Caring for Teenage Parents and Their Children: Role of the Pediatrician in Multigenerational Care

Adolescent parents and their children represent populations at increased risk for medical, psychological, developmental, and social problems.

Pediatricians can play an integral role as primary care providers for both teen parents and their children.

This report updates a clinical report from the American Academy of Pediatrics (AAP) published in 2012.1

Although the most recent birth data from 2017 indicate historically low birth rates for teenagers and young women ages 15 to 19 in the United States, the rate remains higher than in many other resource-rich countries.2-5

> Epidemiology

Birth rates among teens and young women ages 15 to 19 have declined overall and for every race and ethnic group in 2017, the year of the most recent data available.3,4

Overall teen birth rates were 18.8 per 1,000 live births and have fallen 51% since 2007 and 67% since 1991, with the largest decline among 15- to 17-year-olds. Indian or Alaska Native teens had the highest birth rates (32.9 per 1,000), followed by Hispanic (28.9 per 1,000), black (27.5 per 1,000), and white (13.2 per 1,000) teens. 1000).4

Repeat birth rates in teenage mothers have also decreased from 20% in 2004 to 17% in 2016.6 This decline is likely attributable to increased sex education and/or increased contraceptive use among this population over the past 20 years. .7

Despite perceptions that teenage mothers have a high number of preterm births (10.3%), the highest rates of prematurity occur in women ≥ 40 years of age (14.6%). However, among adolescent births, mothers ≤ 17 years of age have a higher risk of preterm birth, low birth weight infants, and neonatal mortality, compared to older adolescent mothers.8,9

> The role of the pediatrician

Pediatricians can shape the health of teen parents and their children because they are optimally trained to provide comprehensive care to infants, children, and adolescents and understand the importance of creating a medical home for all patients, including teen parents.

The teen parent can first present to the pediatrician or adolescent specialist to seek a pregnancy test and advice on options.

The AAP policy statement on options counseling provides more detailed recommendations for best practices when discussing a positive outcome with newly pregnant adolescents.10

Once the teen decides to continue with a pregnancy, the pediatrician may advise her to begin prenatal care with an obstetrician, family doctor, or other qualified professional.11 It is also optimal for pregnant teens to resume their routine pediatric or adolescent care and begin the care of your future child with the pediatrician with whom you have built a long-lasting relationship.

The pediatrician can play an important role in assessing teen parents’ social supports and linking them to appropriate resources, including transportation, health insurance, housing, and food accessibility.12 It is also important for the pediatrician to understand legal rights. that adolescent parents have regarding their children.

Some states do not allow teen parents to make decisions for their children; Pediatricians should investigate what the mandate of state laws is regarding this situation. They can also provide information about community-based social support options for teen parents, such as school, community, and home visiting programs.

There is an association between prenatal and early childhood home visiting programs and reductions in the number of subsequent pregnancies, use of government assistance, child abuse and neglect, and criminal behavior in adolescent mothers.13,14 From the prenatal stage, home visiting programs can reduce the risk of antisocial behavior and substance use for children born to adolescents during the first 15 years of life.13,14

The Nurse-Family Partnership is an evidence-based program that matches young, first-time mothers with trained nurses beginning in early pregnancy and continuing through the child’s two years of age. It is available in many communities and is one of many community programs that can help young mothers. Programs such as Head Start and Early Head Start are designed to address the needs of low-income parents and their children.15

Some health insurance companies offer coordination services during the prenatal period, and the professional can encourage pregnant teens to access these support services. Finally, pediatricians are suggested to begin early to discuss with teen parents the plan to continue and complete their education after birth and provide contraceptive options to prevent early subsequent pregnancies.

