Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine (RS Gross, MJ Messito, and HS Yin), New York, NY.
Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine (RS Gross, MJ Messito, and HS Yin), New York, NY.
Acad Pediatr. 2021 Nov-Dec;21(8S):S161-S168. doi: 10.1016/j.acap.2021.04.005.
Poverty-related disparities appear early in life in cognitive, language, and social-emotional development, and in growth, especially obesity, and have long-term consequences across the life course. It is essential to develop effective strategies to promote healthy behaviors in pregnancy and the early years of parenthood that can mitigate disparities. Primary preventive interventions within the pediatric primary care setting offer universal access, high engagement, and population-level impact at low cost. While many families in poverty or with low income would benefit from preventive services related to both development and growth, most successful interventions have tended to focus on only one of these domains. In this manuscript, we suggest that it may be possible to address both development and growth simultaneously and effectively. In particular, current theoretical models suggest alignment in mechanisms by which poverty can create barriers to parent-child early relational health (i.e., parenting practices, creating structure, and parent-child relationship quality), constituting a final common pathway for both domains. Based on these models and related empirical data, we propose a strength-based, whole child approach to target common antecedents through positive parenting and prevent disparities in both development and growth; we believe this approach has the potential to transform policy and practice. Achieving these goals will require new payment systems that make scaling of primary prevention in health care feasible, research funding to assess efficacy/effectiveness and inform implementation, and collaboration among early childhood stakeholders, including clinicians across specialties, scientists across academic disciplines, and policy makers.
贫困相关的差异在认知、语言和社会情感发展以及生长方面在生命早期就显现出来，尤其是肥胖，并且会对整个生命过程产生长期影响。因此，制定有效的策略来促进妊娠和育儿早期的健康行为以减轻这些差异至关重要。在儿科初级保健环境中开展的初级预防干预措施具有普遍性、高参与性和人群层面的影响，而且成本低廉。虽然许多贫困或低收入家庭都将受益于与发育和生长相关的预防服务，但大多数成功的干预措施往往只关注这两个领域之一。在本文中，我们提出了一种可能的方法，即同时有效地解决发育和生长问题。具体而言，当前的理论模型表明，贫困可能会通过阻碍亲子早期关系健康的机制（即育儿实践、建立结构和亲子关系质量）而产生一致性，这构成了这两个领域的最终共同途径。基于这些模型和相关的实证数据，我们提出了一种以优势为基础的、全面儿童为中心的方法，通过积极育儿来针对共同的前因，并预防发育和生长方面的差异；我们相信这种方法有可能改变政策和实践。实现这些目标需要新的支付系统，使医疗保健中的初级预防能够扩大规模，需要研究资金来评估疗效/有效性并为实施提供信息，还需要包括跨专业临床医生、跨学术学科科学家和政策制定者在内的早期儿童利益相关者之间的合作。
