The transition to parenthood can be welcome, joyous, and celebratory. It is also rarely without challenges, requiring rapid learning, substantial physical and emotional adjustment, and the shouldering of new roles and responsibilities. When peripartum complications occur either in the mother or infant, this transition is even more difficult.

In this issue of Pediatrics, Drs Bruney and Sojar eloquently recount Dr Bruney’s personal postpartum experience of preeclampsia, breastfeeding difficulties, feelings of isolation and inadequacy, and postpartum depression in “Confessions of a Pediatrician: A Resident Mom’s Perspective.”1  The challenges Dr Bruney encountered were amplified in balancing family and residency responsibilities. Given the high rates of postpartum depression and the relationship between child and maternal wellbeing, Drs Bruney and Sojar call for pediatricians to better connect with and support new mothers. They also seek additional support for resident-parents through that transition, specifically, clarification of family and medical leave policies.

As pediatricians at the American Board of Pediatrics (ABP), we agree that the emotional, behavioral, and mental health needs of infants and their parents during the peripartum period are critically important. The American Academy of Pediatrics,2  the US Preventive Services Task Force,3  and the American College of Obstetrics and Gynecology4  have all published guidelines in the last 5 years calling for enhanced screening, recognition, and treatment of postpartum depression. State and federal resources are being implemented, including the Maternal and Child Health Bureau’s maternal mental health hotline for new mothers5  and state-based perinatal psychiatry access lines for clinicians.6  We support Drs Bruney and Sojar’s appeal to pediatricians and training programs. As a certifying body, we will review our own efforts to highlight these guidelines and resources through our content outlines, examinations, continuing certification activities, and efforts to improve competency-based medical education and behavioral mental health care.

Trainee-parent perspectives, such as that provided by Drs Bruney and Sojar, also urge us as a field to provide the time, space, and support that pediatric trainees need to care for themselves and their own children. Parental and child wellness matter, regardless of parental employment or stage of training. Residents should be encouraged to take the time they need for their own and their families’ emotional, physical, and social health. In 2021, the Accreditation Council for Graduate Medical Education (ACGME)7  and the American Board of Medical Specialties (ABMS)8  announced a new requirement that all training programs of at least 2 years in duration offer 6 weeks of paid leave for trainees.

As a certifying body, the ABP aims to support trainees and recognizes that its essential and primary obligation is to the public. The ABP must ensure that credentialed pediatricians meet standards, including completion of core ACGME requirements, program director competency attestation, and the expectation of at least 33 months of training experience for most residents. The ABP parental/medical/caregiver leave policy exceeds the ACGME/ABMS minimum standards for residents in 3-year training programs, allowing for 8 weeks of leave and reducing the expectation for training to a minimum of 31 months, provided other training requirements are met and programs deem the trainees clinically competent.9  Those minimal requirements are necessary to assure families of the competency of a certified pediatrician.

Although the ACGME/ABMS minimum leave requirements or the ABP’s 8-week allowance are sufficient for many trainee-parents, others will seek longer leaves to meet family and personal needs. Longer leaves are compatible with certification, provided that training requirements are met. Fulfillment of those requirements will necessitate an extension of residency completion dates, allowing residents to obtain the leave required for their own families while still gaining the training and experience necessary to care for other families. Trainees who extend their residency to fulfill training requirements should take the leave they need, regardless of the time it takes, without concern of stigma or consequence from their training program, future site of employment, fellowship program, or certifying and accrediting organizations.

Our profession dedicates itself to caring for the physical, emotional, and mental health needs of children and families. Drs Bruney and Sojar enjoin the profession to do a better job for parents in the postpartum period; families deserve that. The authors also honestly voice that training to care for other families’ children can complicate caring for one’s own family and vice versa. Residents should be encouraged to care for themselves and their families, even if it results in a reasonable extension of time to complete training. The ABP’s obligation to ensure to the public that board-certified pediatricians have met training, competency, continuous learning, and improvement requirements need not conflict with residents’ commitments to their own families. When training is completed on a date later than that initially expected, no confession is required. Our profession can adapt to embrace a variety of timelines that allow residents to both care for their own families and train to care for other families.

Drs Schaechter, Woods, and Leslie drafted the commentary and reviewed it critically for important intellectual content; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2022-057775.

FUNDING: No external funding.

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest relevant to this article to disclose. All are employees of the American Board of Pediatrics.

ABMS

American Board of Medical Specialties

ABP

American Board of Pediatrics

ACGME

Accreditation Council for Graduate Medical Education

1
Bruney
E
,
Sojar
S
.
Confessions of a pediatrician: a resident mom’s perspective
.
Pediatrics
.
2022
;
151
(
1
):
e2022057775
2
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
3
Curry
SJ
,
Krist
AH
,
Owens
DK
;
US Preventive Services Task Force
.
Interventions to prevent perinatal depression: recommendation statement
.
JAMA
.
2019
;
321
(
6
):
580
587
4
Committee on Obstetric Practice
;
American College of Obstetricians and Gynecologists
.
Screening for perinatal depression
.
5
Health Resources and Services Administration
;
HRSA: Maternal and Child Health
.
Frequently asked questions about the National Maternal Mental Health Hotline
.
6
Postpartum Support International
.
State perinatal psychiatry access programs
.
7
Accreditation Council for Graduate Medical Education
.
Institutional requirements ACGME
.
8
American Board of Medical Specialties
.
American Board of Medical Specialties policy on parental, caregiver, and medical leave during training
.
Available at: https://www.abms.org/policies/parental-leave/. Accessed September 10, 2022
9
American Board of Pediatrics
.
Absences from training: parental/medical/caregiver leave details and frequently asked questions
.