For many practicing pediatricians, the imperative keeps coming back to the exam room. Recently, in the pediatric outpatient clinic at Bellevue Hospit… - Perri Klass

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For many practicing pediatricians, the imperative keeps coming back to the exam room. Recently, in the pediatric outpatient clinic at Bellevue Hospital, which has served the poor of New York City since 1736, I saw a toddler who was seriously overweight, and I tried to talk with his mother about ending the practice of nighttime milk bottles. The mother became very distressed when I broached the subject of the child’s weight, and the risk of severe dental caries. She knew it all — she had already been through dental procedures for her son, she was worried about the family history of diabetes and the risks associated with obesity. But if she didn’t give her son a milk bottle, he would cry — loudly and at length — and his crying at night disturbed the other people sharing the apartment, who all had to get up early for work or school. She was clearly worried that following my advice might mean losing her living situation, which was already tenuous. The toddler in my exam room was already suffering from some of the chronic diseases — obesity, dental caries — that are part of the medical risk of poverty.