PARENT
NATION• AUTHOR’S NOTE •Throughout this book, I use the word “parent” many times. Sometimes for variety and sometimes because the distinctions matter, I
also refer to mothers, fathers, grandparents, caregivers, childcare
providers, and other adults. I would like to emphasize that parents
come in many forms and that what I mean by “parent” encompasses
the broadest possible interpretation: a caring adult entrusted withthe raising of a child. A parent nation, as I see it, is a society thatcherishes and supports the love and labor that go into nurturing,raising, and educating future generations.
The parents you will meet in these pages are real, but I havetaken some steps to protect their privacy. I have used only firstnames for the families I met through the TMW Center for Early
Learning + Public Health. I did the same for the other parents I
interviewed with a few exceptions, whose full names are included
because their professional aﬃliations make them easily identifiable
and are relevant. The names of Jade and her family, Justin, Katherine, and Ellen Clarke’s friends are pseudonyms.

• PA R T O N E •FOUNDATIONS• ONE •TOWARD A NEWNORTH STAR
“There can be no keener revelation of a society’s soulthan the way in which it treats its children.”—NELSON MANDELA1

A

s we near the “red line,” the demarcation between the hospital’s pre-op area and its collection of operating rooms, amother and father hand me their baby. Their eyes are filledwith tears as they look at me with a combination of hope and fear.
The little boy is just eight months old and was born deaf. He is here
to receive his cochlear implant. When I surgically implant the small
device that will give him access to sound, I am replicating what I did
for his father many years earlier when he was a teenager. As thebaby melts into my arms, I reassure his nervous parents, “I promise
to care for your baby like he’s my own.”
The parents settle in for a long, anxious wait, while I carry their
son to the operating room. In OR4, where I spend each Tuesday
morning, we are greeted by the team of medical professionals I rely
on for every surgery, and by the cacophony of monitor beeps that I
find so comforting every time I hear it. My two OR nurses are circulating. Gary Rogers makes sure the cochlear implant is present

4• PA R E N T N AT I O N •and that my favorite drill and facial nerve monitor are working
properly. Nelson Floresco checks out the operating room microscope, which is the size of a Smart Car and gives me a remarkably
clear, precise view of the ear’s tiny, delicate interior spaces. Robin
Mills, the OR tech, is scrubbed in and organizing the array of sterile
microscopic ear instruments on the surgical table. The pediatricanesthesiologist gently places a face mask filled with colorless gaseson the squirming baby. Very quickly, the baby is fast asleep.
Before I start the operation, we double-check that everything isin order. Do we have the right patient? Check. Do we have the correct implant with all the right instruments? Check. Do we know if
the patient has any medical allergies? Check. Are the pre-operative
antibiotics in? Check. This routine ensures the accuracy and safetyof what we’re doing. Each person in the operating room plays anessential role. No one forgets why we are here: to help a child.
As a surgeon performing delicate work just millimeters from thebrain, I have no room for error. It’s critical that I have the necessary
tools and, even more importantly, my A-team by my side. If any partof this carefully crafted system falls away, no matter my skill or
good intentions, my job will be infinitely more diﬃcult, if not impossible. Some obstacles can be overcome—a few missing instruments, for instance. But what if the power went out in the hospitaland I suddenly had to operate without light or oxygen? Or what if
Robin, Gary, and Nelson suddenly walked out the door, leaving me
alone? The odds would be stacked against me, and the job would
seem impossible.
The challenge of successfully rearing children is not so diﬀerent.
To raise a child into a happy, healthy adult capable of achieving theirfull potential, you need a plan, and you need an appropriate, safe
environment, one that provides backup as required. But far too
many parents are not operating—that is, parenting—in an optimal
environment. For too many parents, in our country and throughout
the world, it is as if they are trying to function in the midst of an• T O WA R D A N E W N O RT H S TA R •5