> Perceptions of adolescent parents

Widespread negative stereotypes of both teenage mothers and fathers persist, with society often viewing teenage mothers as irresponsible, sexually promiscuous, and ambivalent about their future educational and career goals and teenage fathers as absent from their children’s lives and ambivalent towards them.16

Although much of the literature focuses on the negative aspects, the involvement of adolescent fathers in the lives of adolescent mothers and their children can have beneficial effects, such as improved maternal self-esteem, decreased maternal postpartum depression, and decrease in infant stress in the neonatal period, in addition to positive effects on parents.17,18

In cases where the pregnancy may be the result of coercion or rape, the pediatrician can identify supportive parents or partners during the prenatal and postpartum periods. In other cases, adolescents may have chosen to become parents because they live in cultures where it is normative behavior to have children between the ages of 16 and 18. Despite the negative perceptions that may persist regarding teenage parents, it is important to highlight the positive aspects and solutions.

Teenage fatherhood itself can present itself in different ways, such as a teenage mother with a same-sex partner, with the father of the infant, with a male partner who is not the biological father of the child, with maternal or paternal grandparents, or the teenager alone.

It is important to recognize that not all people who will become pregnant identify as women (such as transgender men) and not all people who provide sperm that lead to pregnancy identify as men (such as transgender women).

Additionally, not all teen parents are heterosexual and pregnancies can occur as a result of consensual sexual contact, coerced sexual contact, related to sex work, or in the context of sexual assault. However, to date, most of the literature has focused on cisgender teen parents and heterosexual relationships.

While it is critical to continue exploring the different landscapes of teen parenthood, to simplify this entire report, the term “teen mother” was used to describe a young person who experienced pregnancy and chose to raise a child, and the term “teen father” was used to describe a young person who experienced pregnancy and chose to raise a child. " to describe a young person who contributed to a pregnancy as a result of heterosexual sexual contact. Additionally, the term “partner” was used to refer to the adolescent mother’s male or female partner.

Since this clinical report aims to provide pediatricians with a solid management guide for the care of teenage parents, it is important to dispute these negative stereotypes, focus on positive influences that can help decrease the repetition of teenage pregnancy, and promote behavioral healthy behaviors, social supports, and longitudinal educational and vocational goals to improve the quality of life of adolescent parents.

> Prenatal management

Once a pregnancy is diagnosed by the pediatrician, it is important to provide a timely referral for prenatal care, ideally within the first trimester. Many obstetricians have experience in teen pregnancy and using the medical home model. Timely entry into prenatal care can help reduce medical complications of teenage pregnancy.

As the mother approaches the end of the third trimester, the provider can emphasize the importance of the postpartum visit and provide anticipatory guidance on health insurance options for the mother and child. The adolescent may then be referred back to her primary medical home after pregnancy (to her pediatrician or to an adult or family physician).

Medical complications associated with teenage pregnancy include poor maternal weight gain, anemia, and gestational hypertension, and these complications are greater in younger adolescents.19

Poverty, lower educational attainment, and inadequate family support may contribute to the lack of adequate prenatal care, which may explain more negative health outcomes for both the adolescent mother and child, including anemia, preeclampsia, poor nutrition. , premature birth and low birth weight.20

> The prenatal visit: getting to know the Pediatrician

It is optimal for pregnant adolescents, their partners, and trusted family members to schedule a prenatal consultation with their pediatrician during the last trimester. Bright Futures: Guidelines for Health Monitoring of Infants, Children, and Adolescents , Fourth Edition, by the AAP outlines the goals of this visit to include assessing family resources, community resources, and parent well-being and discussing decisions. about breastfeeding.12

The AAP policy statement on prenatal visits suggests that pediatricians meet with mothers during the third trimester of pregnancy to establish and/or reestablish care.21 The teen mother may not have seen her pediatrician while receiving prenatal care. ; Therefore, it is important for her to reconnect with her pediatrician and care for her and her child. This policy statement discusses the importance of this consultation, especially for new parents, single parents, and/or women with high-risk pregnancies.21

The intention to breastfeed can prompt the initiation of breastfeeding22 and provide time to attend classes and seek support. The prenatal visit is also an opportunity to meet extended family members who can help care for the child. The pediatrician can determine the need for resources, such as infant care, transportation, financial support, housing, and food.

