‘Sometimes, you just cannot put a good journal down!’ This issue of Contemporary Pediatrics covering the father as both parent and influential partner in childrearing from preconception to entrance into young adulthood provides the foundation for thoughtful consideration of how we, as nurse practitioners, can address paternal parenting and apply the past 10 years of research results on fathers to better inform our practices. The American Academy of Pediatrics Clinical Report entitled, Fathers’ roles in the care and development of their children: The role of Pediatricians,1 provides guidance on the roles of the father in parenting and ways providers can engage fathers in the growth and development of their children. Mary Beth Nierengarten’s article Father’s influence on development and well-being of children, describes the developing evidence base for guiding the role of fathers. Of concern, is the lack of screening for paternal depression in pediatric practices despite evidence that a significant number of fathers experience depression that adversely affects and impacts their child’s development.
Epigenetics the new horizon
Epigenetics, discussed in the article authored by Ms Nierengarten and the article Fathers epigenome affects reproductive health, authored by Lisette Hilton, has the potential to change preventive care as we now know it, both prenatally and postnatally. Ms. Hilton discusses the evidence that showed men who were exposed to environmental pollutants have been found to transfer these toxins in their sperm at the time of conception. Similarly, Ms Nierengarten cites research evidence that may link biological factors and spermatogenesis to childhood obesity, atopic dermatitis, attention-deficit/hyperactivity disorder, and even breast cancer. These findings lend themselves to consider what history questions providers should be asking fathers to better understand environmental factors that may influence the health of the unborn baby as well as the child’s health after birth. Rigorously designed research studies are needed to refine these factors and the currently unknown influences of fathers’ health on many facets of growth and development in children, including but not limited to neurodevelopmental growth, obesity, cardiovascular concerns, and paternal age at conception.
Routine child healthcare and father participation
Reflecting on my personal practices in ambulatory care centers over the past several years, fathers rarely attended well-child visits for healthy children. When they did attend, I recall being concerned that their expectations of the child’s behavior differed from the ‘maternal norms’, when for example, a father told his son ‘be a soldier...soldiers don’t cry’ just as we re-entered the room to administer the child’s immunizations. On the flip side, I recall visits with fathers who were ‘stay at home dads’ and truly enjoyed caring for their children, and provided different day to day adventurous stories when asked if they had any questions or concerns about the child. Occasionally, fathers attended visits for children who had chronic illnesses, most often with the mothers, at times when the child’s condition or affect was perceived as ‘out of control’ at home. At times, these visits were challenging, as some fathers tended to demand immediate answers and resolutions to the problems disrupting the child and family’s normal routines. This brief reflection on my practice highlights the importance of rethinking the role of fathers prior to conception and throughout the child/adolescent rearing years. Positive parenting styles that influence positive behaviors and development are critical to raising healthy and happy children. Perhaps we need to rethink our routine history questions and formulate more father-focused questions when the father presents with the child for a well-child, sick visit, or update on managing a child with chronic illness. We may also need to rethink our delivery of anticipatory guidance to fathers to assure that we are focusing on the parenting needs of the father.
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.