endless power failure, asked to achieve a critical goal without thenecessary tools or any backup.
Twenty years ago, I started my own life as a parent with what I
thought were all the necessary tools in place. But, in one painful
day, it all changed, when my husband, Don, drowned while trying
to rescue two boys, leaving me a young widow and my three children with no father. While we still had a roof over our heads andfood on the table, advantages that many families lack, Don’s deathleft a vast hole in our lives.
For a long time after he died, I would wake at night, jolted by thesame terrifying nightmare, which went something like this: I’mstanding on a foggy riverbank. Splinters of moonlight stream
through the clouds and illuminate a small wooden boat next to me
at the water’s edge. Three small, terrified faces—my young children,
Genevieve, Asher, and Amelie—peer from the boat, staring at theforeboding river. Its fierce currents resemble the waters of Lake
Michigan, whose undertow claimed Don’s life. I feel the intense pullof the water, the same pull that Don must have faced when he left
the protective shoreline to swim toward the cries of the two struggling boys. Like Don, I have a desperate need to ensure young children are safe. In my dream, I have to get my kids across the river. I
believe that if I can just do that, they will be okay . . . It will all beokay. But the torrent is too rough, the boat too flimsy, the opposite
riverbank too far away. I wake sobbing, helpless, alone.
It was not hard to grasp the significance of my dream. I wanted
what all parents want: to ferry my children into healthy, stable, andproductive adult lives—that is what awaited on the far shore. I
wanted to give them every opportunity. But it would take some time
before I saw how fully all the elements of my dream—the turbulent
water, the inadequate boat, the fact that there was no one standing
next to me on that riverbank—symbolized the hurdles that so many
parents face in the eﬀort to successfully rear their children.
How could I navigate that torrent on my own, with no support, no6• PA R E N T N AT I O N •help? How can anyone? Although I had been a surgeon for years andthought I had a deep familiarity with the lives of the families whosechildren I cared for, my struggles as a grieving, single parent gave mea new window of understanding into the challenges facing families.

Thirty Million Words . . . and Beyond
I became a surgeon because I thought I could change lives, one childat a time. By giving deaf children cochlear implants, I give themaccess to sound, to hearing, and to spoken language. I want there to
be no barriers to their success, and I believe restoring their accessto sound accomplishes that. Sign language can provide a rich, earlylanguage environment when provided by fluent signers. The baby
whose surgery I just described is now fluent in two languages—
American Sign Language and English. But the reality is that morethan 90 percent of deaf children are born to hearing parents who
don’t sign. And early in my practice, I noticed profound diﬀerencesin my patients’ progress after surgery. Some children excelled developmentally, others not at all. Some learned to talk, others did not.
The ability to hear, it turned out, did not always unlock their full
capacity to learn and thrive intellectually. I could neither accept nor
ignore the disturbing disparities I saw among my patients, but I
didn’t understand them. Compelled to discover their cause and tofind solutions, I began a journey far outside the operating room andinto the world of social science.
Initially, I was inspired by pioneering research that found a starkdifference in the amount of language— the actual number ofwords—that children were exposed to early in life.2 That diﬀerence
often, although not always, fell along socioeconomic lines, withmore language occurring in more aﬄuent homes and less language
in homes where families have been denied access to educational• T O WA R D A N E W N O RT H S TA R •7

opportunities, often for generations. Researchers calculated that by
the time children reached their fourth birthday, there was a gap ofroughly thirty million words between those who heard a lot of language and those who heard very little. Although the research wasdone in hearing children, it explained what I was observing in mypatients. In order to fully benefit from their new cochlear implants,
they needed to hear a lively stream of words every day, they needed
to practice listening. The quantity and quality of the words children
hear stimulate the brain. Regions that are learning to process grammar and meaning will be critical to the ability to speak and later toread. Exposure to words also aﬀects areas of the brain that handle
feelings and reason, which will help children regulate their emotions and behavior as they grow older. The more language a childhears in those early years, the more securely the foundational connections are built in that child’s brain.3
Some of my patients were getting that kind of essential experience with language, others were not. As I learned more, I realizedthat what I was seeing in my deaf patients mirrored the population
at large and that this phenomenon was the basis of what is called
the educational opportunity gap. In all children, the diﬀerence inearly language exposure correlates with later diﬀerences in achievement. Too often that opportunity gap results in disparities between
rich and poor children.4
The research was inspiring because it was based on the idea thatparents are their children’s first brain architects—that every parent,
through the power of their words, has the ability to build theirchild’s brain—and that we, therefore, have to make sure that parents have the resources they need to do that. The research also accentuated the urgency of actively building the brain during the first
three years of life. Those early studies weren’t perfect, and theirlimitations became clearer over time, but I think of them now as thefirst sentence in what has become an extensive body of literature.5