Additional support systems, which include the involvement of the partner and other family members who can act as assistants (e.g., maternal or paternal grandparents), are important in the care of both adolescent parents and their children.12,21 Although This consultation is ideal, potential barriers to scheduling are recognized (e.g. time restrictions, paying insurance for the consultation, etc.). When possible, this visit can help the mother transition back to the pediatrician.

> Newborn screening and routine health checks

The neonatal visit and subsequent health checks are opportunities for the pediatrician to assess the needs of the adolescent mother and other close caregivers.21 The Bright Futures guidelines recommend that pediatricians address family preparation, the newborn’s home life, and routine child care.12

In addition to obtaining a complete prenatal history and evaluating the neonatal course, the pediatrician can obtain a complete social history, including maternal well-being, adjustment to new parenthood, and family resources.12

During these visits, grandparents may be present to provide support. It is important for the pediatrician to reinforce the concept that the adolescent father is primarily responsible for the care of the infant. The teenage mother can give explicit permission for the pediatrician to talk to the grandparents about the baby’s health care.

The pediatrician can use the prenatal visit, neonatal visit, and subsequent health checks to discuss contraceptive plans and safe sleep practices, screen for depression and/or psychological disorders, and ask about the adolescent mother’s educational plans. Double shifts can help with time constraints to address all of these issues.

“Teen” clinics, in which parents and their children are seen by the same professional at the same appointment, have successfully cared for these families in a patient-centered approach.23,24 Brief parenting and /or daily living skills, along with these medical appointments, improved maternal self-esteem and decreased repeat pregnancy during a 36-month study.25

• Management of contraception

Approximately 17% of births among adolescents are repeat births.5,26 There is a significant relationship between repeat births in adolescence and decreased educational achievement, increased dependence on government support of the teenage mother, increased neonatal mortality, and low birth weight.27

In contrast to adult women who experience a second pregnancy, adolescents with a new pregnancy tend to delay prenatal care.28 A second birth can have negative effects on the adolescent mother and her offspring due to the aggravated negative socioeconomic effects and the influence of the short interval between pregnancies.

The American College of Obstetricians and Gynecologists recently published recommendations for interpregnancy care, including the following: avoid interpregnancy intervals ≤6 months; encourage family planning counseling during prenatal checkups, with conversations about interest in future motherhood; screen high-risk women (including adolescents) for sexually transmitted infections; and advise the mother on safe sexual practices.29

Research has shown that the provision of intrauterine devices (IUDs) and implants immediately after delivery is acceptable to adolescents and reduces repeat pregnancies in the short term.30 Long-acting reversible contraceptives (LRAs) can be inserted immediately after delivery of the placenta (IUD) or before hospital discharge (implants).30 Adolescent mothers who receive an IUD are more likely to continue with this form of contraception, with a low risk of expulsion.30,31

Additionally, there is a reduction in repeat pregnancy rates among teen mothers who receive contraceptive implants in the immediate postpartum (labor or delivery unit) compared to those who do not.32 Any implementation of ARAP before 8 weeks postpartum is associated with a decrease in repeat pregnancy rates within 2 years,33 demonstrating the importance of these methods to reduce the possibility of a new pregnancy in a short time interval.

The AAP policy statements on contraception and ARAP for adolescents34,35 recommend that pediatricians have a working knowledge of the various types of contraception and can counsel adolescent patients about all available methods, including implants and IUDs, which are the more effective reversible methods.

After the postpartum obstetric visit, the teen mother may choose to return to the pediatrician for primary care. If she is not on some form of birth control at the time, the pediatrician can provide contraceptive advice.

She may also be referred to a gynecologist or adolescent doctor if the pediatrician is not comfortable managing contraceptive needs. Pediatricians, in conjunction with obstetricians and gynecologists, can help improve the use of ARAP by counseling adolescent mothers about these contraceptive methods.

