Child Advocates

Abstract

To the Editor. I would like to comment on Berman's excellent commentary, “Training Pediatricians to Become Child Advocates.”1The excellence of his approach to child advocacy has been proven by the record of the pediatricians of Colorado in influencing public policy regarding children's health in that state.Dr Berman makes the point that “the perfect can too often be the enemy of the good …” He appropriately uses that aphorism in noting that progress toward a goal is most likely to be made in small steps. I should also like to use the same aphorism to note that, lacking a society of perfect child advocates, trained as suggested by Dr Berman, we should not disdain the help that can be given by [very] good child advocates. Ideally, all of us would have had residency training in child advocacy, a number of years in community organizations establishing credibility, and several years of legislative internship. Unfortunately, many chapters of the American Academy of Pediatrics do not have a large cadre (or anyone) trained in this way. That should not deter us from acting on behalf of children.By following the “approach to child advocacy” specified in Dr Berman's commentary, sensitive (to incipient signs of success or failure) pediatricians can and will make a difference. In Colorado, I am sure, Dr Berman and other fully trained child advocate-pediatricians have led the way, but in the process they have trained and relied ongood pediatricians from Denver, Greeley, Grand Junction, Boulder, and every other part of the state to support their efforts, to work with state legislators, and to rally their patients' parents and their communities to their causes.All of us would be well advised to heed the approach outlined by Dr Berman. However, it is my belief that “one pediatriciancan make a difference,” whether perfect or merely good. Not only can we make a difference, but we should. We all should not hide behind a lack of full training and should offer our support to those who are leading the advocacy effort.In Reply. Thank you for the opportunity to comment on Dr Chilton's letter. Dr Chilton implies that I “disdain the help that can be given by a good child advocate” who may not be fully trained in the way I have promoted in my article. Nothing can be farther from the truth, and I am disappointed that a friend and colleague might misinterpret my message in this way. Child advocacy is not an exclusive club, a boarded subspecialty, or a zero-sum game. Pediatricians have a unique opportunity to contribute to their communities—one pediatrician who cares and is committed can make an enormous difference. We have seen this happen in communities throughout our country. My message is that community service and child advocacy are linked and should be integrated into a pediatrician's career from residency training through retirement. We should expose all residents to the principles of community service and advocacy in a curriculum just as we expose residents to principles of fluid and electrolyte management and the judicious use of antibiotics. We should create opportunities for residents and young pediatricians who want additional child advocacy experiences. Developing a cadre of experienced, effective, and knowledgeable child advocates who can work with committed but less experienced pediatric colleagues is appropriate and should not be viewed as an excuse to “deter any of us from acting on behalf of children.”