Involve fathers in all aspects of family-centered care: AAP
AAP Clinical Report
The number of stay-at-home dads is increasing. More studies are citing the vital contribution
of fathers in children’s lives. And younger fathers are taking a more active role
in child care than in previous generations.
Regardless, pediatricians — and, in some ways, society in general — have been slow
to realize the central role of fathers and have neglected to involve them in all aspects
of family-centered care, according to the AAP clinical report Fathers’ Roles in the Care and Development of Their Children: The Role of Pediatricians.
“We have a tendency in this society and this discipline to think about families and
children as mothers and children despite the tremendous amount of research showing
the way fathers are involved and the increase in their involvement,” said Craig F.
Garfield, M.D., FAAP, a lead author of the report and a previous one in 2004. “We
still take an approach that’s mother-focused. This report is yet another attempt to
try to bring pediatrics to the forefront of where fatherhood is today.”
Different and essential roles
The roles of mothers and fathers are seldom redundant. In fact, studies in the last
10 years have shown that the “involvement of fathers has important consequences for
child well-being, especially with regard to issues of diet/nutrition, exercise, play
and parenting behaviors (e.g., reading, discipline),” according to the report, available
For that reason, let’s not look at whether a father “is as good as” a mother, said
Michael W. Yogman, M.D., FAAP, chair of AAP Committee on Psychosocial Aspects of Child
and Family Health, the group that issued the report. Instead, consider the unique
role of fathers in how they interact with children.
“A male caregiver can do some pretty neat and special things,” Dr. Yogman said. “They
can find their own unique role, especially by watching the baby or child for signs
of joy. They should not feel like their only role is to do everything the same as
Fathers usually talk to children in a way that’s different than moms and exhibit a
particular type of rough and tumble play, Dr. Garfield said. “Dad changes the rules,
explores a little more in a risky way but still keeps it safe. Those are two simple
ways fathers involved with children help them grow, explore and learn about their
Studies also show mothers and fathers stimulate different parts of a child’s brain
based on their interactions.
Prescription for play
The vast majority of fathers are present at their child’s birth, the report notes,
even though 40% of births are to unmarried couples.
From there, it gets more challenging for parents and pediatricians. For example, five
years after a child’s birth, 63% of unmarried fathers are no longer living with the
mother. Even with married parents, fathers may not attend pediatrician appointments
due to work commitments.
“Men want to start off on the right foot,” Dr. Garfield said. “Getting them involved
early is what will keep them involved. Acknowledge them as part of the health care
system, in the doctor’s office, and let them know in concrete ways how they can be
involved with the child and help the mother.”
For example, “fathers can play a critical role in supporting maternal breastfeeding
and, conversely, if feeling excluded and competitive, can undermine it,” the report
If the father does come to appointments, some pediatricians will just talk to the
“That’s what they’re used to,” Dr. Yogman said. “That’s not going to make the father
eager to come back next time. You have to make an extra effort to make people feel
One way to involve men early in child care is to provide some simple training on how
to hold and take care of the child just after birth. It will help them become more
comfortable because they might not have had much experience handling babies. Doctors
also can give a father a “prescription to play” with a baby at the 2-month or 4-month
visit, Dr. Yogman said.
It’s also important for pediatricians to work with mothers in their role as gatekeeper
— especially if the father does not live in the home. “If the mother doesn’t want
the father to be involved, they’re not going to be allowed,” Dr. Yogman said.
Dads and society
Fathers are taking the initiative to be a larger presence in their children’s lives,
with one study showing that fathers took part in child care seven hours per week in
2011 compared with 2.5 hours in 1965.
Dr. Garfield has seen this change in a class he teaches for expectant fathers at Northwestern
Memorial Hospital in Chicago.
In his 20 years of pediatrics, he’s realized parenting is a team sport. When a father
is not involved, “you’re missing one of the key players. Bring him off the bench,
onto the field and I think it will make a difference in how a child does, mother does
and family does. It should be for the better.”
Other key tips for pediatricians
Emphasize how children look to their fathers as role models of well-being and behavior.
Note that father involvement is associated with better academic success, social competence
and less at-risk behavior in their children.
Inform the family about the normal elation, fatigue and challenges of being a father.
Discuss how the couple is adapting to parenthood.
Include both parents, if possible, in medical procedure discussions.
Screen fathers for perinatal depression and have a plan in place should either parent