8• PA R E N T N AT I O N •The work gave me and my colleagues a relatively simple explanationof the underlying disparities to target. It gave me a critical place tostart. And it was persuasive enough to pull me out of the operating
room for much of each week and into the world of research andsocial science.
In 2010, when I launched the Thirty Million Words Initiative,
now the TMW Center for Early Learning + Public Health, my primary goal was to help ensure healthy development in all children
and to give every child the ability to reach his or her potential, intellectually and emotionally.6 Brain science pointed the way. Everything we designed and did was based on the fact that nurturing talkand interaction between caregivers and infants lay the foundations
for brain development. My team and I developed evidence-based
strategies to show parents the importance of talking to babies andyoung children. Those strategies became the theme of TMW: Tune
In, Talk More, and Take Turns, or what we call the 3Ts. Our work iscentered on the knowledge that rich conversation is what unlocks achild’s potential and on the belief that parents as well as other loving caregivers hold the key during those early years. All adults—nomatter their level of education, wealth, or work—can master the
essential techniques for optimally building a child’s brain.
The idea, a straightforward approach to a complex problem, wasintuitively appealing and a great success. It was the “magic bullet”
that people were looking for and it took me to the nation’s capital,
where I convened the first Washington, DC, conference on closing
the word gap in 2013. Soon after, in 2015, I wrote a book called
Thirty Million Words: Building a Child’s Brain, which explained what
research has revealed about the role of early language exposure in
the development of children’s brains. It was never just about the
sheer number of words; but the diﬀerence between the eﬀects of alot of language exposure and a little served as a memorable representation of the brain-building strength of talk and interaction. The
book caught on around the world. Everyone seemed to get its

• T O WA R D A N E W N O RT H S TA R •9message. No matter the nuances of culture, vocabulary, or socioeconomic status, people had an almost instinctive understandingof language as the key to developing the brain to its maximum
potential.
Yet the more deeply I engaged in this new work, the more troubled I became. Or, to put it more honestly, the more I came to realize how naive my ideas were, limited by my own comfortable life
circumstances. I had thought the answers lay in the actions andbeliefs of individual parents, in their knowledge and behavior. (Istill believe those elements are critical!) And it followed that thegoal should be to ensure, as I put it in Thirty Million Words, that “allparents, everywhere, understood that a word spoken to a young
child is not simply a word but a building block for that child’s brain,
nurturing a stable, empathetic, intelligent adult.”7 To that end, wewere testing early language programs in randomized controlled
trials—the scientific gold standard for determining what works andwhat doesn’t. We found that, indeed, our strategies worked and thescience that supports them is solid. The programs we promote at
TMW can—and often do—improve the lives of children.8
But there was more to it than that. For our studies we recruitedfamilies, most of them low-income, from all over Chicago and laterin other parts of the country. Our research followed children fromtheir first day of life into kindergarten, and our programs took us
into families’ homes and into their lives. I was getting to know
people up close and over time. The parents’ enthusiasm was thrilling. They embraced the 3Ts with gusto, tuning in to their children,
talking more as they went about their daily lives, and taking turns,
encouraging their children to join the conversation. They wanted
what we all want: to help their children get oﬀ to the best possible
start. The problem was that the 3Ts took parents only so far. Reallife would intrude, again and again and again.
There was Randy, who was excited to discover that talking about
his love of baseball (Cubs only, never White Sox!) could help his son

10• PA R E N T N AT I O N •learn math but who had to work two jobs and, most days, had lessthan thirty minutes to spend with his kids. There was Sabrina, whogave up a well-paying job to care for her husband when he got sickand whose family ended up spending over two years in a homelessshelter, where she raised her two children, the youngest still a baby,
in a stressful and chaotic environment. Most searing of all was thestory of Michael and Keyonna, whose son, Mikeyon, missed out on
all his father had to teach him for the first five years of his life because Michael spent that time in prison waiting to be tried for acrime he didn’t commit—not appealing or serving a sentence, mind
you, just waiting for his case to be heard.
Parenting is not done in a vacuum. Our research could not be,either. The circumstances varied, but everywhere I looked I saw thehurdles looming in front of mothers and fathers. At TMW, we canshare with parents the knowledge and skills that build their children’s brains; but our programs do not substantially change the dayto-day lives of the parents who participate. The larger realities of afamily’s circumstances—their work constraints, economic stresses,
and mental health as well as the injustices and bad luck they are
subject to—all matter as much as the 3Ts for healthy brain development. They either allow for the brain-building power of talk to occur or, if they limit the opportunities for engaging in the 3Ts, they
stifle it like weeds choking the growth of a garden. When I saw justhow diﬃcult parenting is in a country that does so little to support
the ability of parents to facilitate healthy brain development, I knew
I had to learn more. I hoped I could do more.

