2021 AAP Guidelines for Native American Children

“It is easier to build strong children than to repair broken men.”  — Frederick Douglass

Children in Tribal communities can start off life from a disadvantaged position. 39 percent of them live in poverty, which is nearly double the rate for the total U.S. population. But poverty isn’t the only issue; these children face a matrix of burdens that can impact their health, their scholastic performance, and their futures. Consider how many American Indian/Alaskan Native (AI/AN) kids grow up in food deserts without fresh produce or the lack of broadband access that can lock them out of the digital education resources available to other children. In addition to encountering racism and discrimination across a number of settings, they inherit a legacy of historical trauma. And when it comes to healthcare, they may be treated by providers who don’t understand their cultural beliefs. In fact, they’re unlikely to see many Native healthcare professionals at all, which can discourage them from pursuing a healthcare career.

Those are big (but not insurmountable) barriers – and they won’t be solved overnight. But one thing we can do is align pediatric care protocols with Native American children’s clinical needs. To that end, the American Academy of Pediatricians (AAP) has released their 2021 policy and recommendations for treating Native American children and adolescents.

Overcoming Entrenched Barriers

You can find the entire policy, Caring for American Indian and Alaska Native Children and Adolescents, at the Committee on Native American Child Health. Below are some highlights. Authored by four American Indian pediatricians, the policy examines health inequities and barriers, and shares recommendations and opportunities for advocacy.

This isn’t just important for Indian Health Services (IHS) providers – it should be mandatory reading for all pediatricians. Most AI/AN people now reside in metropolitan areas that include many different tribal groups. 78% of Native Americans live off-reservation, and 72% live in urban or suburban environments. Native children are likely to appear for treatment in a variety of hospitals and clinical practices.

The policy notes that:

  • These children and adolescents frequently need more treatment than other children. “Compared with the general U.S. population, AI/AN children and adolescents have higher levels of obesity and obesity-related cardiovascular issues, mental health concerns, suicide, toxic stress, substance use disorder, injury and violence, exposure to environmental hazards and historical trauma.”
  • NA youth do best with programs and interventions that incorporate AI/AN culture, traditions, and practices.
  • Caring for these children “…presents a unique and complex clinical opportunity … because of the high level of documented health inequities within a sociocultural context unfamiliar to most practicing providers of pediatric care.”
  • Indigenous youngsters experience unique social determinants of health, such as higher levels of adverse childhood experiences (ACEs), special healthcare needs, sex trafficking, abuse, poverty, and foster care. This includes community mistrust of government agencies and generational trauma.
  • Many Native American people experience discrimination in clinical settings, furthering their cynicism toward the healthcare system for themselves and their children.

A Path to Smarter Pediatric Care

The policy recommendations mostly fall into three categories:

Cultural: Clinical and office staff should be trained in culturally informed practices; care delivery models and public health strategies should incorporate traditional therapies. The idea is to offer Native children an inclusive medical home that’s sensitive to past discrimination and historical traumas.

Clinical: Pediatricians should test for prediabetes and type 2 diabetes in young patients who are obese or overweight. Mental health screenings and connecting young children to an oral health provider are also important.

Community involvement: Creating effective interventions caused by social determinants of health starts by working with schools and tribal leaders. In addition to supporting initiatives for food security or ending homelessness, healthcare systems can create strategies based on Native health issues and medical experiences.

Nelson Mandela said, “There can be no keener revelation of a society’s soul than the way in which it treats its children.” It may be a cliché to say that children are our future, but we can’t drive generational change in Tribal communities until we build a stronger foundation for their youngest members. Better medical care and community resources offer Native American children a healthier path to scholastic success and a promising future. In an ideal world, all pediatric practices would incorporate AAP guidance – and give Native American children a more comfortable and consistent patient experience.

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