there to be sad about?” There’s a misunderstanding that depression can be fixed or prevented by providing lots of “stuff.” The pressure to be perfect sabotages the happy, healthy life that we all want for our children. That same pressure also can make it difficult for young people to feel comfortable talking to their parents.

As pediatricians, we need to work with parents to help support their child. I start with, “This is not your fault. We all experience mental health challenges all the time. Don’t own it. Let’s be here to support your child, because the blame game is not going to get us where we need to be.”

The toll of ‘social influencers’

White children also have fewer emergency department visits and hospitalizations for asthma and have better glycemic control with type 1 diabetes than Black and Hispanic children.

We often talk about “social determinants” in relation to these disparities, but I believe nothing determines — rather, many things influence outcomes.

Social influencers such as food access, housing, toxins in the environment and access to quality health care are historically different for people of color, African Americans in particular. Sadly, this country’s wealth has long rested on systematizing these inequities. There is intense, chronic stress from knowing those influences have been weighted against us, hampering our ability to thrive. It is a toll passed from generation to generation.

The work that we do at my non-profit, The Wellness Collaborative, recognizes the importance of weaving these social influencers into the construct of wellness. You can’t give accurate medical advice without understanding the barriers to implementing that advice and the support network needed to actualize your advice.

For example, when a child presents with asthma, the pediatrician needs to ask what is happening within the home, within their physical as well as emotional environment. What may be causing an increase in cortisone or an increased allergic reaction that may be triggering the asthma attack?

Addressing obesity

Similarly, when we discuss obesity, we need to look at it in terms of lifestyle, not simply as a matter of weight loss goals. We need to be aware that a healthy lifestyle can be a particular challenge in communities where people don’t feel safe going outside -- whether because of COVID or safety issues.

We pediatricians can partner with parents to help. I like to tell parents of my patients that your home is a gymnasium. Do you have steps? Run up and down them. Have the kids go up the steps two at a time and make it a challenge. Walk with your kids around your block, briskly, to the point of feeling winded. Even getting up from a seat and sitting down is a form of an exercise. Make it a game.

We need to help parents understand how they can engage young children in developing the skills to make the right choices around food as well. It’s quicker and easier to buy processed, fast foods. If you keep in mind that the most powerful way to lead is by example, and you want to develop leadership skills in your child to make good choices, then you can start with food choices.

Reward systems do play a role. I tell parents “If you’re saying no to one thing, you need to commend and affirm three others. This sends the message that my parents want the best for me, and I bring them great pleasure when I do those things that are best for me.”

Addressing bias

We need societal change to address implicit and explicit bias, especially in the adults who engage with and educate our young people.

We have to recognize that Black children are growing up in a system, in a culture, that labels them as unintelligent, unable to learn, violent, at a very early age, and that labeling is internalized. It is reflected in their behavior. It is reflected in their ability to cope. It is reflected in their ability to advance educationally -- not because they’re not smart, but because self-doubt has often been infused into their understanding of themselves at an early age.

This is why it’s so important to have mentors who understand what children are going through. Mentors, who affirm and believe their unique experiences as people of color, can provide powerful relationships.

Pediatricians can play this crucial role. First, we can take time to understand each child’s issues. We can check ourselves to ensure that we’re not making assumptions about families and their needs. We can normalize asking everyone about mental health, food security and other important issues, without letting our biases determine how we view our patients. Then we can help families find the resources they need, right from the start.

^{PHOTOS OF Dr. JEANETTE ADELE CALLAHAN AND Dr. ASANTE BY FAITH NINIVAGGI}