irst June is the Global Day of Parents. This day is celebrated to acknowledge and appreciate parents and caregivers for their efforts in raising children. Their love, encouragement, care, support and sacrifices for their families significantly contribute in their children’s upbringing and development. A robust primary healthcare system can provide a trustworthy platform for advice and support for parents. From newborn to teenage years, parents need guidance for their children in areas like nutrition, development/ milestones, immunisation, congenital illnesses, behaviour (day time activities, education, sleep) or psycho-social issues, relationship problems, mental health problems, including substance abuse.

Holistic and person-centred approach in primary care consultations not only enables a trained physician to promote health and identify ways to prevent disease but also encourages them to obtain structured history to deal with parental issues of their patients. Managing such patients requires appropriate and timely referral to paediatrics by primary care physicians. Results of a study involving 104 parents of adolescents published in BMC Health Services Research in 2021 showed that 87 percent of parents were interested in having a parenting programme within primary care and a vast majority were keen to receive guidance on communication skills. Conflict resolution was another area where they wanted to seek guidance.

Primary care providers are a good resource for health education topics for adolescents like diet, exercise, smoking cessation, weight loss, safe sex practices and stress management. When dealing with behavioural or emotional issues, a multidisciplinary approach involving paediatrics, community nurses, psychiatrists and rehabilitation teams is required. In such cases where long term care is required, care provision through primary care can help support parents and families.

Losing a child can be a traumatic event. Bereaved parents need support. Pakistan has one of the highest neonatal and under five mortality rates. Grief due to child loss can lead to adverse health (physical and mental) outcomes in parents. They need support and guidance in these difficult times. Studies have shown higher risk of suicide among bereaved than non-bereaved parents. Primary care providers can address their concerns and any expectations while giving advice on appropriate interventions in case of a crisis or referral to specialists (child psychiatrist, family therapist etc).

There are stresses and challenges for parents of children with mental health problems. Primary care physicians play a vital role in guiding parents towards various therapies, resources and specialists. In such situations, primary care physicians tend to have an open conversation during consultations to understand the relationship between the child and the parent.

Pakistan is faced with a double burden of malnutrition. Studies have shown that maternal awareness about neonatal feeding, including breast feeding is deficient. This affects selection of food items for weaning, which predominantly consists of carbohydrate rich foods. Similarly timing of complementary feeds is variable. Lack of access to quality food in under privileged areas and food adulteration are other factors contributing to poor growth and development of infants and older children. Keeping in view these issues and addressing needs of maternal education and timely referrals to nutritionist, the presence of a comprehensive primary care system with trained primary care physicians rather than selective primary care is needed. Alma Ata Declaration (1978) clearly mentions the contribution of primary healthcare in improving nutrition.

Finally, it is essential that parents are empowered through structured health systems i.e., healthcare facilities, trained physicians and appropriate out-reach and community-based services. Parental understanding of their child’s needs and temperament and negotiating a middle ground through flexibly dealing/ solution can be acquired through the introduction of parenting programmes. Introducing such programmes in primary care can help mainly parents and, to some extent, children embrace change. Once aware, parents will be able to advocate for their child’s healthcare needs. This will in turn contribute to the overall health of the population. Better investment (budgetary) to transform existing healthcare system will bring us a step closer to achieving universal health coverage.

The writer is an associate professor in family medicine at the Health Services Academy, Islamabad