“I don’t understand, and no one will explain why it happened.” Jake, my adolescent patient, lamented his experience to me during his well-child visit. “Those boys say that people like me are the devil. They don’t even know me. I’m a good person.” Hours before seeing me in clinic that day, a group of minority teens had confronted Jake while at a local youth community center because he was “the white kid.”

Jake was utterly confused as to why they had accused him of being racist when the teens had never met him before or had any proof for their accusations. He was even more frustrated by his parents’ reticence to discuss the topic of race with him.

As the medical visit continued, Jake and I talked about race and his knowledge of the subject matter. He lacked social awareness about the current racial and social climate within the United States but was eager to learn. Throughout our interaction, his mother’s eyes revealed a desire to contribute to the conversation. Yet, she never overcame her seemingly self-imposed paralyzing silence. The complexity and controversy of race in America has created the reluctance of parents, like Jake’s mother, to initiate conversations about race with their children. However, pediatricians are poised to play a pivotal role in bridging that gap between parents and their children for these difficult conversations.

Many citizens in the United States likely look at the country’s current racial-social context with confusion. After the election of our first African-American president in 2008, many within the country declared that the U.S. is now a “post-racial” society.

President Barack Obama’s election supposedly symbolized that most of us were finally able to live out Martin Luther King Jr.’s dream in which individuals are judged by their character and not by their color of skin.

But we have become inundated with examples disavowing the ideal of a post-racial society and confirming that we are far from a color-blind society. Examples include the un-proportionally high number of people of color in the U.S. prison system and the recent national attention to the “Black Lives Matter” movement and shootings of unarmed Black Americans.

Furthermore, following the recent presidential election of Donald Trump, our nation has seen the recent political emergence of the “nationalist” and “alternative-right” movements that although proponents proclaim are a patriotic movement, to many the movements border on being racially and culturally exclusive and insensitive if not altogether racist.

Some parents with misconceptions about the current state of racial dissension in this country may verbally express negative remarks in front of their children who then absorb the destructive language and bring it into their schools and the community. This hate-filled verbiage and behavior fertilize a plethora of negative environments for generations of children. However, similarly to recognizing the mental, emotional and physical tolls of bullying and sexual abuse, pediatricians can proactively work to prevent these deleterious consequences by providing parents with guidance on facilitating discussions with their children that encourage socio-cultural awareness rather than promote mistrust, stereotypes or hate.

Parents of all races and ethnicities need to conduct honest and developmentally appropriate discussions about race and racism with their children. Jake did not understand why his peers called him names and accused him of being racist despite not knowing him as an individual. When he reached out to his parents for answers and support, they were not able to handle his race-related questions or provide him with answers.

They told him that the issue of race was complicated and advised him to avoid the negative teens. Essentially, they chose silence for their strategy on racial differences. Silence, however, can ultimately promote prejudice and create even more racial division. Silence eliminates parents’ opportunity to teach about diversity and places the instruction about race in the hands of the media or the children’s misguided peers.

During the clinic visit, Jake persisted with his questions about race. He wanted to learn more and develop his social awareness. While walking out the door, Jake stated he was determined to introduce himself to the group of bullying teens and become their friends. At the end of the visit, his mother was thankful for the dialogue and commented that the interaction had encouraged her to continue the conversation with her children at home.

By 2018, most children in the United States will identify as “minority.” Pediatricians will be on the front lines of social change as we care for these children in our offices and communities. As such, we must advocate for healthy discourses about racial, ethnic, and social identities with our patients and their families. We can work to reverse the negative emotional, mental, and physical impact that the current racial tensions in our country are having, not just on children of color, but on children of all races and ethnicities.

Pediatricians regularly speak on matters involving social determinants of health. We routinely screen for exposure to violence in the home, sexual activity, or even television screen time during our well-child visits. Given the current social climate, it is time to approach the topic of race with a similar level of clinical concern during these scheduled health visits. We can support the education of children about socio-cultural awareness at an early age so that they have the tools to succeed in finding solutions for dismantling systematic social oppression within our society and promoting a unified multicultural society.

To give primary care providers the confidence to approach this highly controversial and extremely challenging subject matter, creating guidelines and tools to aid healthcare providers in their discussions with families will be necessary. It will also be important to create screening questionnaires to help medical providers identify patients that may be at an increased risk of developing socially intolerant attitudes. For example, a “socio-cultural awareness and tolerance” themed toolkit designed for the health care provider would provide pediatricians guidelines on how to obtain a focused “socio-cultural awareness/tolerance” history and provide the physician with resources available for families to access and to reference in future discussions about social injustices such as racism.

Finally, as pediatricians, we must individually examine our own socio-cultural tolerance and awareness. Health care providers should create platforms that allow the pediatric community to share amongst one another the best practices on how to engage in open and honest conversations with our patients about race. In conclusion, pediatricians should embrace the role of physician leaders and champions in shaping a better future for our children and creating more socio-cultural harmony within our communities.

Lindsay Wells is a pediatrician.

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