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s an African-American physician who has experienced the effects of racism, I should be comfortable talking about it. I’m not — but I need to be.

That feeling was reinforced by a horrifying news story from the New Hampshire community where I work as a pediatrician. The mother of an 8-year-old biracial boy said he had nearly been lynched by some white teenagers. The image his mother posted on social media before driving him to the hospital where I work showed rope burns on his neck consistent with being hung.

I can’t help but think about how I would have responded to the boy and his family had I been his pediatrician.

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Racism, racist, and related “R” words have become a trigger for many in our society — one that can quickly end conversations. I vividly recall a visit with an adorable 3-year-old, during which her mother mentioned that her ex-husband (the patient’s father) was “extremely racist.” The instant she said that, I wanted to move the conversation in a different direction.

But I didn’t. The mother had begun a healthy relationship with a partner from the Dominican Republic and was expecting her second child. After her ex-husband had learned about the new partner, he started making racist comments about him to their daughter. The mother was visibly upset as she spoke about her daughter’s changes in behavior and attitude towards her partner and she worried about introducing a biracial sibling in this setting. The mother ended with a tinge of hopefulness, saying, “I’m glad you’re her doctor. Hopefully she’ll realize that the things her dad says aren’t true.”

Physicians are charged with understanding their patients’ lives while providing medical care. With the increased presence of racial violence and discourse in the news and social media, this includes understanding how race and racism affect their patients.

Specialists have long studied the development of categorization during childhood for decades. Categorization is a thought process that helps people make sense of complex environments by putting things in groups. The visibility and social importance of race makes it a key factor for categorization and can lead to stereotyping and bias. While we don’t know the exact point in infancy that biases begin, categorizations and judgments based on facial characteristics and skin tones are robust by age 3 and reach full adult level by age 5 or 6. Although the skill of categorization is a necessary milestone for learning how to interact with the world, it can lead to negative stereotypes if children aren’t exposed to varied and diverse experiences.

Last summer, Dr. Benard P. Dreyer, now the immediate past president of the American Academy of Pediatrics, charged the pediatrics community to take an active role in confronting the epidemic of “intolerance in the lives of children, adolescents, young adults, and their families,” which continues to spread across the country. The academy’s Bright Futures Guidelines recommend that pediatricians address discrimination, prejudice, and lack of cultural opportunities at various stages throughout childhood. It will take much more than the concerted effort of dedicated pediatricians to tackle this problem — but that’s a good start.

Talking about racism and bias isn’t easy. Additional research, training, faculty development, and patient education materials are needed to help prepare all of us to talk about these issues. As I reflect upon the many things that I never learned in medical school and residency, race and racism now join the list.

In daily practice, it might work like this: My colleagues and I often give our patients (and their parents) guidance on the normalcy of genital exploration. In a similar way, we could — and should — take advantage of the teachable moments that arise when our patients mention differences in skin color, heritage, or abilities.

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The pediatrician of the 8-year-old New Hampshire boy and his family have an opportunity to build up his cultural awareness and talk about racism. His pediatrician might say, “Tell me about your cultural identity. What opportunities have you had to explore this community?” This story also affords the opportunity to discuss bullying and, more specifically, racial bullying. Likewise, the pediatricians for the teenagers who allegedly injured him have an opportunity to encourage the families to engage in more diverse experiences. This will require some empathy and validation. In a state like New Hampshire, which is not diverse, it takes more effort to engage in cultural opportunities. But there are always options. Just as we work with families as they deal with defiant behaviors or academic concerns, pediatricians should be willing to help parents work through issues of diversity and racism.

In the words of Ruby Bridges, the first African-American child to attend an all-white public elementary school in the South, “Racism is a grown-up disease and we must stop using our children to spread it.”

Pediatricians can — and must — initiate, engage, and continue conversations about racism. To be sure, there will never be enough time to discuss all that we could or should address. But since our profession believes strongly in prevention and early intervention, we must talk about racism just as we do about vaccination, exercise, and healthy eating.

Stephanie White, M.D., is an assistant professor of pediatrics at Childrens Hospital at Dartmouth-Hitchcock, the diversity liaison for student/resident advising at the Geisel School of Medicine, and a Public Voices Fellow with the OpEd Project. The views expressed here are hers and do not necessarily reflect those of affiliated institutions.

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