Why a health behaviour change approach could help parents tackle screen time and other challenges

By Jennifer Stranges

Limiting screen time, managing behaviour and discipline, and developing a solid bedtime routine – many parents would be quick to share that these are among the challenges they feel like they sometimes fail at.

In an editorial in BMJ Paediatrics Open, Dr. Ripudaman Minhas and Dr. Shazeen Suleman, pediatricians at St. Michael’s Hospital, argue that making decisions to tackle these challenges are health behaviours – decisions that have an impact on health long-term – just like exercising, diet choices, or quitting smoking.

We spoke with Dr. Minhas about how pediatricians can help parents achieve optimal health outcomes for children and what doctors need in their training to better support parents.

Can you summarize your editorial?

We assert that the decisions that parents make in their day-to-day parenting behaviours have long-term health impacts and, hence, that parenting should be considered a health behaviour.
As such, pediatricians and other health care providers who attempt to support families in modifying their parenting behaviours should use a health behaviour change approach for sustainable changes to parents’ behaviours, and ultimately, children’s developmental and health outcomes.

As a pediatrician, what are some of the challenges you see parents experience?

They’re often in relation to changing their patterns. Often times, routines in the household evolve and are affected by the factors around them – such as the day-to-day stresses of work, raising multiple children, and the social determinants of health that impact them. All of those things impact how we run households and our parenting decisions.

When you factor in the profile of their child – for example, if they have a developmental disorder – or other key factors such as their own experiences and their family’s cultural norms and beliefs, it can be very challenging.

In your editorial, you and Dr. Suleman acknowledge that doctors are not trained to support families in their parenting behaviours. How could medical students and residents be better prepared?

We’ve seen a shift in recent years with medical education emphasizing updated approaches to help individuals with their health behaviour changes, such as smoking cessation, increased exercise, and dietary changes. However, we’re not using those approaches to teach trainees how to help parents around decisions they make for their children. We need to do more of that because it will lead to more sustainable changes.

When helping a patient quit smoking, we don’t just say “stop smoking” and leave them to it. It’s about process and nuances, and there should be a similar health behaviour change approach to parenting. When helping a family, part of it is looking at where they are in terms of process themselves, how motivated they are to change, what resources are available to them, and if we’re recommending a certain type of intervention, is that something that works in terms of their finances, social norms, and day-to-day life.

What is the takeaway message for doctors when it comes to helping parents?

Go deeper to understand the reality of the family – that’s the underlying crux. These factors impact behaviours, which in turn impact health outcomes. The behaviours are so deeply ingrained in day-to-day patterns that it can be overwhelming for families to imagine change. Something is easier to modify when it’s adaptive and can be taken in a graduated, step-by-step way. Pediatricians play a key role in helping children, but also the parents.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.