I lost my sense of empathy when I worked as a pediatrician in a pediatric emergency department caring primarily for low-acuity patients. I worked there for ten years, but it only took about three years before I realized that while I could help kids with their symptoms, I couldn’t do anything about the reasons they were in the ED at 3 a.m. These kids don’t have reliable transportation to get to the clinic during the day, their parents don’t know what medicine to give them for a fever, or they can’t buy it. I was burning out because I felt helpless to make any difference.

In looking for ways to address the root causes of the problems I was seeing in my ED patients, I realized that the only way to combat obesity, emergency department overcrowding, and childhood trauma is to address the social determinants of health.

So I started Health Stars, a program that brings pediatricians together with homeless and low-income families to read books to kids and talk to parents about a variety of health topics. When our group was awarded a grant from Kohl’s Cares to support this program, it was with the intention to share our medical expertise with these families. But instead, I am humbled to have learned more than I’ve taught. Here’s what I’ve learned:

Share a book every day

Our sessions teach parents about the importance of reading. Research shows that reading to kids from the day they are born helps their brains grow and gets them ready to succeed in school. What we didn’t know was that many of our parents can’t read and don’t own any books.

While many immigrant parents in the program have learned to speak English well enough, many are at the same reading level as their toddler. So now we model the importance of exploring books with their kids. They turn the pages and touch the pictures, make sounds, act out the scenes in the books and ask children questions about what they see. These parents showed me that it’s not reading that is important, the important variable is interacting with a child. I’ve moved from the ED to a primary care clinic. Now I phrase my advice differently: I ask my patients to share a book every day, instead of advising them to read to their kids.

Don’t wish for well-behaved children

Parents all want well-behaved children. That’s why pediatricians spend a lot of time counseling about behavior. In Health Stars we gave evidence-based advice. We discussed that parents should make rules and follow them strictly if they expect their child to follow the rules too. We also taught parents to give their kids choices: “Do you want to walk to the car or use your stroller?”

But none of this advice made any sense to families who had been living on the street. The only safe place for their 18-month-old may be in the stroller with a blanket covering them. We met kids who have spent a good part of their early months covered up and had almost no access to interaction with other people.

Often their development is so impaired that they show signs of autism. They don’t know how to make eye contact and don’t understand boundaries other than physical ones. Fortunately, we also learned that young children are very resilient and they usually develop healthy social skills within weeks when they move off the streets.

What we learned from witnessing these families is that every interaction you have with your child is meaningful and vital. The melt-downs and the times when kids hit their parent are frustrating, but every interaction is an opportunity to teach a child about how to interact with people — and those are critically essential experiences. So I’ve stopped telling parents to make rules and stick to them. Instead, I talk about making their expectations of their child’s behavior clear, and I discuss examples.

The key to eating healthy is creativity

I’ve been counseling my clinic patients about limiting sugary drinks and eating lots of vegetables. And out in the community, I’ve been teaching Health Stars’ families about offering healthy after-school snacks. However, I witnessed that the only snacks available to kids at some affordable housing complexes are M&Ms and Hot Cheetos. In one community there is an elderly resident whose son takes her to Costco to buy snacks to re-sell for income. She opens her front door at 2:30 p.m. weekdays. And the closest grocery store is a bus ride away. So these families who don’t have cars and take the bus to work all day don’t quite have the means to bring home a pineapple for their child’s snack.

What we found was that the Hot Cheetos-M&M-snacking kids loved munching on the frozen peas we brought. These veggies were inexpensive and never got rotten or overripe. I learned never to underestimate the unique palates of children and to offer healthy foods in any form you can get them because you never know what will appeal to a curious elementary-school kid.

By walking into the homes and lives of disadvantaged families, I’ve come to better understand the barriers that my patients’ families face when trying to follow my well-intentioned (but naive) advice in clinic. And indeed, my happiest moments have been sharing parents’ successes that resulted from things they learned from the sessions. One of our greatest successes has been an increase in vaccination acceptance among East African families, and we have also seen a significant increase in reading among all participants. Over the past two years, the program has grown to serve hundreds of families thanks to grant support from Kohl’s Cares and to the many physician volunteers.

Wendy L. Hunter is a pediatrician.

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