An interview with Dana Suskind, MD, author of Parent Nation: Unlocking Every Child's Potential, Fulfilling Society's Promise

Contemporary Pediatrics: What was your goal in writing this book?

Real, essential cognitive and socioemotional change in children will only occur when there is a concerted, collective effort to bring it about. We don’t need another research study to show that parents are important or that rich conversation is key for children’s brain development (though they are and it is!). What we need is to recognize that pediatric health care providers can lighten the parenting load by sharing it. Parents cannot and should not be expected to go it alone when it comes to raising children, and until we offer parents the support they need to meet their children’s developmental needs, our nation will continue to pay an enormous social and economic cost. I would love to see pediatricians help parents understand the important role they play in building their child’s brain—not beginning on the first day of school, but beginning on the first of life. I would love to see the physical and mental health of parents discussed and supported during well-child visits, with the understanding that the health of children depends on the well-being of their parents.

The COVID-19 outbreak left families reeling, with millions forced to scrape by with no backup whatsoever.Parents were left on their own. They were called on to manage every aspect of their children’s lives—to be teachers, coaches, therapists, and camp counselors—all day, every day. Even among those who didn’t lose their jobs, millions of parents, mostly mothers, ended up quitting or cutting back on work hours. As we slowly make our way toward recovery, we’re seeing how a lack of accessible, high-quality childcare hampers workers’ ability to return to jobs, employers’ ability to staff workplaces, and the economy’s ability to rebound.

Of course, the reality facing parents and families was daunting long before the pandemic hit. As the burdens placed on parents have grown over recent decades, fertility rates have dropped, a majority of new mothers have reported feeling isolated, and all but the most advantaged parents have faced incredible constraints when it comes to making foundational and critical decisions during the early childhood years.

So, how does being a “parent nation” help to tackle these issues?

A parent nation, as I see it, is a society that cherishes and supports the love and labor that go into nurturing, raising, and educating future generations. There is no limit on who can provide that love. So, when I say “parent,” I mean any caring adult entrusted with the raising of a child. This can be grandparents, aunts, uncles, neighbors—anyone who has loved and uplifted a child.

I know firsthand the power that other caring adults can and do have in shaping a child’s life. When my husband Don died, my young children and I were wrapped in the loving support of grandparents, relatives, friends, and teachers. They helped us survive those early days, weeks, and months, offering us the protection we needed to ensure we would one day be able to thrive again.

And many years later, after I met and fell in love with John, a devoted father who was raising 5 children with his ex-wife, I saw that my children could be unconditionally loved by another parent. My children and John’s children have become our children.

I also meet, through my work as a surgeon and at the TMW Center, so many devoted grown-ups who are helping raise children who aren’t their sons or daughters, but pour themselves into that job nonetheless—child-care providers, educators, aunts, uncles, neighbors.

What does this interconnected view of children, families, and communities need to thrive?

Understanding the complexities of what is needed to safeguard the promise of every child’s promise is my life’s work. And while most parents want the same thing—to help their children get off to the best possible start, so that they may grow into happy, healthy adults, the real world gets in the way. We erect barriers in the path of far too many mothers and fathers—from mundane issues like irregular work hours that complicate childcare to profound structural problems like the systemic racism that holds back sizable portions of our population.These barriers limit the time and energy parents can devote to the brain development of their children. And I see the consequences in my clinic, in my research studies, and in the world around me.

The bottom line is, we have made it exceedingly difficult for most parents to raise children in our country, and almost impossible for some. And until we make it easier for all parents to fulfill their promise as brain architects so that their children may reach their full potential, our society will fail to reach its own. Parents need support and protection, in the form of fair wages, paid time off, and a social safety net, that allow them to provide secure environments for their young children.

Can you elaborate on how your years of research and bedside experience have informed this belief?

I truly do believe that neuroscience gives us a roadmap to follow as we strive to ensure that all children are given an opportunity to thrive.

Early in my career as a pediatric cochlear implant surgeon, I came to realize that brain science held the answer to a puzzling challenge I was encountering: dramatically different outcomes in my patients. Some excelled developmentally and academically after their implant, while others did not. This troubling trend led me to discover the body of research demonstrating the incredibly strong connection between a child’s foundational brain growth and their exposure to nurturing language and interaction.

