Growing evidence shows the positive influence that fathers have on the development and well-being of their children. Longitudinal data published over the past decade or so support that paternal involvement from the prenatal stage through a child’s lifetime benefits the psychosocial and behavioral development of their children, often in ways different from and complementary to maternal involvement.1,2 Other data exploring the biological and epigenetic influences of fathers on their children are revealing the complexity of this paternal influence on their children.3-7 Among the most studied areas of research is paternal depression and the associated adverse effects on children.8-13
In 2016, the American Academy of Pediatrics (AAP) updated its guidance for pediatricians on the role of fathers in the care and development of their children based on the increasing number of “high-quality” studies that now quantify and qualify this role.1 According to the guideline, among the drivers underlying this increased interest in fathers are socioeconomic forces in which the traditional roles of men and women are changing. More mothers are working outside the home and more stay-at-home fathers are taking on caregiving activities. Fathers also are increasingly taking on the primary caregiving role as single parents. Also highlighted are changing social mores encouraging more involvement by fathers beyond their historic protector and provider role. Data show this, with involvement by fathers in childcare nearly doubling between 1965 and 2011.14
Despite this growing involvement of fathers in their children’s lives, pediatric visits largely still focus on the mother-child relationship.15,16 A recent systematic review of father-inclusive perinatal parent education in the United States found only a small number of early parent education programs for fathers.15 In addition, recent survey results of 100 pediatric primary care providers found that less than 50% of the respondents regularly implemented recommendations for engaging fathers as listed in the recent guidelines by the AAP.16 The survey also found that supporting parenting skills and perinatal depression screening for fathers were the least implemented recommended practices.
Craig F. Garfield, MD, professor of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, attending physician at the Ann and Robert H. Lurie Children’s Hospital of Chicago, and one of the authors of the AAP guidelines on fathers, emphasizes the persisting lack of focus on fathers when it comes to pediatric care.
“Pediatrics has been slow in embracing the roles of fathers,” he says, citing, for example, a recently published AAP guideline on postnatal depression that largely focused only on maternal depression.17
This article reviews some of the data on ways fathers contribute positively to the development and wellbeing of their sons and daughters, and suggests opportunities for pediatricians to better engage fathers in the care of their children.
1. Yogman M, Garfield CF; Committee on Psychosocial Aspects of Child and Family Health. Fathers’ role in the care and development of their children: the role of pediatricians. Pediatrics. 2016;138(1):e20161128. Available at: https://pediatrics.aappublications.org/content/pediatrics/early/2016/06/10/peds.2016-1128.full.pdf. Accessed May 28, 2019.
2. Sarkadi A, Kristiansson R, Oberklaid F, Bremberg S. Fathers’ involvement and children’s developmental outcomes: a systematic review of longitudinal studies. Acta Paediatr. 2008;97(2):153-158.
3. Vaughn AR, Sivamani RK, Lio PA, Shi VY. Paternal vs maternal factors in childhood atopic dermatitis. Dermatitis. 2017;28(4):241-245.
4. van den Hoofdakker BJ, Hoekstra PJ, van der Veen-Mulders L, Sytema S, Emmelkamp PM, Minderaa RB, Nauta MH. Paternal influences on treatment outcome of behavioral parent training in children with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry. 2014;23(11):1071-1079.
5. Romanus S, Neven P, Soubry A. Extending the Developmental Origins of Health and Disease theory: does paternal diet contribute to breast cancer risk in daughters? Breast Cancer Res. 2016;18(1):103.
6. Phillips N, Taylor L, Bachmann G. Maternal, infant and childhood risks associated with advancing paternal age: the need for comprehensive counselling for men. Maturitas. 2019;125:81-84.
7. Rajhans P, Goin‐Kochel RP, Strathearn L., Kim S. It takes two! Exploring sex differences in parenting neurobiology and behaviour. J Neuroendocrinol. April 29, 2019. Epub ahead of print.
8. Paulson JF, Dauber S, Leiferman JA. Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics. 2006;118(2):659-668.
9. Garfield CF, Duncan G, Rutsohn J, et al. A longitudinal study of paternal mental health during transition to fatherhood as young adults. Pediatrics. 2014;133(5):836-843.
