America's pediatricians are tired of watching their patients traumatized by gun violence and racism.
Now, they're launching an effort to do something about it.
The American Academy of Pediatrics on recently issued recommendations that children under the age of 6 be shielded from on-screen violence, that video games stop awarding points for shooting living targets, and that the media avoid downplaying the proven link between virtual and real violence.
But the organization is also organizing a bolder and far more ambitious campaign — involving education, advocacy, and changes in clinical practice — to address the larger issues of violence and intolerance. It may include coaching pediatricians to determine whether their patients have been exposed to violence or danger. Or helping doctors understand how they might intervene to protect a child.
The group also wants to help pediatricians understand the experiences of children who are growing up in very different circumstances than their own. (Only about 4 percent of doctors are African-American.)
This broad effort, which is just in the earliest stage, was inspired in part by the images cascading out of the violence of recent months.
There was the preschooler who sat in the back seat of the car as her mother's boyfriend was fatally shot by police in Minnesota; the 15-year-old who sobbed on camera the day after his father was killed by police in Louisiana; and two sets of children who mourned their policemen fathers, shot in an act of retaliatory hatred in Texas.
"Seeing this unfold and recognizing how all of these episodes impact children, we can't just say something like 'How terrible this is,' and we can't be defeatist and say 'Well, I'm not sure what we can do,'" said Dr. Bernard Dreyer, president of the pediatricians' organization. "It doesn't matter if we will succeed or not. We still have to act."
The science is compelling: "Toxic stress" caused by racism and violence can take a heavy toll on the learning, behavior, and health of children, said Dr. Jack Shonkoff, director of the Center on the Developing Child at Harvard University.
Kids don't have to be the direct victim of violence to become overly stressed. Watching current events on TV, or picking up a parent's anxiety may be enough to lead a child to feel unsafe, said Shonkoff, who is not directly involved in the Academy of Pediatrics' effort.
Such "toxic stress" can affect brain development, the cardiovascular system, the immune system, metabolic regulation, and of course, mental health. "We're jeopardizing children's lifelong health," he said.
Parents can make a crucial difference in buffering children from stresses — but they can't do it alone, Shonkoff said.
Before they can step in as advocates, pediatricians will need help overcoming their own discomfort in talking about race, said Dr. Joseph Wright, chairman of pediatrics at Howard University College of Medicine.
Wright said he can vividly remember every detail of the first time he was called a racist slur. The sense of betrayal and confusion from an event like that — which virtually every black child experiences at some point — can cause trauma.
Pediatricians should be educated to help the child and family through such painful moments, he said.
Tanya Nixon-Silberg would love to have those conversations with her pediatrician.
When Nixon-Silberg, who lives in the Boston neighborhood of Jamaica Plain, told her biracial 3-year-old about the recent water crisis in Flint, Mich., the toddler immediately worried about the safety of water coming out of their own tap. So Nixon-Silberg suggested buying bottles of water to send to Flint.
"Changing the narrative … to 'What can we do?' it immediately changes her mind about it,"Nixon-Silberg said. "They feel like they're a part of the solution and not so much that 'This is going to happen to me.'"
In May, Nixon-Silberg co-founded a social justice organization called Wee The People, which sponsors child-oriented dance, music, and art-making events, some in collaboration with the Boston Public Library.
She said her own hopelessness lifts when she sees the enthusiasm that children have for such social justice efforts. "If I see this through my child's eyes, the possibilities are endless," she said.
The American Academy of Pediatrics plans to convene a task force to work on these issues. It will "address gun violence as well as the underlying contributors of racism, religious intolerance, homophobia, xenophobia, terrorism, and any other form of intolerance," the group said.
At the local, state, and national levels, the AAP's 66,000 members can be foot soldiers advocating the academy's positions, Dreyer said. The group will also look for other organizations it can partner with to amplify its voice, and for causes it can support, such as providing funding for gun violence research.
"Education, clinical practice, advocacy: We have roles in all of those areas," Dreyer said. "We have yet to start the conversation but we will … Soon."
This story was produced by STAT, a national publication covering health, medicine, and life science. Read more and sign up for their free morning newsletter at statnews.com. You can also follow STAT on Twitter and like them on Facebook.