The connections built in a child’s brain during the first three years of life lay the foundation for a lifetime of learning—and they are almost entirely dependent on the early language environment, particularly the presence of rich “serve-and-return” exchanges between parent and child. This nurturing interaction is powerful enough to help children build cognitive skills like reading and writing, numeracy, and pattern recognition, as well as noncognitive (or “soft”) skills like grit and resilience. In other words, nurturing interaction builds the whole brain.

I have devoted the past decade to helping ensure as many parents and caregivers as possible are aware of this powerful brain science, and equipped with tools to put it into practice.

But it is not appropriate, fair, or realistic to expect parents alone to act on this science. Just as it tells us what to prioritize individually as parents, it can show us where to go societally in order to optimize healthy brain development for all children. So, where does this roadmap point us?

First, neuroscience tells us to begin when learning begins: not on the first day of school but the first day of life. The brain’s incredible ability to reorganize itself by forming new neural connections (ie, neuroplasticity) is at its peak between birth and the age of three. While our brains remain plastic throughout our lives, they will never be more so than in the essential early years.

And neuroscience shows us that environments matter tremendously. Stable, calm environments foster socio-emotional skills and executive function, while disruptive environments impede their development. Our society robs far too many families of the opportunity to provide healthy environments, and the resulting toxic stress becomes a risk factor endangering healthy brain development.

When the ultimate intellectual development of a child is hampered, we all lose. We must follow the brain science to emerge from this dark chapter with an eye toward stronger, sustainable support for all parents and children. Most brain growth — close to 90 percent, in fact — occurs in the first five years of a child’s life. Those five years are an evolutionary gift, providing the human brain a once-in-a-lifetime opportunity to form strong neural connections and build the foundation for lifelong cognitive and socio-emotional development.

They’re also the years when we leave parents completely on their own, struggling to patch together time off work to care for a new baby, struggling to find high-quality childcare, struggling to make ends meet.

The vast majority of parents in the United States have to work outside of the home, yet high-quality childcare remains out of reach for far too many families. The average cost of childcare is around $10,000 a year per child — close to two times what the government considers affordable. In some parts of the country, childcare costs double or triple that. Approximately half of Americans live in childcare deserts.

The United States remains the only country among 41 nations that doesn’t mandate paid leave for new parents, forcing countless families to opt into an expensive, fragmented, overtaxed childcare system whether they’re ready to or not. These shortcomings aren’t just logistically galling, they expose a nation evading our moral imperative to help all children reach their promise. They can be solved by public policies, but first we need a mindset shift that acknowledges parents are worthy of demanding and receiving societal supports.

Parent Nation proposes a paradigm shift in how we view early childhood education and childcare. Do you see any examples in our national history of social, cultural, and political change that mirror what you hope to accomplish?

Only when we create a movement to support parents will we succeed in reimagining what early childhood looks like in this country. Fortunately, there is precedent for a group of formerly isolated individuals banding together to achieve important, lasting change.

In the mid-twentieth century, Americans over sixty-five years of age were the poorest, most underserved segment of the U.S. population. According to a government study, 50 percent of the elderly existed “below minimum standards of decency.”

The American Association of Retired Persons changed all that. Thanks to AARP’s efforts over the last fifty years, there is now no age group better served by society and government than the elderly.

Tragically, the plight of some parents and young children today is not so dissimilar to that of the elderly prior to the advent of the AARP. In fact, the poorest segment of the population today is no longer the elderly, but children under five years of age, with one in six living in poverty, according to the Children’s Defense Fund. Let me repeat that: Children, from newborn infants to four-year-olds, are the poorest of our citizens. Of course, practically speaking, this means that these young children are living with impoverished parents and caregivers.

Like the elderly once were, parents are in many ways invisible, often marginalized and struggling. Just as we dramatically improved the quality of life of the elderly, we can do something similar for our youngest citizens, by first helping their parents. AARP provides a roadmap for today’s parents to follow, paved by a business-friendly orientation, partnership with corporate America and, importantly, bipartisan support. Ultimately, a parent lobby with a singular focus on improving the circumstances of children and families in our country would have exponential downstream societal impacts. As the AARP taught us, when a group of people speak with one voice, it’s amazing what they can accomplish.

In Parent Nation, you discuss the idea of a collective identity when it comes to parenting. Can you elaborate on this concept?

There’s a saying, “You count what you value.” So, what does it tell us that it’s very hard to find an official count of parents in this country?

The number is hard to pin down, but it is fair to say there are tens of millions—forty million is a conservative estimate—parents of young children in the United States. Those forty million individuals have the potential to be the largest special interest group in the country. But that potential has, thus far, not been met.

Even though there is much that unites parents—sleepless nights and overpowering love, the desire to be home with a newborn, the stress of finding a babysitter we trust, the worry over hitting milestones, and the wonder at new accomplishments—we have not yet forged a sense of collective identity.

I think this has a lot to do with the mythic idea of American individualism. The notion that Americans have to be tough and independent prevails, and it perpetuates going it alone as a virtuous ideal. The result has been to convince parents that they should be able to shoulder the enormous responsibility of early childhood care, development, and education on their own without formal support. And that if they struggled to do so, the failure was theirs alone.

I think that’s beginning to change. Now, finally, parents are looking around and noticing they are not alone. They are realizing that when parents repeat the same stories of struggle across the country, the problem is not personal, it is systemic. And systemic problems require systemic solutions.

There is real power in recognizing how much we share, and I hope more and more families will come together, forge a collective identity, and fight for change on behalf of all children.

In 1972, the Comprehensive Child Development Act, which included universal childcare, nearly became the law of the land. Congress is poised to vote on a similar act once again. What’s different now? What do we want from this iteration?

Fifty years ago, we stood at a crossroads, and we turned back. We had an opportunity to dramatically change what it means to be a child or a parent in America, and we squandered it.

Today, we are at a new crossroads. We cannot afford to turn back this time. The need to take action on behalf of children and families is more urgent than ever.

What we now know of the brain demands urgency. In 1971, when the CCDA was being formulated, people were just beginning to understand how critical the early years of experience were to children’s development. Since then, we have learned substantially more. There is neuroscientific heft backing the facts about what children need, when they need it, and the essential role of parents and caregivers as children’s first, best teachers.

If children of all races, ethnicities, and genders are to flourish and grow up to participate equally in the economy and civic life of the nation, society must attend to and allow for healthy brain development from birth. Healthy brain development is a fundamental condition for equality. Without it we will never be able to create true and lasting change.

What developing children need is time, enrichment, and protection. And the best way to ensure these needs are met is to support and empower parents.

Loving mothers and fathers do not need a PhD or expensive gadgets to do an excellent job at supporting early brain development. They need access to basic but critical knowledge about how best to foster critical neural connections. They need time with their children to put that knowledge into practice and nurture those connections. They need high-quality childcare that complements their efforts. They need to be able to provide children with stress-free homes.

I’d like to see legislation that supports all of these goals. As Congress debates the American Families Plan, some solutions, like paid family leave and subsidized child care, are obvious. Others, like portable benefits and fair workweek laws, are less so. I am not a policymaker or expert. But I can confidently say this: If brain science is our roadmap, it is parents who do the steering. Parents are the captains of their families’ ships, manning the helm. But just as every captain needs a crew, every parent needs and deserves policies that help them do what they do best.

As Parent Nation releases, you and your team have been hard at work putting into motion the ideas this book promotes. What does this look like on the ground?

In order to help bring the ideas of this book to life, indeed to do our part to help build a Parent Nation, we are launching a grassroots, partner-driven campaign alongside the book.

As part of that campaign, we’ve developed a free suite of tools and resources that can be used by individuals, employers, and the many organizations that already work with parents in support of their efforts to lead change. These resources include an action guide, a book club guide, an immersive website (www.parentnation.org) and most exciting, a curriculum and guide for hosting Parent Villages.Parent Villages are small groups of parents who come together to support one another, identify and discuss the needs of families in their community, and make a plan to get those needs met.

Developed in consultation with leading parent-serving organizations, these materials have been beta-tested and previewed by diverse groups of caregivers across the nation. The response had been incredible. To date, we’ve had almost 2,000 people express interest in hosting a Parent Village. Nearly 200 have attended detailed informational sessions and will be ready to launch their Villages when the materials go live on our website in April. Several states have also included Parent Villages in their funding proposals for statewide family engagement centers.

I am inspired every day by the parents I meet, in my medical practice, in my research, and now, in my discussions around Parent Nation. I cannot wait to see what these dedicated change makers accomplish with their Parent Villages.