American Indian and Alaska Native children and teens face considerable hurdles from birth that stem from historical trauma, health inequities, socioeconomic barriers and racism—and yet they endure with proper support. Pediatricians who work with young children are in an ideal position to improve health in these underserved communities while advocating for long-term solutions.
That is the message of the American Academy of Pediatrics (AAP), which released its first policy statement on this population, “Caring for American Indian and Alaska Native Children and Adolescents," published in the April 2021 Pediatrics. The statement was written by American Indian physicians on Coast Salish and Pueblo lands. They acknowledge that the statement represents a diverse and far-reaching group of U.S. Indigenous peoples, while offering strategies for pediatricians to provide culturally sensitive, family-centered care.
“The needs of American Indian and Alaska Native children are extraordinary, as they are disproportionately affected by violence, substance use, obesity-related diseases and toxic stress related to adverse childhood experiences," said Jason F. Deen, MD, FAAP, an author of the policy statement, written by the AAP Committee on Native American Child Health.
Tools to promote grounding & growth
“As pediatricians, we have the tools to help promote grounding and growth, and improve the health of all children with respect for their individual experiences and cultural backgrounds. This is key for building stronger communities, as children grow up and raise their own children."
The AAP policy statement describes health disparities among Native American and American Indian children, including among those who identify as lesbian, gay, pansexual, bisexual, transgender, gender queer, intersex, and “two spirit"—a widely used term in Indigenous communities that encompasses both
gender identity and traditional Indigenous understandings of identity.
Pediatricians are encouraged to assess children for multiple risks to their health, and to help families identify practical solutions. American Indian and Alaska Native children may be at higher risk of
adverse childhood experiences (ACEs); poverty; food insecurity; homelessness; lack of neighborhood safety; incarceration of parents or other family members; or mental health conditions of parents or other household family members.
Earning trust & helping children thrive
“It's important for us to acknowledge a long history of bias and racism experienced by these communities," said Shaquita Bell, MD, FAAP, a statement author. “This has led to a deep mistrust of health care and of health care-related research. While systemic changes are needed, we can take immediate steps to offer culturally sensitive, family-centered care in our clinics and communities. We know children can and do thrive with our help."
The AAP offers recommendations on the care of American Indian and Alaska Native patients, as well as advocacy with governmental entities at the tribal, local, state and federal levels.
Recommendations include:
Partner with local tribes and communities to set health priorities, understand historical experiences, and combine efforts already underway such as cultural enrichment and preservation programs.
Provide opportunities for adequate training of clinical and office staff in culturally sensitive care practice.
Provide evidence-based supports for parents and young children by promoting the use of home visiting models,
high-quality child care, and early childhood programs such as early Head Start, Head Start, and Nurse-Family Partnership. Start a Reach Out and Read program in any clinic serving these families, and include
books representing American Indian and Alaska Native Indigenous children and families.
Assess patients for Adverse Childhood Events and social determinants of health, and identify protective factors to promote positive youth development, including cultural preservation-based efforts.
Consider testing for prediabetes and Type 2
diabetes in children and adolescents who are
overweight or obese as recommended by the American Diabetes Association.
Promote
breastfeeding in tribal communities, ideally coordinated by tribal entities and involving community members, elders, and health care providers, including paraprofessionals.
Include early childhood
oral health as part of overall childhood health and well-being.
Create a
medical home that acknowledges and is sensitive to discrimination in clinical settings and generations of unresolved traumas and racism that American Indian and Alaska Native children and families experience.
“There are many ways we can help support children—whether it's offering information on breastfeeding, starting a Reach Out and Read program or advocating in support of funding and legislation that improves access to quality food, education and housing security," Dr. Bell said.
“We can also be good listeners, to support families and communities that have so much to teach us about their cultures and traditions. Every child deserves a chance at a heathy start, to be nurtured, loved and respected."
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