Introduction

After a long 3-h ride from New York City to Albany, we eagerly anticipated exiting the bus and getting started on our annual New York State American Academy of Pediatrics (AAP) Advocacy Day. We proudly wore pins stating, “We’re here for the kids!,” excited to speak to our legislators about proposed child-health-focused bills. As the bus pulled in front of the building where our meeting was to be held, we heard a quiet roar outside that grew louder as the door of the bus swung open. A large crowd of people holding picket signs were being kept in place by police officers about 5 feet away. People were shouting, “My child, my choice!” and holding signs with the words “Medical freedom” and suggesting that pediatricians were pharmaceutical company representatives. While walking the short distance from the bus to the building, people yelled, “You don’t care about kids! You only care about your pockets!” The roar of “My child, my choice” continued. I wanted to shout back, “I am a pediatrician - of course I care about kids!” Instead, I looked straight ahead and walked as quickly as I could, trying to swallow the lump in my throat and will the tears in my eyes to not stream down my face. It was March 3, 2020, and New York State had recently eliminated the religious exemption for school-required vaccination. We had been told that there may be anti-vaccine protesters, but never would I have imagined that they would be protesting Pediatricians, as we were there to support children.

The politicization of children in public health, health care, and science is not limited to the realm of vaccination. In the early 2000s, coverage for children through the Children’s Health Insurance Program was the focus of contention between Republicans and Democrats engaged in a policy battle over investing in domestic anti-poverty programs and fiscally supporting the war in Iraq, which would have significant implications for the 2008 presidential election.1 Unfortunately, these debates occurred despite clear evidence that children who have health insurance are healthier.2

Why children?

Although political debates over topics pertaining to child health such as vaccination or insurance coverage are not new, what has emerged in recent years is a politicization not on these broader topics surrounding children’s health but on children themselves. It is unclear why children have been pushed to the forefront of political debates, notably with the more recent “Don’t Say Gay” Bill in Florida, debates over gender affirming medical care access, and discussions involving critical race theory education in schools. We can postulate that children have become the focus of such politicization simply because of they are our future, or perhaps the passion that often accompanies their involvement incites the politicization itself. The recent focus on children is particularly interesting in that children and children’s health are often marginalized or altogether excluded in major health policy and financing decisions. Regardless, it is apparent that there has been a shift in the political paradigm recently, and this certainly has had impact on pediatricians, children, and the patient–doctor relationship.

Impact on children

Perhaps more important to consider are the potential effects of politicization on children themselves. This discussion is emerging in the mainstream media, with most of the dialogue centering around the partisanship rhetoric in Congress and how this rhetoric is hindering progress for America’s children and families.3 Despite the politicization of children being a recognized entity in the media and among pediatricians, there is very limited scholarly work evaluating the connection between politicization of children and its impact on children’s health. Such future study is of vital importance, specifically in the context of the current examples mentioned above: “Don’t Say Gay” Bill in Florida, transgender individuals’ access to medical care, and critical race theory. These emerging debates are of particular importance as they will directly impact how children see themselves and their families, and thus ultimately may be detrimental to self-identity and mental health. This is especially concerning because, as with many facets of child health, the true impact of politicization may not be recognized until it culminates into a crisis.

Impact on pediatricians

As a result of the recent politicization of children, as evidenced in the narrative above, pediatricians and pediatric researchers have often become villainized for their promotion of evidence-based children’s health. As an example, firearm violence, one of the leading causes of morbidity and mortality in children, has become the subject of intense scrutiny for those seeking evidence-based approaches to prevention. Despite clear evidence of the massive toll that firearm injuries have on children and families, pediatricians and pediatric researchers focused on reducing firearm violence are forced to consider their personal safety due to the fierce political divide surrounding firearms.4 Recently, the treatment of unaccompanied minors immigrating to the United States represents another recent example of the politicization of children. There was widespread public facing news coverage of children being separated from their parents and living in excruciatingly poor conditions that were and continue to be both traumatizing and debilitating to their development. When pediatricians brought attention to these children and families, it was often viewed as a political effort as opposed to shedding light on the distress and potential consequences of our collective actions at our borders.

Impact on patient–doctor relationship

There is also concern that the politicization of children could lead to mistrust of pediatricians, pediatric researchers, and pediatric organizations as they may be viewed as motivated by political factors as opposed to science and expertise. This deserves serious attention as this trust is the basis of what we do as pediatricians and pediatric researchers. It is imperative to mention that there is evidence to suggest that our own political beliefs as physicians may impact care decisions, notably with clinical presentations that involve drug use, firearm safety, and sexual behavior. Based on this, it is of the utmost importance for all of us to consider our own political biases as pediatricians. We must continue to rely on available scientific evidence and expertise on child health as opposed to political beliefs in making care decisions to retain the trusted relationship we share with all our patients.5,6 These considerations are also important as we craft research studies and participate in pediatric professional organizations. To retain the treasured relationship we all value, we must prioritize the well-being of children above personal political beliefs.

What do we do?

Although at times the politicization of children can be frustrating, disheartening, and even anger-provoking for pediatricians and pediatric researchers, there are strategies we can utilize to communicate our expertise that are less likely to be politicized. These communication strategies are often outside of our current educational training; however, they do provide a framework for effective communication that ranges from individual patients and families to the mainstream media.

  • - Clear, consistent and nonpartisan messaging (ex. “vaccines are safe, effective, and life-saving”)

  • - Utilize the correct language (ex. firearm vs. gun)

  • - Stick to the current science (ex. “We have clear data to support this approach as in the following x,y,z evidence”)

  • - Keep children’s health at the forefront (ex. “I support policies that promote children’s health, not a particular candidate or “side””)

  • - Consult known pediatric organization materials and groups of individuals with experience to assist (see Table 1)

    Table 1 Examples of Pediatric Organization Evidence-Based Statements.
    Full size table

Conclusion

Pediatricians and pediatric researchers are facing serious and at times life-threatening challenges when advocating for children’s health and communicating their science. Despite these challenges, this work is necessary to keep child health at the forefront of health policy. We must work independently and collectively, including across professional societies that support evidence-based practice and its implications on child health, to continue to deliver timely and appropriate messaging that avoids further politicization of children based on the most up to date research and shared expertise.