Social Determinants of Health: Identifying Risks and Protective Factors for Children and Families

Dramatic advances in a wide range of biological, behavioral, and social sciences have shown that each child’s future depends on genetic predispositions (the biology) and early environmental influences (the ecology), which affect later abilities to play, learn, work, and be physically, mentally, and emotionally healthy (Bright Futures 4th ed.). These are the social determinants of health, the social and physical environments that influence the growth and development of children.  Nurses play an important role in ensuring that the social determinants of health are considered during each interaction with pediatric clients and their families.

The focus of this teaching strategy is on the social determinants of health as they relate to the pediatric population. Learners will have the opportunity to identify key social determinant risks and protective factors and discover local community resources for families and children.

Social Determinants of Health: Identifying Risks and Protective Factors for Children and Families

Learning Objectives

 Students will:

  • Identify the key social determinant risks and protective factors for each developmental stage.
  • Describe various community resources that support families and children in relation to the social determinants of health.

Learner Pre-Work

Read the report Promoting Lifelong Health for Families and Communities, and answer the following questions (review pages 1-23, read pages 23-35):

  • What are the pediatric social determinants of health risk factors?
  • What are the pediatric social determinants of health strengths and protective factors
  • What can nurses do to support children and families?
  • How can the determinants of health, in early life, influence adult health?

Suggested Learning Activities

1.  Use the links below from Bright Futures, American Academy of Pediatrics to complete the charts titled Social Determinants of Health Age Chart Activity. Drag and drop the Risk or Protective Factor into the correct age group on the chart. Students can add their own notes regarding Anticipatory Guidance by using the Social Determinants of Health Age Chart - Anticipatory Guidance Notes Word document. The suggested responses in the Bright Futures Resource are to be used as a guide. If the family has other concerns, or if the practitioner notes something that is concerning, then the focus should shift to fit the context of the child care situation. 


2.  Connecting families and children with community resources is an essential part of the nurse’s role when considering the social determinants of health. Have students find resources in the community that support children and families by searching online and connecting with community agencies. Use the table created in Suggested Learning Activity #1 as a resource when determining which age group needs specific resources.

  • Divide students into groups and assign each group to a different risk factor. Each group will present their findings to the class. As a class, students can develop a resource to share with local community health care agencies.
    • Intimate partner abuse
      • Find an intimate partner abuse assessment tool that is used at local community and/or acute health care facility. If none is found, search online for an assessment tool.
      • Find resources in the community for individuals who have experienced intimate partner abuse.
    • Child care
      • Find local child care facilities that care for children from low-income families. Are these centers adequately funded to provide developmentally supportive activities for children? What are some of the activities they provide?
      • Are there programs in the state that provide families with financial resources to access safe child care?
    • Food security
      • Find local food banks in the area and find out what food options they have for children from low-income families
      • Are there programs in the local schools that support children who cannot afford lunch?
    • Living situation – including environmental toxins and neighborhood safety.
      • Are there areas in the state that are at risk for environmental toxins? Consider air quality, water sources. Does the government have a plan in place to decrease the environmental risk?
      • Find tools that families or home health nurses can use to do a home environmental assessment.
      • Find government resources in the state/community that support individuals with environmental home risks (e.g., mold, radon).
    • Substance abuse and tobacco use – parental and older child
      • What assessment tools are used in the local community/acute health care setting? If one is not accessible to you, search for an assessment tool online.
      • What are the resources available in the community to support cessation of tobacco use?
      • What community resources are available for adults and/or adolescents who are abusing or have abused substances (alcohol, illegal and legal drugs)?
  • It is important to connect families with resources that support areas of strength. Identify community resources for the following social determinants of health strengths and protective factors.
    • Supportive family – relationships within families (positive family interactions, connectedness with family)
      • Are there local courses for parents/families relating to: child care, developmental stages of children, childhood support through divorce, supportive family relationships, and/or intimate partner relationships? Are there others that focus on supporting family relationships?
    • Community engagement (connected with peers)
      • What are some of the local community groups, support groups, or other programs that may help families connect with the community.


3.  During clinical experiences, students may use the following resources to complete assessments on children in community and acute care settings.

Author Information

Lee-Anne Stephen, MN, RN 
University of the Fraser Valley
Chilliwack, British Columbia