SUBJECT REVIEWS: SPIRITUALITY AND FOSTER CARE Spirituality, Religion, and Pediatrics: Intersecting Worlds of Healing

Religious practices such as prayer represent the most prevalent complementary and alternative therapies in the United States. However, biomedicine has sometimes viewed faith and related religious worldviews as relevant only when they obstruct implementation of scientifically sound biomedical care. Recent efforts to arrive at a new synthesis raise challenges for pediatricians. This article reviews theories of child faith development, and models of child spirituality from different disciplinary perspectives. It provides sources illustrating how spirituality and religion may inform children’s lives; play a part in children’s moral formation, socialization, and induction into a sacred worldview; and provide the child with inner resources. It also suggests some of the positive and negative effects of spiritual and religious engagement. Second, this article examines aspects of spirituality and religion that parents may bring to bear in relation to their children’s health. Third, this article addresses the spiritual and/or religious identity of the provider. These topics are discussed in the context of cultural competence and the related importance of religious diversity. The authors suggest 1) some approaches for appropriate inclusion of spirituality in clinical practice, 2) challenges for medical education, and 3) areas requiring further research. Pediatrics 2000;104:899–908; pediatrics, spirituality, religion, complementary therapies, cultural competence. Religious practices such as prayer represent the most prevalent complementary and alternative therapies in the United States.1 Eighty-two percent of Americans believe in the healing power of personal prayer, 73% believe that praying for someone else can help cure their illness, and 77% believe that God sometimes intervenes to cure people who have a serious illness.2 A number of studies suggest that spiritual/religious beliefs and practices may contribute to decreased stress and increased sense of well-being,3 decreased depressive symptoms,4 decreased substance abuse,5 faster recovery from hip replacements,6 improved recovery from myocardial infarction,7 and enhanced immune system functioning.8 A recent meta-analysis of 29 earlier studies involving nearly 126 000 patients argued that the odds of survival were significantly greater for people who scored higher on measures of religious involvement than for people who scored lower, even after controlling for a variety of social and health-related variables,9 although the design and interpretation of these findings have been questioned.10 Since the time of Sir Isaac Newton (1642–1727), scientists in Europe and the United States have accepted the reality of a material universe controlled by fixed physical laws. This perspective considers faith and related religious worldviews as standing apart from scientific-based biomedical understandings. Indeed, it is common for clinicians to come into contact with this tension through direct challenges to clinical benefit by Christian Scientists, Jehovah’s Witnesses, and faith healers. This separation may also be expressed by the clinician’s feeling comfortable introducing discussions of spirituality and religion primarily in the face of life-threatening illness, dying, and death. However, pediatric practice may need to recognize that religion and spirituality are not confined to issues pertaining to death, but rather may play an important role in determining the way(s) families live, and therefore, have a broader impact on child health. Recent efforts are underway to arrive at a new synthesis between medicine, religion, and spirituality, extending notions of healing to include concern for the body, mind, and spirit. In addition to the growing popularity of nontraditional, New Age workshops and programs on spirituality and healing, mainline religious traditions have also expanded healing services.11 The topics of spirituality and religion have also appeared in leading medical journals12,13 and major medical conferences. More than 30 medical schools have introduced courses in the academic study of the relationship between spirituality and medicine.14 For the past 2 years, the American Association of Medical Colleges has cosponsored annual conferences with the Maryland-based National Institute of Healthcare Research regarding spirituality in medical school curricula, which have drawn represenFrom the *Spirituality and Child Health Initiative, Department of Pediatrics, Boston Medical Center and Medical Anthropology, ‡Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts; §Center for Medicine and Spirituality, Academic Health Center, University of Minnesota and Internal Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota; and iDepartment of Pediatrics, Wayne State University Medical School, Detroit, Michigan. Received for publication Mar 20, 2000; accepted Jul 10, 2000. Reprint requests to (L.L.B.) Spirituality and Child Health Initiative, Department of Pediatrics, Maternity Bldg Room 405, 91 E Concord St, Boston Medical Center, Boston, MA 02118. E-mail: [email protected] PEDIATRICS (ISSN 0031 4005). Copyright © 2000 by the American Academy of Pediatrics. PEDIATRICS Vol. 104 No. 6 October 2000 899 by guest on April 13, 2017 Downloaded from tatives from more than 40 to 50 medical schools each year. Despite this integrative activity, the importance of these efforts for pediatric practice has received little attention. This article addresses the implications of the new synthesis of spirituality, religion, and medicine for pediatric practice. It reviews the literature on the relationship of spirituality, religion, and family and community well-being, and examines implications for clinical practice, training, medical education, and research in the United States. RELIGIOUS TRADITIONS, SPIRITUALITY, AND FAMILIES