• Breastfeeding by teenage mothers

The AAP and the Centers for Disease Control and Prevention (CDC) recommend that mothers exclusively breastfeed their babies for the first 6 months of life, followed by continued breastfeeding, after introducing complementary foods, until the infant is 1 year old. or more, as ideal.36,37

Teen mothers who lack social support and are in a lower socioeconomic status are less likely to breastfeed compared to older mothers.38 Teen mothers who are in a higher socioeconomic status and who attend prenatal classes have higher rates. discharges of exclusive breastfeeding at the time of hospital discharge.22

Preparation before birth and early support are crucial for successful breastfeeding among teenage parents.22 Studies have shown that certain early maternal behaviors, such as skin-to-skin contact, are associated with positive decisions and initiation of breastfeeding before birth. hospital discharge.39 Educating mothers about breastfeeding extends the duration of breastfeeding.40,41

Breastfeeding-related interventions, including school programs, home visits, and telephone support, demonstrate that combining education and counseling produces better outcomes in the initiation, duration, or exclusivity of breastfeeding.42,43 Professional support programs and peers have been shown to increase both initiation and duration of breastfeeding, but can be resource intensive.44

Regular use of a breast pump also helps to continue exclusive breastfeeding.45 Policies to support breastfeeding, such as having appropriate space and break times at school and work, should also be encouraged.

Breastfeeding cessation has been linked to a lack of knowledge and pain associated with breastfeeding, often as a result of inadequate positioning and attachment to the breast.45 The role of the adolescent’s partner is important because their participation in mother’s life is associated with increased breastfeeding.46

The pediatrician can ask about breastfeeding challenges and provide supportive advice to promote successful breastfeeding. She can also encourage teen mothers to breastfeed their babies to improve bonding as well as their children’s cognitive development.

• Adaptation to motherhood

The transition to motherhood for teens can be difficult, and common themes and barriers often emerge for teen mothers of all ethnicities.47-51 A common theme is coparenting, in which a maternal grandmother or other parental figure helps with the upbringing of the child.

Studies have shown that more prevalent coparenting , specifically with maternal grandmothers, can have positive effects on adolescent parenting efficacy, social competence, and children’s academic achievement.51 These results can be strongly influenced when the parent’s family origin gives high priority to positive family values.47

In addition to teen mothers learning successful parenting techniques, such as strong communication and minimal coparenting conflict, it is important for professionals to identify adolescents’ readiness for parenthood. Some teen mothers do not anticipate new responsibilities, and this is reflected in their emotional readiness to mother.50 Screening tools exist to identify mothers at high risk for suboptimal parenting and depressive symptoms, such as the Emotional Preparedness and Responsibility screening tool. Parental (PERP).50

Teen mothers may also experience low self-esteem during pregnancy and may benefit from social supports to improve parenting effectiveness.52 Changes during pregnancy may lead to poorer body image, which can lead to poor maternal attitudes. and affect the ability to adapt to motherhood during pregnancy and thereafter.48

Teenage mothers may have difficulty accepting their pregnancy, leading them to avoid thinking about their mothering role during pregnancy and only incorporate thoughts of maternal identity intermittently during pregnancy.

same.50 Despite various risk factors, teenage mothers can demonstrate resilience and the ability to manage their home without risk of child abuse or other adverse effects on their children.53 These findings underscore the importance of family support and pediatrician to help adolescents in their transition to motherhood and self-discovery of their identity as mothers.

•  Paternity

When discussing teenage pregnancy, pediatricians may inadvertently overlook the role of the teenage mother’s partner. Of all pregnancies among teenage mothers, an estimated 18% to 35% involve fathers under 20 years of age at the time of birth.54

There is a long-standing gender bias related to adolescent boys’ perspectives and attitudes toward pregnancy and its outcomes, as most research has focused on adolescent girls’ perspectives regarding the views of their male peers. . Few studies have specifically explored the views of male adolescents directly.55

Although much of the attention on adolescent fatherhood focuses on the mother, the participation and commitment of the father or adolescent partner in his child’s life is important for the child’s psychosocial development.56 The literature defines paternal involvement in terms of commitment, accessibility, and responsibility toward the child, in other words, the amount of support from the father to his partner and his child.57

