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In this tumultuous year, our country has been faced with a health crisis that has forced us to change the way we go about our daily lives and has exposed the age old fault lines of racial inequities in our society. COVID 19 has attacked young and old, but has been especially virulent in African American and Latinx communities. During this time of national economic and physical fragility due to the virus, these communities have also been assaulted by the murder of their citizens. As health care providers, we hope that science will develop a vaccine to reduce the spread of Coronavirus, but addressing racism requires all of our participation as allies against this disease. This is essential as racism is toxic to the social-emotional health of all children.

Racism flourishes in ignorance and pre-conceived ideas and beliefs. To address it, we must first acknowledge that we all have implicit biases and it is what we do after we accept this fact that is important. If unaddressed these implicit biases can develop into explicit actions of personal racism that are adverse childhood experiences demonstrated to damage the mental health not only of the targeted child but the perpetrator and bystander as well. While discussions about racism can be difficult and elicit a gamut of emotions, they are essential and pediatricians can coach parents on how to successfully raise these issues with their children. These discussions will take varied forms depending on the age and race of the child. As with learning any new skill, they must be reinforced over time to allow for comfort and mastery. Proactively engaging in these discussions throughout the child’s life will lead to more positive emotional and social health.

As studies have shown, toddlers can discern differences in race, so exposures to other races should begin in this age group. Parents should read books that celebrate diversity or have a protagonist who is not of their family’s race. Parents of young children of color can be coached to the use the strategies of positive racial socialization, which refers to anticipatory strategies that teach children to navigate a racist environment. This process aims to reinforce pride in the minority child’s cultural heritage through literature, music and personal family history. Although much of our society still resides in segregated communities, it is important for parents to find opportunities for their children to interact with children of all races. This proactive exposure includes choosing diverse play groups, schools, camps and religious organizations where racial equity is practiced.

School age children are very attuned to issues of right, wrong and fairness. Therefore when communicating with the school age child, discussions about racism should emphasize that treating people unfairly based on the color of their skin is a form of bullying that is unacceptable. As parents, modeling how your family addresses racial differences in a positive way is essential. For many families of color, preparing their children to deal with racial bias begins at a very young age, but becomes most impactful in adolescence. Adolescents exposed to racism are vulnerable due to the repetitive traumatizing incidents that erode self-esteem and affect their social emotional health. Pediatricians must ask about issues of discrimination and reinforce coping strategies with these parents that will allow their adolescents to remain safe and yet hopeful for their futures. Children of all age groups and races should be taught by their parents about the importance of activism and non-acceptance of prejudicial actions by society and authority figures.

Pediatricians must align with families and provide counsel and guidance to them in this time of turmoil. The children we care for have questions about what they see on television and videos and these conversations can no longer be put off for another time. Minority families have a legacy of engaging in different versions of these conversations. For those families who have not addressed this before, the time is now. As Dr. Joseph Wright MD, MPH, FAAP, past chair of the AAP Task Force on Addressing Bias and Discrimination stated, “If we are to progress in this country, it’s going to be because we help our children, adolescents and young adults learn not just that racism exists, but that it is something all of us can work together to dismantle.” While we hope that the present activism will lead to substantive change, these changes require daily continued effort to bridge the gaps between the races. This must be a call to action for all of us who care for children. Pediatricians and parents must partner, as we do for other issues that challenge children, through open dialogues to raise children who reject racism. Much of their future positive social emotional development depends on our decisions and actions as we move forward.