10. Davé S, Petersen I, Sherr L, Nazareth I. Incidence of maternal and paternal depression in primary care: a cohort study using a primary care database. Arch Pediatr Adolesc Med. 2010;164(11):1038-1044.
11. Tichovolsky MH, Griffith SF, Rolon-Arroyo B, Arnold DH, Harvey EA. A longitudinal study of fathers’ and young children’s depressive symptoms. J Clin Child Adolesc Psychol. 2018;47(supp 1):S190-S204.
12. Cameron EE, Sedov ID, Tomfohr-Madsen LM. Prevalence of paternal depression in pregnancy and the postpartum: an updated meta-analysis. J Affect Disord. 2016;206:189-203.
13. Ramchandani P, Stein A, Evans J, O’Connor TG; ALSPAC study team. Paternal depression in the postnatal period and child development: a prospective population study. Lancet. 2005;365(9478):2201-2205.
14. Parker K, Wang W. Modern Parenthood: Roles of Moms and Dads Converge as They Balance Work and Family. Washington, DC: Pew Research Center; 2013. Available at: http://genderedinnovations.taiwan-gist.net/institutions/Modern Parenthood _ Pew Social %26 Demographic Trends.pdf. Accessed May 28, 2019.
15. Lee JY, Knauer HA, Lee SJ, MacEachem MP, Garfield CF. Father-inclusive perinatal parent education programs: a systematic review. Pediatrics. 2018;142(1):e20180437.
16. Allport BS, Solomon BS, Johnson SB. The other parent: an exploratory survey of providers’ engagement of fathers in pediatric primary care. Clin Pediatr (Phila). 2019;58(5):555-563.
17. Earls MF, Yogman MW, Mattson G, Rafferty J; Committee on Psychosocial Aspects of Child and Family Health. Incorporating recognition and management of perinatal depression into pediatric practice. Pediatrics. 2019;143(1):e20183259,
18. Shannon JD, Cabrera NJ, Tamis-Lemonda C, Lamb ME. Who stays and who leaves: father accessibility across children’s first 5 years. Parent Sci Pract. 2009;9(1-2):78-100.
19. Nepomnyaschy L, Waldfogel J. Paternity leave and fathers’ involvement with their young children. Evidence from the American ECLS-B. Community, Work & Family. 2007;10(4):427-453.
20. Pancsofar N, Vernon-Feagans L. Mother and father language input to young children: contributions to later language development. J Appl Dev Psychol. 2006;27(6):571-587.
21. Raeburn P. Do Fathers Matter? What Science is Telling Us About the Parent We’ve Overlooked. New York, NY: Scientific American/Farrar, Straus, Giroux; 2014.
22. Feldman R. Infant-mother and infant-father synchrony: the coregulation of positive arousal. Infant Ment Health J. 2003;24(1):1-23.
23. Jia R, Kotila LE, Schoppe-Sullivan SJ. Transactional relations between father involvement and preschoolers’ socioemotional adjustment. J Fam Psychol. 2012;26(6):848-857.
24. Yogman MW. Games fathers and mothers play with their infants. Infant Ment Health J. 1981;2(4):241-248.
25. Yogman YW, Lester BM, Hoffman J. Behavioral and cardiac rhythmicity during mother-father-stranger infant social interaction. Pediatr Res. 1983;17(11):872-876.
26. Fletcher R, St George J, Freeman E. Rough and tumble play quality: theoretical foundations for a new measure of father-child interaction. Early Child Development and Care. 2013;183(6):746-759.
27. Sarkadi A, Kristiansson R, Oberklaid F, Bremberg S. Fathers’ involvement and children’s developmental outcomes: a systematic review of longitudinal studies. Acta Paediatr. 2008;97(2):153-158.
28. Ellis BJ, Schlomer GL, Tilley EH, Butler EA. Impact of fathers on risky sexual behavior in daughters: a genetically and environmentally controlled sibling study. Dev Psychopathol. 2012;24(1):317-332.
29. Guilama-Ramos, V, Thimm-Kaiser M, Benzekri A, et al. Father-son communication about consistent and correct condom use. Pediatrics. 2019;143(1):e20181609.
30. Vakrat A, Apter-Levy Y, Feldman R. Fathering moderates the effects of maternal depression on the family process. Dev Psychopathol. 2018;30(1):27-38