“My hope from this work is that it helps fathers to see themselves out there in the bigger world and see that it’s not an anomaly — that investing your time in being a dad is an acceptable thing to do and that you have the support of other people around you, including your pediatrician. That’s important because, if you look around and don’t see people like you doing these sorts of things, then you’re less likely to do them.” – Dr. Craig Garfield
Interview with Dr. Craig Garfield
We had the privilege to Zoom chat with Dr. Craig Garfield, a professor in the Departments of Pediatrics and Medical Social Science at Northwestern University’s Feinberg School of Medicine and an attending physician at Ann & Robert Lurie Children’s Hospital in Chicago. Dr. Garfield has devoted much of his career to expanding the field’s understanding of fathers’ role in improving child health outcomes and how transitioning to fatherhood can have a positive impact on the health of the dad.
His is a clarion call for pediatricians to consider how best to engage fathers — whether in the pediatrician’s office, in the hospital or NICU, or in the prenatal period. We spoke with Dr. Garfield about his pioneering work with the Centers for Disease Control in expanding pregnancy risk-assessment data collection to include fathers, and his development of an app to increase parenting self-efficacy.
Read on for highlights from our illuminating conversation.
What brought you to medicine and to pediatrics, specifically?
I was an English major at the University of Michigan and toward the end of my college experience, I started thinking that as an English professor I could teach English literature to those who spoke English, but that wasn’t the thing that could have the biggest impact on the most people. I realized that health was that thing.
I spent a year taking pre-med classes and applied to medical school at Rush University in Chicago because they offered students the opportunity to run volunteer programs. I started a night clinic for homeless people on the southwest side of Chicago in an old mop and bucket factory that served as a homeless shelter. Each night, 250 men and women would stay there and, if they had a medical issue, they’d come to the clinic in the back of the shelter to talk with us. I spoke with a lot of the men and tried to figure out how they ended up in their current situations. It seemed like things had gone well in their lives up to a point, and then they went really badly, and they never quite recovered from that. For many of them, what went wrong happened when they were kids. And so I started thinking that pediatrics could be a means of identifying and addressing those issues earlier in a person’s timeline.
During my pediatric training at Mass General in Boston, I started to see differences in being able to provide the most advanced tertiary and quaternary care to children, yet not dealing extensively with violence and injury and things that were happening to kids on the street.
Much of the research you’ve engaged in during your medical career focuses on fathers. What drew you to this?
Several factors led up to it. I realized that, as a pediatrician, I had given very short shrift to fathers when, for example, they would come to the emergency room with their child at three in the morning without a lot of knowledge about their child’s health condition — though often it was because they’d just be coming home from work. And with my own son, when we would go to the pediatrician, the pediatrician really didn’t give me much attention at all. Most of his questions were directed to my wife.
When we moved to Evanston for my wife’s medical residency, I stayed at home with our son, who was 18 months old. And that year ended up being remarkable. I learned what it was like to be the only man on the playground, to go to a mom-and-tot class, but first have to ask if dads are allowed. And to eventually break through after six months and be invited to the play group that the moms had been going to since the beginning of the year.
I thought a lot about how we’re missing the father as a team member in the family. So, when I started at University of Chicago the next year as a Robert Wood Johnson scholar, that’s what I really wanted to study. I took public policy classes that helped me think about how families make decisions from an economic perspective. Before, I never understood why, when I would say to the dad, “I hope to see you at the next visit,” he might not be coming back. Most of the time, I think it’s because of the economics. We don’t have ways to support dads early on after the birth of the child, and that in many families, the contribution dads make is to remain employed. We just don’t pay that much attention to dads from the very beginning.
I teach an expectant fathers’ class and run a dads’ support group in the neonatal intensive care unit, where nearly all the dads I come across want to do what’s right by their child. But they don’t necessarily know what that means. So they fall back on what they know, which is bringing home a paycheck. Our job is to say to them, “It’s really important that you’re at home for the first two weeks after you bring a baby home so you understand what’s going on and how you can help your partner.”
You’ve been at the forefront of expanding the field of research around fathers. Can you talk to us about PRAMS for Dads — what it is and how it came about?
It started with my own experience as an at-home dad and then wanting to look at it from a research perspective. We did some qualitative interviews with 30 dads in Milwaukee and Chicago, the majority of whom were minority, low-income dads. These are the dads who in the past would have been called “deadbeat dads” — who likely were not going to be around. We interviewed them about the impact of having a child and they told us they tried to clean up their act. They tried to drink less. They tried to be in risky situations less. They tried to take better care of their health. It boiled down to wanting to be there for their child. That was the phrase that kept coming up. “I wanted to be there when my child went into kindergarten…I wanted to be there when my child graduated high school.”
