Doctor's Orders

Article excerpt

In Boston, a pediatric resident is experiencing a vague sense of disquiet as she interviews a Puerto Rican mother who has brought her baby in for a checkup. When she is at work, the mother explains, the two older children, ages six and nine, take care of the two younger ones, a two-year-old and the threemonth-old baby. Warning bells go off for the resident: young children cannot possibly be sensitive to the needs of babies and toddlers. And yet the baby is thriving; he is well over the ninetieth percentile in weight and height and is full of smiles.

The resident questions the mother in detail: How is the baby fed? Is the apartment safe for a two-year-old? The responses are all reassuring, but the resident nonetheless launches into a lecture on the importance of the mother to normal infant development. The mother falls silent, and the resident is now convinced that something is seriously wrong. And something is-the resident's model of child care.

The resident subscribes to what I call the "continuous care and contact" model of parenting, which demands a high level of contact, frequent feeding, and constant supervision, with almost all care provided by the mother. According to this model, a mother should also enhance cognitive development with play and verbal engagement. The pediatric resident is comfortable with this formula-she is not even conscious of it-because she was raised this way and treats her own child in the same manner. But at the Child Development Unit of Children's Hospital in Boston, which I direct, I want residents to abandon the idea that there is only one way to raise a child. Not to do so may interfere with patient care.

Many models of parenting are valid. Among Efe foragers of Congo's Ituri Forest, for example, a newborn is routinely cared for by several people. …