Ep. 208: The Father Factor: Why Engaged Dads Make a Difference

Fathers have a profound impact on their children's physical, mental and emotional well-being, yet they're often left out of pediatric research. John James "JJ" Parker, MD, Researcher, Attending Physician, Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital, Chicago, explores what the science tells us about involved fathers, where critical research gaps remain, and how supporting dads can improve outcomes for children and families alike.

Watch the episode on YouTube.

Featuring:

John James "JJ" Parker, MD, Researcher, Attending Physician, Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital, Chicago

Host/Producer: Carol Vassar

Views expressed by guests do not necessarily reflect the views of the host or management. 

Subscribe, review or let your voice be heard at NemoursWellBeyond.org.

Transcript

Announcer (00:00):

Welcome to Well Beyond Medicine, the world's top-ranked children's health podcast produced by Nemours Children's Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube.

Carol Vassar, podcast host/producer (00:12):

Each week we'll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor's office. I'm your host, Carol Vassar. And now that you are here, let's go.

MUSIC (00:28):

Let's go well beyond medicine.

Carol Vassar, podcast host/producer (00:36):

We're talking dads today on the Nemours Well Beyond Medicine Podcast. Thanks for joining us, specifically research around fathers and their roles in the health of their children. Right now with me is Dr. John James, JJ, Parker. Dr. Parker is an attending physician in advanced general pediatrics and primary care at Lurie Children's Hospital, which is in Chicago. He and I were both recently at the Pediatric Academic Societies meeting in Boston. He presented on this very topic.

(01:06):

Dr. Parker, welcome to the podcast.

John James (JJ) Parker, MD, Ann & Robert H. Lurie Children's Hospital (01:09):

Thanks so much for having me. Excited to be here.

Carol Vassar, podcast host/producer (01:12):

You are helping to build an evidence base around fathers in pediatric health. Let's talk at a very high level. What are we missing when fathers aren't included and included meaningfully in research and care around pediatrics?

John James (JJ) Parker, MD, Ann & Robert H. Lurie Children's Hospital (01:30):

Yeah, I think it's intuitive to everyone. Everyone has a family, and they know that every family member plays a major role in the health and well-being of each individual family member. And I think for a long time, fathers have kind of been left out of pediatric health and thinking about child health. And we know that they're influencing moms, grandparents, their children, but we don't really know how and where their opinions are coming in. And so I think the time is definitely now to think about engaging fathers and to learn their voice. I see it clinically a lot. We'll talk to parents about, "Okay, we talked about changing the diet last time. You're still drinking soda. What's going on?" It's like, "Well, dad loves soda." And it's like, "Okay, dad's not here. He's the one who's buying the soda. Why is it in the house?" And it's like we need to make sure to get those perspectives as much as we can to help address the child in front of us that we're trying to make healthier.

Carol Vassar, podcast host/producer (02:38):

And you're talking not just from a professional perspective; you yourself are a father. When we talk about father involvement, what does that look like both in your work and in your life?

John James (JJ) Parker, MD, Ann & Robert H. Lurie Children's Hospital (02:50):

Yeah. So I have three kids; I'm blessed to have three kids, a son and two daughters. They're six, four, and a year and a half, so they keep me busy on my toes. But definitely influenced what I wanted to do in my career, as once I had my son during residency and realized how unprepared I really was to manage-

Carol Vassar, podcast host/producer (03:12):

We all are.

John James (JJ) Parker, MD, Ann & Robert H. Lurie Children's Hospital (03:13):

Yeah, yeah. Being a physician and a father, it's the same with anybody who's working or doing other things, trying to manage it all. And really, even despite being in I was an internal medicine and pediatric resident, I'd get all this training. I had very little training on how to take care of a child. So then I was like, wow, we're really kind of missing this. And even how I adjust fathers in clinic totally changed. And going through being a partner for my wife during the birthing process, that was all kind of eye-opening to me. So I was like, all right, there's a major need to include fathers in healthcare, to promote their engagement with their children, and also to think about research, how fathers are influencing child health. And I'm also interested in how fatherhood influences men's health and the health of fathers.

Carol Vassar, podcast host/producer (04:09):

Interesting.

John James (JJ) Parker, MD, Ann & Robert H. Lurie Children's Hospital (04:09):

So really trying to tie it all together. And I've always liked thinking about the life course, and that's why I did internal medicine and pediatrics. And then shifted to, okay, how do we prevent these diseases? We need to focus on the children. But then tied into that is we actually need to focus on the parents so we can focus on the children. And so it's kind of all full circle, starting with having my own child and realizing that there's these major gaps in research and wanting to pursue a career in research too.