In pediatrics, we need to meet those men with our best intentions and open the door when they’re looking to get involved. That qualitative work made me think about how becoming a father may impact the health of the dad himself. So, we used the Longitudinal Study of Adolescent and Young Adult Health, a study examining participants’ health from adolescence to adulthood, and compared men who were fathers to those who weren’t. We then looked at two different outcomes — their mental health and their body mass index (BMI) during the transition into fatherhood. We found an increase in depression in the first five years for men with babies compared to those without them. And in terms of BMI, we found dads with babies also averaged a five-pound weight increase compared to non-dads. We happened to publish that at the same time as the “dad bod” craze was sweeping the popular culture. So, that finding was picked up. One of the headlines was something like “Science Confirms the Dad Bod.”
The CDC, having seen our work, approached us. CDC has had a Pregnancy Risk Assessment Monitoring System (PRAMS) in place for 35 years. This is where we get data on the perinatal period for moms. But the CDC was starting to get feedback on their survey from moms asking, “Why is the only question you asked about my partner whether he hit, kicked, beat, or slapped me during pregnancy, when I would never have made it through this pregnancy without the help of my partner?”
There just isn’t good data for understanding anything about the dad and that’s because we never thought of PRAMS as a vehicle to understand the family. It was about moms.
The CDC asked how we’d get more data about dads? And it opened up this wonderful opportunity. We started talking to dads and moms, to find out what they thought was important to ask. Then we figured out how to ask it.
We got a small amount of funding to pilot this data collection in Georgia and in 2018 we sent 800 surveys to dads. We got good data and we learned a ton. It led us to encourage dads, as part of their responsibility of caring for the child to take care of themselves, too.
What’s the most beneficial use of the data from PRAMS for dads?
For me, it’s really about gender equity. Despite all our work on inequities in this country, this is one area where we’re missing the boat, where we aren’t thinking about the potential benefit of this second person in a child’s life.
From a policy perspective, how do we even know what will be helpful for men if we don’t collect data from them? Before we got started on this, we were relying on mothers to report on fathers. But you need to hear from the person who actually is affected. This will be the first population representative survey of men, during the transition into fatherhood, that focuses specifically on dads. We can use this data to understand how best to support today’s families — because, generally, you’d have higher-income, white married men represented in much of the literature up until the past couple decades. And that’s just not America, not our families today.
I make sure that, when I see families, that I ask mom, “How’s it going with you? Tell me about the breastfeeding. Tell me about how you’re doing with the transition.” And then I turn to ask dad, “How’s it going for you? What are the questions that you have?” And not, “How about the Chicago Bears?” Instead, we can say, “Dad, your child just started to eat — it’s really important to take these steps and encourage this particular type of nutrition. And oh, by the way, have you seen a doctor? Have you gotten your pertussis boost? Have you gotten your COVID shot?”
My hope from this work is that it helps fathers to see themselves out there in the bigger world — that investing your time in being a dad is an acceptable thing to do and that you have the support of other people around you, including your pediatrician. That’s important because, if you look around and don’t see people like you doing these sorts of things, then you’re less likely to do them.
If fathers are involved early on with the baby, they’re much more likely to be involved when the baby is 9 months old, 12 months old, or older, and participate in diapering, clothing, feeding, and bathing the child. It’s about making that commitment early on to gain confidence and feel comfortable.
Every dad I’ve met, whether their baby was born at 25 weeks, or full term and weighed 12 pounds, is scared they’re going to break their baby. They think, “they’re small, I’m big. I don’t want to do something wrong.” And getting over that is the beginning of becoming a parent and then realizing, “I can do this.” I love it when dads pick up an area of expertise and say, “I’m doing diapers.” Or when they come to a visit a month later and they say, “I’m the 3 am feed”— whatever it is that they can take ownership of. This all leads to increased confidence and comfort, and it starts in the very first days.
What are other important arenas where more research or advocacy could be useful around fatherhood and child health?
From a fathering perspective, there is a tremendous amount of work still to be done to understand important subgroups of fathers, like incarcerated, teen, and military fathers — and immigrant fathers who may have left their families at home.
From a practitioner side, there are certain highlights where we can work collectively to put down a good foundation for fathers. These touch points might be at the 20-week ultrasound, at the birth and in the newborn nursery, and in the early pediatric visits when dads want to be involved but are not sure how to be involved. Being inclusive at these timepoints may yield the biggest payback of healthy, helpful, fulfilling involvement for fathers in their child’s life.
In your Twitter bio, you call yourself a “fatherologist.” Is that a real thing or something that you invented?
I totally made it up. We have maternal child health and you can find any number of people who say, “I work in MCH.” I was just trying to think about fun ways to play with this concept. One thing I will say about fathers is that humor really works with them; it’s a great way to win dads over and in the support groups that I’ve done with fathers, there’s a lot of laughing. There’s also a lot of crying and a lot of opening up when you provide a safe venue for dads to do that. “Fatherologist “just came about when I was thinking about how an “ologist” is someone who has an expertise in a branch of knowledge; that’s kind of what I’ve developed over the years, both as a pediatrician and a researcher and trying to make change through policy. So it seemed to be the kind of thing to put on a Twitter handle and I went with it.