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AMERICAN ACADEMY OF PEDIATRICS
POLICY STATEMENT
Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of All Children
Committee on Community Health Services
The Pediatrician's Role in Community Pediatrics
ABSTRACT. This policy statement reaffirms the pedi- · A commitment to use a community's resources in
atrician's role in community pediatrics. It offers pediatri- collaboration with other professionals, agencies,
cians a definition of community pediatrics and provides and parents to achieve optimal accessibility, ap-
a set of specific recommendations that underscore the propriateness, and quality of services5 for all chil-
critical nature of this important dimension of the
dren and to advocate especially for those who lack
profession. Pediatrics 2005;115:10921094; community, pe-
diatrics, pediatrician, role of, definition of, profession. access to care because of social, cultural, geo-
graphic, or economic conditions or special health
care needs6,7; and
ABBREVIATION. AAP, American Academy of Pediatrics. · An integral part of the professional role and duty
of the pediatrician.
INTRODUCTION
T
oday's children and families live in a period of For many pediatricians, efforts to promote the
rapid social change. The economic organiza- health of children have been directed at attending to
tion of the health care and other human service the needs of particular children in a practice setting,
systems in the United States is undergoing profound on an individual basis, and providing them with a
changes. Pediatric training programs are searching medical home.8 This approach, in combination with
for the optimal blend of knowledge, skill, attitudes, pediatricians' own personal community interests
and experience to prepare tomorrow's pediatricians and commitments, has proven to be very successful.
for the new challenges and morbidities that they will Increasingly, however, the major threats to the health
face.13 As clinicians and educators encounter new of America's children, the new morbidities,9 arise
demands on their expertise and resources, it is im- from problems that cannot be addressed adequately
portant to reaffirm the vital and long-standing role of by the practice model alone.10 These problems in-
pediatricians in promoting the physical, mental, and clude high infant mortality rates, children with
social health and well-being of all children in the chronic health care needs, obesity, disproportion-
communities they serve. ately high levels of intentional and unintentional
injuries, exposure to lead and other environmental
DEFINITION OF COMMUNITY PEDIATRICS hazards, substance abuse, behavioral and develop-
The American Academy of Pediatrics (AAP) offers mental consequences of inappropriate care and ex-
a definition of community pediatrics to remind all perience, mental health conditions, poor school
pediatricians, generalists and specialists alike, of the readiness,11family dysfunction, sexually transmitted
profound importance of the community dimension diseases, unwanted pregnancies, and lack of access
in pediatric practice. Community pediatrics is all of to medical homes.12 An integral component of a com-
the following: munity-pediatrics approach incorporates interdisci-
· A perspective that enlarges the pediatrician's fo- plinary practice. As former AAP president Robert
cus from one child to all children in the commu- Haggerty, MD, FAAP, reminded us in 1995, "we
nity; must become partners with others, or we will be-
· A recognition that family, educational, social, cul- come increasingly irrelevant to the health of chil-
tural, spiritual, economic, environmental, and po- dren."13
litical forces act favorably or unfavorably, but al- Communities should impart a sense of health,
ways significantly, on the health and functioning safety, and well-being and promote a supportive
of children; environment for families of all types. Just as children
· A synthesis of clinical practice and public health depend on the interaction of families in which they
principles directed toward providing health care live, the communities that support them affect fam-
to a given child and promoting the health of all ilies. The health and welfare of children depend on
children within the context of the family, school, the ability of families and the community support
and community4; system to foster positive emotional and physical de-
velopment.14 Recently the AAP's Task Force on the
doi:10.1542/peds.2004-2680
Family examined the concept of family pediatrics
PEDIATRICS (ISSN 0031 4005). Copyright © 2005 by the American Acad- and the discipline that must be practiced within the
emy of Pediatrics. context15 of the community.16,17
1092 PEDIATRICS Vol. 115 No. 4 April 2005
Pediatricians remain instrumental in efforts to cre- 7. Pediatricians should educate themselves con-
ate, organize, and implement changes in communi- cerning the availability of community resources
ties' efforts that can substantially improve the health that affect the health and well-being of the chil-
of children. As far back as Abraham Jacobi, MD dren they serve.
