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Involve fathers in all aspects of family-centered care: AAP :

June 13, 2016

The number of stay-at-home dads is increasing. More studies are citing the vital contribution of fathers in children’s lives. And younger fathers are taking a more active role in child care than in previous generations.

Regardless, pediatricians — and, in some ways, society in general — have been slow to realize the central role of fathers and have neglected to involve them in all aspects of family-centered care, according to the AAP clinical report Fathers’ Roles in the Care and Development of Their Children: The Role of Pediatricians.

“We have a tendency in this society and this discipline to think about families and children as mothers and children despite the tremendous amount of research showing the way fathers are involved and the increase in their involvement,” said Craig F. Garfield, M.D., FAAP, a lead author of the report and a previous one in 2004. “We still take an approach that’s mother-focused. This report is yet another attempt to try to bring pediatrics to the forefront of where fatherhood is today.”

Different and essential roles

The roles of mothers and fathers are seldom redundant. In fact, studies in the last 10 years have shown that the “involvement of fathers has important consequences for child well-being, especially with regard to issues of diet/nutrition, exercise, play and parenting behaviors (e.g., reading, discipline),” according to the report, available at

For that reason, let’s not look at whether a father “is as good as” a mother, said Michael W. Yogman, M.D., FAAP, chair of AAP Committee on Psychosocial Aspects of Child and Family Health, the group that issued the report. Instead, consider the unique role of fathers in how they interact with children.

“A male caregiver can do some pretty neat and special things,” Dr. Yogman said. “They can find their own unique role, especially by watching the baby or child for signs of joy. They should not feel like their only role is to do everything the same as the mother.”

Fathers usually talk to children in a way that’s different than moms and exhibit a particular type of rough and tumble play, Dr. Garfield said. “Dad changes the rules, explores a little more in a risky way but still keeps it safe. Those are two simple ways fathers involved with children help them grow, explore and learn about their world.”

Studies also show mothers and fathers stimulate different parts of a child’s brain based on their interactions.

Prescription for play

The vast majority of fathers are present at their child’s birth, the report notes, even though 40% of births are to unmarried couples.

From there, it gets more challenging for parents and pediatricians. For example, five years after a child’s birth, 63% of unmarried fathers are no longer living with the mother. Even with married parents, fathers may not attend pediatrician appointments due to work commitments.

“Men want to start off on the right foot,” Dr. Garfield said. “Getting them involved early is what will keep them involved. Acknowledge them as part of the health care system, in the doctor’s office, and let them know in concrete ways how they can be involved with the child and help the mother.”

For example, “fathers can play a critical role in supporting maternal breastfeeding and, conversely, if feeling excluded and competitive, can undermine it,” the report said.

If the father does come to appointments, some pediatricians will just talk to the mother.

“That’s what they’re used to,” Dr. Yogman said. “That’s not going to make the father eager to come back next time. You have to make an extra effort to make people feel especially welcome.”

One way to involve men early in child care is to provide some simple training on how to hold and take care of the child just after birth. It will help them become more comfortable because they might not have had much experience handling babies. Doctors also can give a father a “prescription to play” with a baby at the 2-month or 4-month visit, Dr. Yogman said.

It’s also important for pediatricians to work with mothers in their role as gatekeeper — especially if the father does not live in the home. “If the mother doesn’t want the father to be involved, they’re not going to be allowed,” Dr. Yogman said.

Dads and society

Fathers are taking the initiative to be a larger presence in their children’s lives, with one study showing that fathers took part in child care seven hours per week in 2011 compared with 2.5 hours in 1965.

Dr. Garfield has seen this change in a class he teaches for expectant fathers at Northwestern Memorial Hospital in Chicago.

In his 20 years of pediatrics, he’s realized parenting is a team sport. When a father is not involved, “you’re missing one of the key players. Bring him off the bench, onto the field and I think it will make a difference in how a child does, mother does and family does. It should be for the better.”

Other key tips for pediatricians

  • Emphasize how children look to their fathers as role models of well-being and behavior.
  • Note that father involvement is associated with better academic success, social competence and less at-risk behavior in their children.
  • Inform the family about the normal elation, fatigue and challenges of being a father.
  • Discuss how the couple is adapting to parenthood.
  • Include both parents, if possible, in medical procedure discussions.
  • Screen fathers for perinatal depression and have a plan in place should either parent show symptoms.
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