Carol Vassar, podcast host/producer (04:40):

And it's much more complicated, as you just stated, as you were describing father's health, mother's health, child's health. It's more than just the child's health; it's also the community's health. Let's talk about the research you're doing. How do you define and measure what a father's influence on child health is in a way that's rigorous? We can be as anecdotal as we want, but medical research is very rigorous in the work they do.

John James (JJ) Parker, MD, Ann & Robert H. Lurie Children's Hospital (05:08):

Yeah, that's a great question, and it actually highlights a need for the field moving forward. I think there's a growing body of evidence on the importance of father involvement in child health outcomes. And the more involved fathers are, the better the various physical, mental, and developmental outcomes we see. But most of the studies are looking at crude measures, and there's not a lot about which individual behaviors are the most beneficial for child health. I think there is some good evidence that shows that the stronger the emotional ties and the quality of the relationship and the willingness to really show emotion for your children is especially beneficial. So I think that aspect of father involvement is starting to emerge.

(06:09):

But I think we don't have, there's no standard measure that says, okay, this is what father involvement means. There's many different ways it's been measured in the literature. The good news is most of them have shown, I mean, almost all of them have shown benefit, which is not surprising to anyone. If father's involved, the child is going to have benefit. But I think there's a need to define it in a more rigorous way or to have tools to understand or to measure at a survey level how father involvement is characterized and then can be associated with child health.

Carol Vassar, podcast host/producer (06:54):

If there's no set definitions on some of these terms that we're using, it must make the research difficult, but it sounds like some of the research is showing some proof of the theory that fathers involved with their children influence their children's health. Is that correct?

John James (JJ) Parker, MD, Ann & Robert H. Lurie Children's Hospital (07:13):

Yeah, absolutely. I think there's a lot of research now, I would say, that shows really at every stage of development, father involvement has been associated with various outcomes. So you talk about even prenatal involvement is associated with positive birth outcomes, the perinatal time, father involvement's associated with breastfeeding and maternal health and wellbeing. And you move on to the developmental phases: father involvement is associated with improved language development and cognition. Then you go into school, and father involvement is associated with academic achievement. And then moving on, mental health and decreased use of substances. All sorts of positive aspects across the whole continuum of childhood.

(08:07):

And so I think part of the reason ... So that's great. There's lots of data to support the need for father involvement. A lot of the reason that father involvement hasn't been, there's no clear definition and measured rigorously is it's kind of what data's out there and what we have. And fathers are underrepresented in pediatric research. At most, they're 10% of the parent voice throughout all the studies. And so we a lot of times are asking mom, "How involved is dad?" Or, "Has the dad seen your child in the past 30 days?" So these very crude measures. And we can't have a rigorous measurement if we don't have the data to use them. So these studies have used what's available, and that still is a marker of father involvement. And then they have the outcome data such as child development. If they have certain ... Whatever father involvement piece they have, they can look at that with the child development outcomes.

(09:16):

So I think there is nothing ... All those studies are extremely important to show those associations. We're just moving forward when we actually start including fathers in pediatric research, we can get a better idea of what father involvement is and a better measure of what father involvement looks like and should be when we are conducting child health studies.

Carol Vassar, podcast host/producer (09:41):

How have you and others like you, I know the PRAMS data is out there, go about getting information from fathers and getting more fathers involved in this kind of research?

John James (JJ) Parker, MD, Ann & Robert H. Lurie Children's Hospital (09:54):

Yeah. I think that one of the easiest ways is to also include the father if the mother is participating or other caregivers participating in a study, whether it's a qualitative study or a survey-based study; it's okay to get both parent voices. I mean, if it's multiple times and you don't want to pay for two caregivers at each of these follow-up visits, at least get the father voice every once in a while. Let's get their perspective; let's ask them a few questions. It's often not difficult to do, especially when the family's already engaged. So that's one easy way to include fathers.

(10:37):

If there's still just one parent and you want to diversify your parent participant group, being targeted towards fathers is very important. So often when you say we're having one parent represented in this child health study, a lot of families want to defer to mom. Even if the father is very involved, it's just kind of standard, and they don't want to take over for that mother. I mean, I would feel the same way even if someone asked us to do a study of just one parent; I would feel bad. We'd have a discussion about who should join, and most families are going to choose the mother. And so if you're at a point where you're like, okay, we've got a lot of moms, we need some dad voices, just go directly to the dad. Say, we need a father whose voice is represented, and men will respond; the response rate will be good.

(11:34):

Historically, it's not as good because we're targeting - we just say parents, and then you say, oh, dads, they're not enrolling in these studies. It's like, well, you're choosing a parent, and that society has generally accepted the mom to respond for this study. And so I think that's an easy way to tailor things to fathers to get them into the studies.