(1830 1919), a leading child advocate of his time and 8. Pediatricians are encouraged to become involved
a founder of the discipline of pediatrics, pediatricians in the education of residents and medical stu-
recognized that children are best understood, and dents in community settings. Pediatricians have
their needs attended to, within interlinking contexts the unique opportunity to model roles outside
of biology, family, and community.18 More recently, the traditional clinical roles that students and
Haggerty identified the unique contribution and fo- residents encounter. Pediatric academicians
cus of community pediatrics: should use resources from the AAP and the Am-
Community pediatrics [has sought] to provide a far more bulatory Pediatric Association to engage the
realistic and complete clinical picture by taking responsibility community pediatrician as an educator, both in
for all children in a community, providing preventive and the care of individual patients in community-
curative services, and understanding the determinants and based practice and in roles related to promotion
consequences of child health and illness, as well as the effec-
tiveness of services provided. Thus, the unique feature of of the well-being of all children in the commu-
community pediatrics is its concern for all of the population-- nity. Community-based resources outside the
those who remain well but need preventive services, those bounds of the traditional hospital and outpatient
who have symptoms but do not receive effective care, and office setting should be used to instruct residents
those who do seek medical care either in a physician's office
or in a hospital.19
in the effect of the community on child health
status and the positive effect of interdependent
With the sweeping changes occurring in medicine collaboration of community agencies with health
and other human services, it is especially important professionals on child health.24
now for pediatricians to reexamine and reaffirm their 9. Medical student, resident, and continuing medi-
role as professionals in the community, as commu- cal education programs should consider and pe-
nity pediatricians, and prepare themselves for it just riodically review basic community pediatric
as diligently as they prepare for traditional clinical competencies to be included in training and
roles. maintenance of certification efforts for pediatri-
cians.25
RECOMMENDATIONS 10. AAP chapters and their members should provide
leadership for furthering the understanding of
1. Pediatricians should use community data (epide- community pediatrics and encourage participa-
miologic, demographic, and economic) to in- tion in creative, community-based, integrated
crease their understanding of the health and so- models such as those supported through the
cial risks on child outcomes and of the Community Access to Child Health program and
opportunities for successful collaboration with the Healthy Tomorrows Partnership for Children.
other child advocates. 11. AAP chapters should provide leadership, sup-
2. Pediatricians should work collaboratively with port, and recognition for pediatricians involved
public health departments and colleagues in re- in advocacy efforts at the local, state, and na-
lated professions to identify and decrease barri- tional levels to ensure that children have access
ers to the health and well-being of children in the to care and to foster integration of these activities
communities they serve.20,21 as an integral part of the professional role and
3. Pediatricians should become comfortable with duty of the pediatrician.
an interdisciplinary collaborative approach and
advocacy effort to child health. Pediatricians can Caring, compassionate, and knowledgeable pedi-
play an important role in coordinating and fo- atricians should address the needs of their patients
cusing new and existing services to realize max- and all children in the context of the community.
imum benefit for all children.22,23 Committee on Community Health Services,
4. Pediatricians and other members of the commu- 20032004
nity should interact and advocate to improve all Helen M. DuPlessis, MD, MPH, Chairperson
settings and organizations in which children Suzanne C. Boulter, MD
spend time (eg, child care facilities, schools, Denice Cora-Bramble, MD
youth programs). School and community re- Charles R. Feild, MD, MPH
sources should be considered as assets in devel- Gilbert A. Handal, MD
oping strategies for the problems that children Murray L. Katcher, MD, PhD
will face now and throughout their lives. Ronald V. Marino, DO, MPH
5. Pediatricians should nurture and advocate for *Francis E. Rushton, Jr, MD
Wyndolyn C. Bell, MD
neighborhood structures that support healthy David L. Wood, MD, MPH
families capable of promoting optimal health, Stanley I. Fisch, MD
safety, and development in their children. Past Committee Member
6. Pediatricians should advocate improving the ef-
fectiveness and efficiency of health care for all Liaisons
children, striving to ensure that every child in the Jose Belardo, MSW, MS
community has a medical home. Maternal and Child Health Bureau
AMERICAN ACADEMY OF PEDIATRICS 1093
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Ambulatory Pediatric Association findings for the American Academy of Pediatrics Task Force on the
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18. Jacobi A. The best means of combating infant mortality. JAMA. 1912;
Consultant 58:17351744
Denia A. Varrasso, MD 19. Haggerty RJ. Community pediatrics: past and present. Pediatr Ann.
1994;23:657
Staff 20. Zuckerman B, Parker S. Preventive pediatrics--new models of provid-
Aiysha Johnson, MA ing needed health services. Pediatrics. 1995;95:758 762
21. Elster AB, Callan CM. Physician roles in medicine-public health collab-
*Lead author oration. Am J Prev Med. 2002;22:211213
22. Mullan F. Sounding board. Community-oriented primary care: an
agenda for the 80s. N Engl J Med. 1982;307:1076 1078
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pt 2):15411571 reaffirmed, revised, or retired at or before that time.
1094 THE PEDIATRICIAN'S ROLE IN COMMUNITY PEDIATRICS