Work Samples

Pediatricians putting new focus on how violence, other problems affect children's lives


Violence, racism, intolerance and religious bigotry made headlines this summer and the American Academy of Pediatrics took notice. These issues are impacting children and the organization wants to address the societal problems proactively with kids and their families.

“We need to talk more about this, definitely,” said Dr. Sylvia Blaustein of St. Joseph’s Regional Medical Center in Paterson. “I think everybody should be discussing these issues because of what’s going on nationally and internationally.”

The AAP was pushed to action in early July after shootings in Baton Rouge and Dallas. It announced an initiative aimed at addressing gun violence as well as the underlying contributors of racism, religious bigotry, homophobia, xenophobia, terrorism and general intolerance. The organization’s group of experts will “identify new approaches to protect children, adolescents and young adults from the epidemic of violence occurring in their everyday lives.”

Dr. Karen Remley, executive director and CEO of the organization, has been in charge for about a year, a span that saw attacks, shootings and unrest around the world including in Paris, Istanbul, Charleston, San Bernadino, Orlando, Baton Rouge and Dallas and daily gun deaths plaguing the country’s cities, most notably in Chicago.

“The pervasive acts of daily gun violence — which don't make media headlines — have also not abated,” Remley said in a statement. “Every person involved was once a child. Children and members of their families and communities continue to be targeted for acts of discrimination and violence because of the color of their skin, the gender with which they identify, the people they love or the uniform they wear.”

Many doctors are already talking about these issues, as well, even if it’s not directly related to incidents.

“It’s constructed into each visit probably a little differently,” said Dr. Darren Saks, a pediatrician with Tenafly Pediatrics. “With teenagers, the main discussions are going to be around social platforms and media exposure and how they can safely and responsibly digest that. Teenagers are the ones who are really just getting bombarded more than any generation prior. Pretty much any kid 13 and up has a smart phone which is a whole new experience for us as pediatricians to help them understand that.

“So do we directly address the Orlando shooting or bombing in the Middle East? No, we don’t unless it’s brought to our attention — ‘My child or teenager is struggling’ with something specific from that.”

The main concern has been desensitization, something Saks sees all too often.

“Teenagers, more than any other generation, are very desensitized to violence,” he said. “They really just get hit from so many different angles, from the constant phone use, television, violent video games. I don’t really think they totally feel the same weight of the violence that does exist, at least on our patient population.”

Blaustein is an adolescent medical specialist at St. Joseph’s and works in the pediatric outpatient clinic, but she is also the associate program director of the pediatric residency program.

It is that last role where she can arguably have the biggest impact as she helps the next generation of doctors to prioritize these problems of violence and intolerance and their repercussions. When training residents right now, she said, instructors “absolutely” talk to them more about addressing these issues with patients and families.

At the New Jersey Medical School in Newark, such social issues have long been addressed; but its curriculum is being ramped up. Last spring, NJMS began a new course, “Healthy Equity and Social Justice.” The class for first- and second-year students discusses institutional racism, bias, culturally effective communication, proper use of translators, privilege and racial and ethnic health care disparity. The issues of violence, intolerance and patient and doctor perspective are all examined and discussed.

“There’s been a call from the federal government to put a greater emphasis on this, a call from the American Medical Association, a call from other medical associations and the AAP [American Association of Pediatrics] as well,” said Dr. Michelle Dalla Piazza, an associate professor at the medical school, who is the course director. “We started thinking about this a long time ago and started to develop this curriculum in creating this new course about a year ago before a lot of these statements came out.”

Working with patients in Newark, Dalla Piazza and her colleagues have long seen the impact social issues can have on children’s health and are trying to learn how to best advocate for their patients to change the situation.

Each person — doctor, administrator or professor — is only part of the answer for kids.

“Pediatricians may not be able to solve these problems — which leave in their wake fear and mistrust, confusion, anger and deep sorrow — but pediatricians know children best,” Remley’s statement said. “We care for children in the communities where violence erupts, and we talk to parents about how to keep their children healthy and safe. Pediatricians who work in urban and suburban pediatric practices, emergency rooms and rural clinics, can come together to understand what is happening and how to address it. Through this new effort, we will confront the violence in children's lives and its root causes.”

Saks applauds the AAP’s initiative.

“As a general concept, I think it’s wonderful, good leadership,” he said.

In practicality, though, statements like these don’t alter daily life for the typical pediatrician quickly.

“I think they take years to really filter down to the private community doctor,” said Saks. “Real specific policies – whether it’s checking lead levels — that’s easy, you’re talking about a specific agenda. As far as discussion and talking points with families, I really feel that the typical community pediatrician, it would take time to come up with real rigid parameters to affect our day-to-day practice.”