Carol Vassar, podcast host/producer (11:55):

And with the parents that you work with generationally, are you seeing more involvement with fathers with their children? What I'm seeing, and I have a daughter who is married to a wonderful man, my son-in-law, who is so involved with his children. It is amazing to me, and I'm seeing his friends are doing the same. Is this generation different? I guess that's the question I'm trying to ask, with involvement with their children and ultimately benefiting their children's health overall.

John James (JJ) Parker, MD, Ann & Robert H. Lurie Children's Hospital(12:28):

Yeah, I think there's a few studies that have shown that father involvement has been increasing. I think that there is a need to measure how father involvement has changed and how involved fathers are today, how often, and in what ways. But I think being involved in this work, I've had hundreds of people tell me, "Oh, this is amazing that you're doing this because we see it now." It's like, "I've been dropping off my kids for 10 years and then all of a sudden now it's all the dads in the line." And even in other pediatric providers who've been practicing for a while, we see dads so much more in clinic.

(13:08):

For me, just being out with my kids at the playground, going to swim class, all those sort of things, there's so many dads everywhere. And so I think that it's a very exciting time to be in this field because fathers are starting to step up to the plate, realize the benefit of being with their children. We're also riding the success of mothers and women who have made giant movements in the workplace. And so now fathers need to take up that role at home for more of the mothers who are working and have high-powered jobs, and fathers are doing more at home to help their partners. And so I think those are some of the forces at play, but I think that is all very beneficial for families, for mothers, for children, for fathers to have them play a larger role in the family.

Carol Vassar, podcast host/producer (14:12):

When you take a look at the presentation that you did at the Pediatric Academic Society's meeting, what did you want to impart to those who were in the audience who were mainly your peers, your pediatric provider peers? What did you want them to know?

John James (JJ) Parker, MD, Ann & Robert H. Lurie Children's Hospital (14:29):

Yeah. So we got to do it; it was our first-ever special interest group on fathers in pediatrics. So also similar to the last question, we're seeing fathers more involved, and so now the Pediatric Academic Society is like, "We'll allow you to have this meeting so you can connect with your peers and promote the importance of father involvement." So I think one of the focuses was to discuss the multiple ways that you can engage fathers in research because we know there's this large gap with fathers only being represented about 10% of parents in pediatric health. And so we had a great panel of speakers, and we tried to think about the multiple levels where you can engage fathers. So Craig Garfield did the PRAMS for Dads, which you mentioned earlier. So he did that the public health surveillance. How do you get fathers at a public health level and added to an existing PRAMS surveillance system? We had work at the community level with home visiting programs to support father involvement. We talked about weight loss intervention. And so that's more of a clinical community-based intervention.

(15:51):

My study that I discussed was looking at fathers' health and how we can connect to fathers when they're with their partners in OB spaces to promote their health. And then we had a discussion about the treatment of fathers in the community. So I think a nice mixture of speakers doing work in this field. And then we had a discussion with audience members about how we can engage fathers and what are some tips that a lot of the audience members wanted to know: "How do I do a better job of including fathers in my studies?" And other people who were interested in this work shared their experience and how we're often missing fathers in child health.

Carol Vassar, podcast host/producer (16:38):

How does that work that all of you are doing complement one another? And I'm particularly interested in how PRAMS for Dads, which began to bring fathers into the population-level data, how does that complement what you are doing specifically, Dr. Parker?

John James (JJ) Parker, MD, Ann & Robert H. Lurie Children's Hospital (16:56):

Yeah, I think we really had no surveillance system at a population level of fathers. And the PRAMS program is excellent because it uses the Pregnancy Risk Assessment Monitoring System that has surveyed mothers for years, and this is run by the CDC and state departments. And so they sample individuals in a way that is representative of the state. So you get more of that population level. And with the surveys repeating, you can change questions that are more relevant to the time, and you can monitor trends. And then also with the partnership with the state departments, this data can be directly passed back to policymakers. And so it can be very relevant to public health and to health policy, and say this is ... You also can connect fathers, mothers, and infants in the PRAMS program. So you really get this relationship and how father involvement is connected to family wellbeing. And then it can be immediately relevant to policymakers and public health leaders.

Carol Vassar, podcast host/producer (18:07):

Talk about ... You're still practicing, right? Or are-

John James (JJ) Parker, MD, Ann & Robert H. Lurie Children's Hospital (18:10):

Yes.

Carol Vassar, podcast host/producer (18:10):

... you just strictly research? When you talk to fathers, do you have any examples of fathers who are really, really involved with the health of their children and what you think that means for that family?

