Day in and day out, pediatricians are on the front lines of care for infants, children, and adolescents around the world. Whether they are giving a diagnosis in a remote clinic, providing care in an urban hospital, or counseling mom on the best regimen for atopic skin in a modern facility, pediatric health care providers adapt to the circumstances of their setting to deliver the best care for baby.

In two sessions at this week’s American Academy of Pediatrics National Conference & Exhibition (AAP16), pediatricians shared ideas on practices that are best for baby, even in the most challenging settings. From rural communities to urban settings and to disaster areas, the challenges are unique but the commonality is a desire to do whatever it takes to bring the best science and care for child health.

Addressing Challenges in Rural Settings

Dr. Marsha Raulerson, a community pediatrician in Brewton, Alabama and fellow of the American Academy of Pediatrics, helped illustrate the challenges that pediatricians face in low-resource, rural settings. According to Dr. Raulerson, while we know that poverty is linked to conditions like low birth weight, chronic illness, and injury, poverty and its adverse health effects disproportionately affect rural populations. With 85% of the most persistently poor counties in the U.S. in rural areas, and fewer pediatricians in those parts of America, new solutions are needed to ensure the best care for babies and children.

However, as we heard from Dr. Raulerson, building on the strengths of rural communities and thinking creatively can help offer stronger, integrated care to these vulnerable communities. The “social capital,” as Dr. Raulerson put it, of close-knit communities, family support, and local networks can help fill in gaps that exist in transportation, childcare, and peer support. Moreover, pediatricians like Dr. Raulerson utilize creative ways to leverage other community assets to help support better health in their communities. By connecting families to resources like Head Start and Habitat for Humanity, pediatricians help influence the social factors that can determine health outcomes. Through those community partnerships that support transportation, access to books, and parent-to-parent peer support, rural pediatricians can find unexpected avenues to care for baby.

Strengthening Care in Urban Communities

Dr. Olanrewaju Falusi shifted the conversation towards opportunities to strengthen pediatric care in urban communities. Pulling from her own experience as a pediatrician and professor in Washington, D.C., Dr. Falusi began her presentation reminding us that, “regardless of your setting, there are things you can do in your community to alleviate the affects of poverty and challenges you face.” Her poignant reminder drov home that not all poverty is the same, and even in challenging settings – rural, urban, or conflict areas – not all health effects manifest in the same way.

Challenges in urban areas, as Dr. Falusi described, are similar yet unique to those in rural areas. Challenges like food insecurity, crime and violence, and transience of communities create unique barriers to pediatric care in cities and urban metro areas. Yet even with somewhat distinct challenges, pediatricians in urban settings are finding similar solutions to help provide the best care for baby. Community support networks can play an important part in the whole health of a child and family, and for urban immigrant populations in particular, this has shown particularly strong impact. Because urban infrastructure tends to be more stable, pediatricians can work with institutions such as food banks, community health clinics, and mobile clinics to help connect babies and children to crucial care services. 

Meeting Needs in Disaster Areas

In a separate session focused on the unique challenges of pediatric care in disaster areas, Dr. Jeffrey Upperman, a Los Angeles pediatric surgeon, effectively summed up the simplicity of a pediatrician’s mindset, even in the most complicated and chaotic of environments, “This child is a person we need to take care of, to keep safe, because that’s what we do.”

Since 2008, more than 185 million people have been displaced from their homes and communities. With numbers equal to one-third of the U.S. population, those living in disaster areas – and in particular children who are most vulnerable within these communities – require unique solutions. While the scale of this group lends itself to population-level interventions, the individual human child at the center of the greatest need, Dr. Upperman urges, must be the ultimate focus of a health care provider’s work.

Pediadvocates

Disasters take all shapes and forms. Whether it’s the economic disaster that hits a rural community, immense challenges of urban poverty, or humanitarian conflicts and natural disasters displacing millions, a “broad and deep safety net,” says Dr. Upperman, must leverage all pediatrics resources available to provide the best care. While all three settings provide unique challenges for quality care, a common beacon illuminates the path forward for pediatricians regardless of context: advocacy. Whether advocating for patients in local communities, connecting to decision-makers in your city, county, and state, or working through AAP to support various policy initiatives, pediatricians must play an active role as an advocate for the youngest and most vulnerable among us.

As Dr. Upperman encouraged us, “everybody is important in crafting the plan, using resources like school systems and social agencies, to have an impact on keeping families healthy and whole.”