Mirroring a Larger Problem
Reflecting on what I was seeing, I began to look beyond my patientsand families at TMW to the entirety of the more than sixty million
parents in the United States who have children under eighteen.9

• T O WA R D A N E W N O RT H S TA R •11

And I saw how, regardless of income level, parents are being sidelined by our country’s lack of family-friendly policies. I don’t mean
to minimize the herculean struggles of poor families or to suggestthat more aﬄuent families face equivalent challenges but to pointout that society has abdicated its responsibility for all families. With
the exception of the top 1 percent, our society makes raising children hard for everyone—and impossible for some. Some problems
are obvious, others are more insidious. How is it that we spend lessmoney on early childhood care and education than any other developed nation? By the end of 2021, why was the United States still the
only one of the thirty-eight countries within the Organisation for
Economic Co-operation and Development (OECD), an international
body that seeks both to measure and to stimulate economic progress
among its members, not to mandate paid parental leave?10 The fact
is that the great majority of parents have to work. Yet we have afragmented and overwhelmingly low-quality childcare system; approximately half of Americans live in so-called childcare deserts andfewer than 10 percent of existing programs were judged high quality
in a National Institute of Child Health and Human Development
study.11 Given that roughly twenty million working Americans havechildren under the age of six and that more than 70 percent ofmothers were in the workforce in 2020, this means that many millions of parents do not have adequately nurturing childcare for theirchildren during the formative early years.12 For this we can thankour economy. Wages for the middle and lower classes have beenstagnant for decades. “Innovative” disruption has aﬀected everything from bookstores to taxicabs and has created employment
practices directly antithetical to the needs of parents and their children. The net eﬀect is to place a heavy hand on the scales toward
what benefits employers and their shareholders and away from what
benefits families. In the process, and as a direct result, inequality
has dramatically increased.13
To stay afloat, some parents have to take on multiple minimum-

12• PA R E N T N AT I O N •wage jobs that leave them little time for their children; others havethe kind of job that requires constant contact with the workplace,
via phone and computer, days, nights, and weekends. Everyone ends
up overworked, stressed, and disconnected from family life.
As I talked to more people—you’ll hear many of their stories—I
saw how thoroughly all of this limits parents’ choices. No matter
their political or religious orientation, employment, or educational
status, they all seemed to be struggling. I met Kimberly, a pediatrician at a community health center whose daughter was born prematurely at twenty-seven weeks. Kimberly had to leave her new babyin the neonatal intensive care unit just two weeks after her birth inorder to go back to work. Imagine the pain of that! But her family
could not aﬀord to live without her salary, and Kimberly’s state did
not mandate paid family and medical leave, nor did her job oﬀer it.
I listened to Jade, who is deeply religious and believes that a mother’s place is in the home, as she explained through tears that a lackof health insurance and an inadequate family income sent her backto work at Starbucks after her kids were born, despite her dreams ofstaying home. And I could relate to Talia, who had two babies while
earning a PhD in psychology but gave up a promising postdoctoral
position when it became untenable to manage the demands of thejob, the economics of childcare, and the needs of two children under four.
Despite a culture that champions “family values,” our society is
not centered on families. It is not built around programs and policies that protect or promote those values. Quite the opposite. We
erect daunting barriers in the path of far too many mothers andfathers—from mundane issues like irregular work hours that complicate childcare to profound structural problems like systemic racism that hold back sizable portions of our population. All thesebarriers limit the time and energy parents can devote to the brain
development of their children. The barriers are unsupportive of parents, and they are holding back our next generation.