John James (JJ) Parker, MD, Ann & Robert H. Lurie Children's Hospital (18:25):

Yeah. I see it all the time. I think I immediately thought of 10 faces that popped into my mind about fathers who are like, they're the ones who are kind of ... Mom is often there, and they're still the ones that are running the interview, running the consultation in clinic. I feel like the moms love it from my experience. It's not like the moms are like, "Oh, I'm in the shadow, even though dad is kind of upfront." They like, "This is great. We're really working as a team." And I think that's what I see mostly is mom and dad: this is a team effort. We're in this together to make our child as happy as we can. And that's how it should be. And so that's, I think, the most exciting part about it.

Carol Vassar, podcast host/producer (19:18):

Where do you see the research going next? It sounds like there are gaps that need to be filled, but where would you like to see the research go in terms of fathers and children's health?

John James (JJ) Parker, MD, Ann & Robert H. Lurie Children's Hospital (19:31):

Yeah, absolutely. So yeah, we talked a lot about father involvement and increasing the voice and responses in pediatric health studies and then defining father involvement. So those are some of the things that we already talked about as some major gaps. I personally am also an internist who takes care of men, and most men are fathers. And so I like thinking about how fathers' health is influencing family health. And I think that has a lot of gaps. There's not a lot of studies that have thought about fathers as a population and what happens to men's health when they become fathers.

(20:12):

And this is very important because the health of fathers obviously influences the health of their family. We think about preconception health, even the more physically active dad is, the diet that they're having, not using substances, that affects the genetic material passed onto their children. Then if they're going to be healthy and active, they're going to be more likely to be involved with their children. And then the behavior modeling that trickles down as well. So I think there's a huge need to think about how specifically fathers' health is tied into family health. And so that's one path forward for me, and others are doing that work. But there's lots of different ways we can think about promoting the health of fathers and families through men's health promotion.

Carol Vassar, podcast host/producer (21:03):

When fathers are fully integrated into research, into care, and it sounds like they're more and more involved with care, so the research part is a little bit of a gap. What do you think we'll see for children and families over the long-term? And are there any long-term longitudinal studies about the relationship between father and child and child's long-term health and even men's long-term health?

John James (JJ) Parker, MD, Ann & Robert H. Lurie Children's Hospital (21:28):

So for father involvement in child health, there are several really great longitudinal studies that taken birth cohorts of children and then looked at father involvement and then measured the child health outcomes moving forward. So some of this data is very rigorous. There's not a lot, and there needs to be more, but it's not just all cross-sectional, like dad involved, child health. It's like, okay, we look at the father involvement and then we're following this kid over time, and we can control for lots of variables. So there's good data to show that, and there needs to continue to be those excellent longitudinal cohort studies. Some things we haven't looked at are fathers' health as much as how that influences the child in a longitudinal cohort. And then I'm starting to think about also measuring when a man becomes a father and what happens to their health at that time. So that influence in their life course. And so those are some various ways that we can think about the longitudinal life course, and I think the data is there.

(22:41):

One part of the gap is that some of the studies have men who have become fathers; it's been a few decades since they had that transition to fatherhood. If you're trying to measure more of mortality or cardiovascular data, that's like you need time for it to develop. One challenge is that if they became fathers in the '80s or '90s, years have passed and times are different. So we need to complement the longitudinal studies with more current data, and we need to continue those so we can measure fatherhood as it is now in 2026.

Carol Vassar, podcast host/producer (23:17):

 Dr. John James "JJ" Parker is an attending physician in advanced general pediatrics and primary care at the Ann and Robert H. Lurie Children's Hospital in Chicago.

MUSIC:

Well Beyond Medicine. 

Carol Vassar, podcast host/producer:

As researchers like Dr. Parker continue to delve into the research and evidence about the relationship between dads and their kids’ health, one thing is already becoming clear: when we better understand and better engage fathers in that research, we create new opportunities to improve health not only for children, but for entire families.

Our thanks to Dr. Parker for highlighting that, and to you, as always, for listening to this episode of the Nemours Well Beyond Medicine podcast 

If you haven’t yet subscribed to the podcast, I invite and encourage you to do so on your favorite podcast app or by visiting our website at nemourswellbeyond.org. All our past episodes are there, as well as the opportunity to also subscribe to our monthly e-newsletter. That’s nemourswellbeyond.org. You can also check out all of our episodes on the Nemours YouTube Channel. 

Our production team for this episode includes Lauren Teta, Cheryl Munn, Susan Masucci, and Alex Wall. Video production by SarahKate Reger. Audio production by Steve Savino and me. Join us next time when we have a conversation with three surgeons who practice the science and art of fetal surgery. It’s the next episode in our series on Maternal-Fetal Health. Don’t miss it!

I'm Carol Vassar. Thanks for listening. Until then, remember, together we can change children's health for good—well beyond medicine.