Several factors influence the father-child dynamic, including the nature of the romantic relationship with the adolescent mother during pregnancy and after birth, the father’s ability to provide and support the family, the father’s educational and socioeconomic level, the relationship of the adolescent with their family of origin, and their ethnicity, cultural values, and beliefs.58 Evidence supports that fathers who remain in romantic relationships with teenage mothers are more involved with their children.58

The paternal relationship between the adolescent male and his son or children is related to the type of relationship he has with his own father. Teenage parents who had major conflicts with their own parents are more likely to have signs and symptoms of depression and less engagement with their children.59

It is important to foster positive relationships between teen parents and their children. Social workers, parenting classes, and formal parenting education can be great resources for the teen father.60 More research on teen parenting is needed because most of the literature on teen pregnancy includes only mothers.

Additionally, teen pregnancy prevention programs often target women.61–63 The positive contributions of teen fathers have not been well studied. It is important to understand the social and demographic context of adolescent parents to provide comprehensive support to the couple.

Teen parents are more likely to live in poverty, which is often repeated from one generation to the next. Children of teenage parents are more likely to become teenage parents compared to children of older parents.64

Additionally, substance use, early dating, school delinquency, and a high physical risk environment are important predictors of teen parenthood.64 Research has shown that risky sexual behaviors, low educational attainment, and lack of self-confidence -effectiveness of birth control are associated with future fatherhood in male adolescents.57

Young adult men who father children with teen mothers are also more likely to have low socioeconomic status and lack contraceptive knowledge.65 It is important for teen fathers to be aware of contraceptive methods and engage in conversations with their partners to help reduce repeat contraception. pregnancies and the potential for further economic stress.

Pediatricians can encourage teen parents to play a central role in their children’s lives. If teen fathers feel that their parenting role is peripheral or insignificant, they are unlikely to seek future advice or education on parenting issues.66 Therefore, it is important for pediatricians to promote equal parenting and provide community resources to assist them in developing their role as parents.

Children of teenage mothers who continue to have a close bond with their biological father have better work and educational outcomes, become less depressed, and have a lower risk of becoming teenage parents themselves.67 Paternal involvement positively affects the psychosocial, cognitive, and behavioral outcomes of children. children, with evidence that the coexistence of both parents is associated with less externalization of behavioral problems in children.67

Adolescent fathers or adults who maintain active participation in the prenatal, immediate postpartum, and neonatal periods with adolescent mothers have a greater likelihood of continued involvement in their children’s lives.68 These interactions include playing with their children, giving them gifts, or feeding them, but they are less likely to involve changing diapers, bathing the child, and caring for the child.

In contrast, adolescent fathers who exhibit depressive symptoms within the child’s first year of life are more likely to have depressive symptoms within the next 3 to 5 years and have less parental involvement.69

Depressed parents read less frequently to their children and are 4 times more likely to spank them.70 Parenting interventions can help teach such skills to teen parents. There are several successful programs for teen parents that focus on parenting, but it is important that they involve the teen in his task of becoming a successful parent.71

Additional education should focus on child abuse prevention because risk factors for abuse include young parental age, low income, and mental health problems,72 which can be seen in teen pregnancies. Given that the alleged perpetrator of child abuse is usually a man in most cases,73,74 this education should aim to include parents.

> Family management and support

Family factors associated with better outcomes for the teen mother and her child include early child care provided by the baby’s family of origin, allowing the teen mother to focus on positive perspectives during her journey through motherhood.75

Teen mothers who experience positive health outcomes are more likely to have a positive outlook, set educational goals, and have strong social supports. It is also important that the adolescent mother develops autonomy from her maternal figure to fully adapt to her own motherhood.76

> Mental health management

Adolescent parents face multiple competency challenges, including the transition to parenthood, complex life situations, and varied relationship dynamics with maternal and/or paternal grandparents.77

Several studies suggest that being a teenage mother may be associated with worse mental health outcomes, such as mood disorders.78 The System for Monitoring Pregnancy Risk Assessment (SMERE) reported that approximately 12% of postpartum women across ages self-reported depressive symptoms in 2012-2013.79

Younger parental age (15-24 years) at the time of the child’s birth was associated with a higher risk of maternal depression.79 Additionally, 3% of fathers experienced postpartum depression during the first year.80

Young fathers (ages 15 to 24) with no prior history of mood disorders were more likely to experience depression compared to older fathers.80 Parenting stress during pregnancy and postpartum increases the risk of developing postpartum depression, and Teen mothers with higher parenting stress and parent-child dysfunction scores have higher rates of depression.81

It is important for pediatricians to be aware of adolescent parents who have prior diagnoses of mental illness and to refer them for care during the postpartum period if they have not continued follow-up. Research highlights the importance of screening for depression in parents, particularly younger ones, as it is associated with adverse outcomes in children.78–81

The AAP recommends integrating postpartum depression screening and surveillance into the prenatal pediatric visit and into the child’s well-child checkups at 1, 2, 4, and 6 months.21 Both the American College of Obstetricians and Gynecologists and the AAP recommend use a validated tool, but the AAP prioritizes the Edinburgh Postpartum Depression Screening Test (PDDPE) or a 2-question test, such as the Patient Health Questionnaire 2 (CSP-2) or PDDPE-2. Recent studies have shown that the PDDPE and its subscales (PDDPE-7 and PDDPE-2) are accurate screening tools for adolescent mothers.21,82

Once the adolescent demonstrates symptoms of depression, the pediatrician may consult or provide treatment. Prevention and treatment of postpartum depression are important in the management of adolescent parents; However, few studies have shown consistent improvement in depressive symptoms.83

Some studies have shown improvement in depressive symptoms with increased therapy and use of a variety of care management models.83 More research is essential in the area of ​​prevention and treatment of perinatal depression in adolescent mothers. so that healthcare professionals can support the mental health of this population.84

Pediatricians may also screen parents or adolescent partners for depressive symptoms. The 2018 AAP clinical report “Incorporating the Recognition and Management of Perinatal and Postpartum Depression into Pediatric Practice” recommends screening the adolescent father or male partner with PDDPE at the child’s 6-month well checkup or online.85

Pediatricians can find other useful tools for mental health assessment in primary care settings in the AAP Mental Health Screening and Assessment Tools for the Primary Care Network (available at https://downloads.aap.org /AAP/PDF/Mental_Health_Tools_mental_for_Pediatrics.pdf).

In addition to depression, exposure to stress for both the teen mother and her partner can lead to behavioral and health risks, such as substance use, and has implications for both the pregnant teen and her fetus. As with all adolescents, screening for substance use, brief intervention, and referral for treatment will be even more critical issues for pregnant women.86,87

During health checkups, pediatricians can obtain information about the adolescent’s history of substance use (including e-cigarettes and similar devices) and any increased risk for child abuse.10,12,88 The AAP provides additional guidance on substance use. alcohol, tobacco, and marijuana during pregnancy.89-91 Pregnancy provides opportunities to help teen parents reduce exposure to stress and change or establish healthier habits.92

> Gender violence

The prevalence of intimate partner violence (IPV) specifically among teen mothers is 7%, compared to 2% in mothers over 30 years of age.93 Formal screening for IPV among teen fathers during pregnancy and postpartum It is important. Violence during pregnancy is recognized as a serious public health problem, particularly for those of younger age (12-24 years).

In the United States, approximately 27% of women and 11% of men have experienced IPV during their lifetimes.94 The National Sexual and Intimate Partner Violence Survey defines 5 types of IPV, including sexual violence, stalking, physical violence, psychological aggression, and control of sexual and reproductive health.

IPV, which can include verbal abuse, assault by a partner or family member, getting into a fight or being hurt, or witnessing violence, may increase during pregnancy, with 3% to 19% of pregnant women being identified as victims of IPV.95

Another form of IPV can be "contraceptive sabotage," in which the partner refuses to allow the woman to use contraception for pregnancy prevention.96 A teen mother’s own exposure to violence as a child complicates and Sometimes, it normalizes their view of gender violence.92 Specifically, there is a direct relationship between IPV and adolescent mothers’ experiences of violence in childhood.97

Teen mothers may be reluctant to disclose IPV to their doctors and are more likely to stay with the abusive partner so that the father can remain in the child’s life.97 Children who witness IPV are more likely to experience abuse or maltreatment infants, especially those born to mothers under 21 years of age.98,99

Pediatricians can use multiple screening tools to evaluate IPV. The use of universal screening methods is suggested, preferably the use of self-administered surveys rather than verbal assessment tools.94,100,101

> Social determinants of health

More recent research suggests that health determinants strongly influence adolescent pregnancy. The CDC defines social determinants of health as "conditions in the places where people live, learn, work, and play that affect a wide range of outcomes and risks to health and quality of life."102

Poverty, a key social determinant of health, greatly affects adolescent mothers, fathers, and their children.103

Within the first year of a child’s life, 63% of teen mothers will receive public assistance benefits, and 52% of mothers receiving welfare will have had their first child in their teen years.104

Poverty also influences early repeat pregnancy. Therefore, it is ideal that prevention efforts expand from the individual level to the community level, including the social, political, and economic environments in which adolescents live, work, and play. These efforts involve forging alliances between health care programs and nontraditional groups, such as male mentoring programs and transportation services.105

A broader focus on the communities where adolescents and their children live, rather than just a focus on individuals, can also help reduce other social disadvantages of adolescents.61

For many teen parents and their children, poverty plays a key role in the difficult circumstances in which children are raised. Therefore, focusing on a bi-generational approach to poverty reduction can improve outcomes for low-income families.103

This strategy is aimed at simultaneously helping both low-income children and their parents through interventions such as job training for parents while their children attend high-quality child care programs103 or addressing risk factors that increase the likelihood of daughters of teenage mothers becoming pregnant,62 which can reduce the continuation of this cycle.

Other social determinants of health in adolescent mothers include high rates of residential mobility, decreased levels of financial support, and limited resources for child care during the prenatal and postnatal periods.63 Adolescent pregnancy is a high-risk period for individuals homeless as a result of parents kicking out the pregnant teen or due to intimate partner conflict or violence.106

Pediatricians can ask about housing or safe shelter status and refer the pregnant teen to social and/or community services if necessary. Adolescents may self-report the need for financial support and job training in the immediate postpartum period but may have relatively low use of community resources to meet their needs.63 More research is needed to determine potential barriers that drive parents away. adolescents from community resources.

> Addressing toxic stressors

Adverse childhood experiences can increase lifelong risks for medical and psychological illnesses, such as obesity, heart disease, diabetes, and suicidality.107

To prevent the effects of childhood adversities, models that address both teen parents and their children (i.e., a bigenerational approach) can be used.108 This approach includes increasing the resources available to teen parents and their children. , supporting workforce development and increasing awareness of adverse childhood experiences.109

Directing resources toward schools and early childhood programs can help mitigate risk.109 Identifying exposure to childhood adversity, focusing on parenting practices, and encouraging return to school can reduce the effects of adversities and promote health development.109 Two types of programs have been shown to improve school completion: multi-service packages with academic and vocational support, case management, and child care provision, and assistance with financial support.110

Assessing the effects of social disadvantages, such as unsafe housing, neighborhood violence, and racial discrimination, is very important. Capitalizing on the strengths of adolescent mothers and their families can facilitate intergenerational repair of the effects of childhood adversities on both the mother and her child.111

Low family income, low infant birth weight, maternal smoking, maternal history of child neglect, IPV perpetrated by the mother or her partner, and maternal use of mental health services are associated with child neglect. 112 Identifying high-risk families and intervening during the first months of life can help prevent neglect and its subsequent effects on the child.112 These interventions include providing counseling on effective non-physical disciplines to decrease potential physical harm and emotional of the child.

> Cognitive development of children born to teenage parents

Maternal support can directly affect children’s cognitive development. Children born to teenage mothers who have low levels of emotional responsiveness and do not show interest during play time with their babies are at greater risk of having poorer cognitive and language skills compared to children born to adult mothers.15

In contrast, higher levels of maternal support during childhood play may lead to greater gains in cognitive and language skills from infancy to age 3.15 Greater resources within the family environment and lower levels of conflict family can improve developmental gains over time.

