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Racism: Developmental Perspective Can Inform Tough Conversations

Updated: May 4, 2021

Can we help our pediatric patients with the complicated problems of racism, especially if we are

privileged (and even white) professionals? We may not have experienced discrimination, but we can still advise and address it. Racist discrimination, fear, trauma, or distress may produce or exacerbate conditions we are treating. I have found it often revealing to ask: “Have you, your child, or your family had an experience with racism that may be contributing to today’s concern?”

Three levels of racism impact children’s health and health care:

  1. “Structural or institutional” policies that influence social determinants of health

  2. “Personally mediated” differential treatment based on assumptions about one’s abilities, motives, or intents

  3. “Internalization” of stereotypes into one’s identity, undermining confidence, self-esteem, and mental health

We can help advocate about structural racism and ensure equity within our offices, but how best to counsel the families and children themselves?

Racism includes actions of “assigning value based on the social interpretation of how a person looks” (Ethn Dis. 2008;18[4]:496-504). “Social interpretations” develop from an early age.


Newborns detect differences in appearance and may startle or cry seeing a parent’s drastic haircut or new hat. Parents generally know to use soothing words and tone, bring the difference into view gradually, smile and comfort the child, and explain the change; these are good skills for later, too.


Infants notice skin color, which, unlike clothes, is a stable feature by which to recognize parents. Social interpretation of these differences is cued from the parents’ feelings and reactions. Adults naturally transmit biases from their own past unless they work to dampen them. If the parent was taught to regard “other” as negative or is generally fearful, the child mirrors this. Working to reduce racism thus requires parents (and professionals) to examine their prejudices to be able to convey positive or neutral reactions to people who are different. Parents need to show curiosity, positive affect, and comfort about people who are different, and do well to seek contact and friendships with people from other groups and include their children in these relationships. We can encourage this outreach plus ensure diversity and respectful interactions in our offices.

Three Years and Older

Children from age 3 years value fairness and are upset seeing others treated unfairly – easily understanding “not fair” or “mean.” If the person being hurt is like them in race, ethnicity, religion, gender, or sexual preference, they also fear for themselves, family, and friends.

How to Discuss Racism

Balance is needed in discussing racism to avoid increasing fear or overpromising as risks are real and solutions difficult. Children look to adults for understanding and evidence of action to feel safer, rather than helpless.

We should communicate directly to children (whether you believe it completely or not) that: