Because adolescents are less likely to participate in high-risk behaviors when they are connected to their parents, pediatricians should use well visits to encourage family bonding and connectedness.


The family is, and always has been, the entity that has served to provide the essentials for the rearing of children. The family provides protection; religious, moral, and general education; work skills; financial resources; and identity. Cultural shifts have worked to remove many of these functions from the confines of the family. As children (and often parents) grow to depend on other institutions, such as school, to provide for their essential needs, including meals, scholastic and other education, and identity, children are losing the important connection to their families.


The family is the root of a stable society and should be supported and strengthened by society and its institutions.



The National Longitudinal Study on Adolescent (1) Health has been following more than 40,000 adolescents since 1997. These adolescents were surveyed confidentially. In addition 20,000 of these adolescents participated in “in-home” surveys, along with their parents.

The first article to appear in the literature on this group of adolescents demonstrated that the most protective factor in helping adolescents avoid high-risk behaviors was family and school connectedness. (2)

Given these research results, pediatricians and other health care professionals should commit themselves to maintaining family-child connectedness.



This conversation usually occurs during an elementary school well visit.

This conversation involves the young child and the child’s parents/guardians. .

Ask the child what chores he or she routinely does. Your conversation will depend on the child’s response.

If the child states he or she has no chores, discuss with the parent how this places the child at risk.

  • Chores teach responsibility.
  • Chores teach a child how to do a job properly.
  • Chores tell a child he or she needs to contribute to the family and society.
  • Chores help a child stay connected to the family, which will help protect the child during the adolescent years.

If the child does chores that just help himself (such as keeping his room clean or making his lunch), discuss with the parent the need for the child to contribute to the family in other, selfless ways.

If the child is doing age-appropriate chores, congratulate the child and parent and state how this will help the family stay connected and protect the child during the adolescent years.

Ask the family how often they are able to share mealtimes together. You can use the conversation on family meals for this discussion.

Discuss with the family shared risk experiences.

Shared risk experiences are times when families successfully navigate a frightening or risky event and “survive” by working together. An example of a shared risk experience might be having a tent blow down in the wind while camping and the family working together to reset the camp. Another example might be working together during a power outage in the home. Shared risk experiences have a powerful effect on individuals and bond them together. Because some shared risk experiences involve outdoor activities, encourage families to talk about them with you and compliment them for their efforts to explore nature and spend time outdoors.

Discuss with the family the importance of volunteering for children.

Volunteering together helps families bond. Have some suggestions for possible volunteer opportunities in your community. Most communities will have a website that lists volunteer opportunities that are specifically designed for families, even those with young children (for example, delivering meals for the Salvation Army).

Also discuss with the family the influences of media and pop culture in the world around their family.

  • Encourage parents to help moderate the impact of media and widely promoted cultural norms on their children. Ask the child who sets the rules for his or her screen time. If parents do not set boundaries for their children in their use of media, encourage them to do so.
  • Encourage parents to take time to watch a television show, movie, or video game with their children and discuss the content together. This is an opportunity for parents to share their values with their children.
  • Encourage parents to discourage the use of social media or to at least be their child’s “friend” on social media so they can be aware of what is happening in their children’s lives and the lives of their children’s friends.

When necessary, discuss the important roles that having a father can play in the family dynamic.

Children benefit greatly when their fathers are involved in their lives. Sons need fathers who are warmly supportive and openly love and respect them. Sons need to see their fathers as supportive, sensitive, and caring. When fathers demonstrate appropriate attention and support, their sons will respect and identify with them. This helps their sons develop a masculine gender identity. Encourage fathers to look for ways to reinforce their sons’ masculinity, such as including them when tackling jobs around the home.

Daughters also need fathers who can affirm and help them develop a healthy self-image by recognizing and emphasizing internal qualities rather than solely external appearance.

Sons and daughters need fathers who are consistent and loving in their discipline. For families with no father presence, encourage the mother to identify a trustworthy father figure who will help her parent her children.


  2. Resnick MD, Bearman PS, Blum RW, et al. Protecting adolescents from harm: findings from the national longitudinal study on adolescent health. JAMA. 1997;278(10):823-832.