Although children of teenage mothers may have lower school achievement, there are modifiable factors related to greater school readiness, including maternal educational attainment, maternal age of at least 18 years, lower rates of postpartum depressive symptoms, and receipt of non-parental child care in childhood.113

The following policy changes can improve school performance: attendance of children in childcare in centers with qualified staff while their mothers attend school, and provision of specific pregnancy prevention services for school-aged adolescents who have not yet completed secondary school.113

Although studies show concern about the low IQ and long-term academic development of children of adolescent parents,114 there are interventions that can improve cognitive development; Specifically, interventions that were shorter in duration, delivered in smaller groups, or that placed a strong emphasis on the quality of parent-child interactions led to greater gains in cognitive achievement among children.115

> Social development of infants

Adverse social developmental outcomes of infants born to teenage parents are associated with high levels of maternal depression and preterm birth.116,117 Increased social support, including social work participation, home visiting programs, and early intervention programs, positively influences in the development of babies of adolescent mothers.117

Head Start and Early Head Start programs support early learning, including the areas of social and emotional health, physical health, and family well-being for low-income families.118 Coordinated comprehensive follow-up for extremely preterm infants and their teenage mothers is also important.117

Other clinical interventions, such as those that focus on coparenting relationships and conflict resolution skills between teen mothers and their partners, may improve the social-emotional development of children of teen mothers.119

Teen parents may not be prepared to manage a young child’s emotional and social development, and studies suggest that teaching parents how to play with their children can improve children’s vocabulary skills and emotional regulation.120

Sit and Play 121 and Reach and Read 122 are interventions that pediatricians can integrate into their practices. Sit and Play teaches low-income families how to make toys and interact with their children in a positive way. Promotion of this program may involve partnerships with community resources, such as Parents as Teachers, to facilitate positive parenting behaviors through home play activities.

The AAP clinical report on the importance of play123 also provides tips to encourage play in high-risk children. Reach and Read promotes child development by strengthening parent-child relationships, advising families on the importance of literacy and modeling reading together, and provides a new book for children ages 6 months to 5 months. years of age during well-child checkups.122 Additional early literacy resources can be found at https://www.aap.org/en-us/literacy/Pages/Early-Literacy-Resources.aspx.124

> Role of the medical community

The medical community is made up of pediatricians who can have positive effects on teenage parents and their children, particularly during the prenatal period. Obstetricians care for the pregnant teen, along with other support professionals such as doulas, who can provide emotional, physical, and social support and information during pregnancy, childbirth, and the postpartum period.125

The pediatrician can play an important role in mitigating some effects of teenage pregnancy by encouraging early entry into prenatal care. If the adolescent mother chooses to return to her pediatrician for primary care after the postpartum obstetric consultation, the physician’s role may include social and financial support, educational support, and contraceptive management in addition to routine care of the adolescent.

The pediatrician can provide anticipatory guidance to strengthen the family’s social support, encourage the adoption of positive parenting techniques, and facilitate the emergence of the child’s social, emotional, and linguistic skills.126 Resilience refers to the ability to overcome adversity based on positive experiences and learned coping skills.

Primary prevention includes promoting the 7 Cs of resilience: competence (knowing you can handle a situation effectively), confidence (believing in one’s abilities), connectedness (developing close ties with family and community), character ( developing a solid set of morals and values ​​to determine right from wrong and demonstrate a caring attitude toward others), contribution (understanding that the world is a better place because the person is in it), confrontation (effectively coping with stress), and control (realizing that you can control the results of your decisions).127

The pediatrician can also link the family with support groups to help promote optimism as well as encourage early learning through programs and provide information about community resources that provide positive parenting strategies.128,129

Teen parents and their children face multiple barriers to optimal development, including negative stereotypes, lack of resources, depression, poverty, poor support, and low educational attainment.

Pediatric health care providers can positively influence the long-term health and life trajectories of adolescent parents and their children by creating a supportive and nurturing environment.