Drawing the Curtain

A Racial Equity Framework for Pediatric Professionals

Kia Ferrer, MS, CCLS, GC-C


Pediatr Nurs. 2021;47(3):149-155,148. 

In This Article

How to Draw the Curtain on Racism

Pediatric professionals have been socialized into a professional working culture that silences conversations about race and supports the widespread distribution of subtle racialized images (Trent et al., 2019; Winkler, 2009). Van Ausdale and Feagin (2001) remind us that educating children about these issues "requires that we rethink our ideas about several dimensions of everyday life, including the nature of racial and ethnic oppression, the intellectual capacity of children, our willingness to effect changes in oppressive social conditions, and the extent of children's social skills" (as cited in Winkler, 2009, p. 199).

Furthermore, it is well documented that pediatric professionals are underprepared for providing children of non-dominant races the services they deserve in culturally appropriate ways (Garcia Coll & Ferrer, 2021). Professional organizations, such as the Council for Exceptional Children (CEC) and the National Association for the Education of Young Children (NAEYC), note the importance of fostering children's sense of belonging, engaging in inclusive efforts to prevent discrimination, and examining, responding to, and challenging bias (Beneke et al. 2018; NAEYC, 2016).

We know that pediatric professionals are underprepared for providing children of non-dominant races the services they deserve in culturally appropriate ways (Garcia Coll & Ferrer, 2021). How do we implement racially conscious practices, which are especially important for children in the 3- to 5-year-old range as their developmental understanding of their own skin color, in contrast to that of their White teachers (Derman-Sparks & Edwards, 2019; Gilliam et al., 2016), is a core component of their identity development?


Studying oneself is a process in which pediatric professionals initiate conversations about similarities and differences in their identities, such as race, ethnicity, gender, sexuality, spirituality, and socioeconomic circumstances, and how these dimensions may (directly or indirectly) influence the relationship between the child and the professional (Hernández, & Blazer, 2006). In addition to examining the interpersonal dimensions of bias and racism, those who have the tools and access must also interrogate the structures and institutions that keep racism and privilege in place. As part of the efforts to dismantle these structures, professionals must research, examine, and adequately understand the nature of the system, as well as the forces that shaped its creation and evolution, before it will be possible to effectively dismantle the inequalities built into its structures (de Oliveira, 2018). See Figure 4 for questions that can serve as a guide to group processing and reflective discussions.

Figure 4.

1. Examine


Many professionals have publicly acknowledged the racial divide in pediatrics and have admitted that some have worked to raise the racial consciousness of Whites. To echo the words of DiAngelo (2011), the author of the book White Fragility, simply getting Whites to acknowledge their privilege is not enough because the resistance runs deep. If one is White, in order to stand in solidarity with colleagues and families that identify as Black, Indigenous, or families of color, one needs to allow oneself to feel and be a little uncomfortable. Initiate conversations, take ownership of what you don't know, sit in the discomfort, and open yourself up to learning about the personal, institutional, and systemic racism that children and families of color feel on a daily basis (see Figure 5).

Figure 5.

2. Acknowledge


We are in the midst of widespread transformations, rapid cultural change, and globalization. As pediatric professionals, we must embrace the fact that social changes impact our activities, programs, and the context of our practice. Nursing students enter the workforce with knowledge and experiences that are rooted in their life-experiences, and pediatric nurses must be reflective and responsive enough to create an inclusive learning space that values and incorporates these experiences. Learning must be authentic, and this should involve creating space in which our nursing students have agency, ownership, and control over their own learning. We must also make sure the purpose of our instruction is rooted in action as a means to promote change. Asking ourselves reflective questions found in Figure 6 can help us acknowledge and respect the people who have been affected by our actions, while also embracing and accepting that there is room for growth and change.

Figure 6.

3. Embrace


We must acknowledge the existence of racism and affirm that health equity is "unachievable unless racism is addressed through interdisciplinary partnerships with other organizations that have developed campaigns against racism" (Trent et al., 2019, p. 6). It is normal to feel discomfort as we reflect on our own experiences with racial inequality and deepen our understanding of racism. The more we practice facilitating difficult conversations, the more we will be able to manage the discomfort. The conversations may not necessarily get easier, but our ability to press toward more meaningful dialogue will expand. Overall, our commitment must be to challenge what we value as true and develop our critical consciousness so we can work toward decolonizing the educational experiences of our children and embrace education as an act of liberation and freedom. Once pediatric professionals acknowledge and are sensitive to the racism children and families experience, we will be better equipped to integrate patient- and family-centered communication strategies and evidence-based screening tools into our clinical practices that incorporate valid measures of perceived and experienced racism (see Figure 7).

Figure 7.

4. Advocate