• T O WA R D A N E W N O RT H S TA R •13There is an alarming disconnect between what we know about
what children’s brains need and what we have actually done to develop those brains. At the very moment when parents and children
could most use help, and when that help would have an outsize
influence on children’s ultimate ability to learn and succeed bystrengthening neural connections, society does nothing—or worse,
makes things harder. When it comes to children, public attention
and money have been focused on K–12 schooling. But supportingchildren only during these years means we have skipped over theearlier phase that is critical to laying the foundation for learning at
the K–12 level. Our eﬀorts come too late for many, who will havebeen left so far behind during that critical period that by the timethey get to kindergarten, they may never be able to catch up. Evenpreschool for all, while important, is not early enough.
The first three years of life are when the brain is in its most rapid,
most critical period of growth. Successful education is predicated on
the ability to learn, and that ability is dependent on what happens
long before a child sets foot in kindergarten or even preschool.
During those early critical years, parents are left largely on theirown. This is why, despite decades of eﬀort, we have not moved theneedle on educational outcomes or equity. In the OECD’s 2018 international educational rankings, the United States ranks 38 out of 79
countries in math and 19 in science.14 Among developed countries,
ours is near the bottom of the pack. We are the richest country in theworld, per capita, yet we have lost sight of what is required to give all
children a strong start on the road to being productive adults.

A Crystallizing Moment
I was already contemplating these deep-seated problems when the
COVID-19 pandemic shut down the country in March of 2020.
At the University of Chicago Medical Center, where I work, it was

14• PA R E N T N AT I O N •all-hands-on-deck. I spent hours screening patients, talking to andcorresponding with frightened people, noting their symptoms, andadvising them on whether or not to go to the hospital. When I wason call as an ear, nose, and throat surgeon, my medical specialty
meant I was working on the areas of the body—the nose andmouth—where the risk of transmitting the virus was highest. (The
first doctor to die of COVID in China was an otolaryngologist likeme.)15 One diﬃcult day I treated a man in his early forties who
could not breathe on his own and needed a tracheotomy. Normally,
that’s a routine procedure to provide a surgical airway, but during
COVID, it became a high-stakes procedure that required me to callin two chief residents to help. The medical side of the experience
was exponentially harder than usual because of the anxiety and extra protocols COVID brought, but the human side of it was harrowing. As I stared at the man’s thin, wasting body, I could see only
hints of the strong construction worker he had been just a few weeks
before. I knew his mother had already died from COVID-19 and that
his wife was also sick and hospitalized in another unit. I had towonder who was taking care of their young children and what
would become of this family, which was being torn apart by thisterrible disease.
And then, on April 21, more than a month into the pandemic, I
got a text from Nelson, one-third of my operating room A-team.
Pls pray for Gary Rogers. He was intubated today.

I was so shocked I could barely breathe. Because of the pandemic,
we weren’t performing elective surgeries, so we hadn’t seen eachother in a few weeks. But Gary, tall and strong with a quick wit andquicker smile, had been a warm, steady, supremely capable part of
my life for years. Both Gary and Nelson had been OR nurses
at Comer Children’s Hospital within the University of Chicago• T O WA R D A N E W N O RT H S TA R •15

Medical Center since it opened in 2005. It was while at his second
job, caring for dialysis patients—work he took on to help his daughters pay for college—that Gary contracted COVID. As a fifty-eightyear-old Black man, he was in a demographic group that seemed to
be at higher risk of serious illness. And I knew as well as anyone thatat that point in the pandemic, as doctors were scrambling to understand how to treat this new disease, once someone required a ventilator, the prognosis wasn’t promising. I feared Gary was goingto die.
After more than a month in the intensive care unit and two
weeks on a ventilator, Gary was left with generalized muscular atrophy and cardiomyopathy and had to spend several weeks in rehab
before he was strong enough to go home—and ultimately to return
to work. When we reunited in OR4 for our first cochlear implant
surgery late in June, I was flooded with relief to have Gary, Nelson,
and Robin (who had had a milder case of coronavirus) back
together.
For a time, I took comfort in the thought that at least children
were relatively immune to the virus. Alas, that was wishful thinking. Some did get sick (especially once the Delta variant of the virus
arrived), many lost parents and loved ones, and nearly all suﬀered
terribly from the loss of in-person schooling. The eﬀects of the pandemic on children are still being calculated as I write. But within all
the trauma and hardship of the pandemic, a sliver of positive news
emerged. Even in the face of the extraordinary stresses the pandemic created—in many cases precisely because of those stresses—
many families reported spending more time together. That wascertainly true for me. With my kids (now in high school and college)in the house all the time, we had more family dinners than we had
had in years. Even for families who suﬀered job losses, the pandemic’s social safety nets helped some to cushion the blow and allowedfamilies to enjoy being together. In March 2020, Congress’s first16• PA R E N T N AT I O N •relief bill, the $2.2 trillion CARES Act, replaced lost income formany workers, even those without unemployment insurance.
Several more relief bills followed. They included, among otherthings, more direct payments to families and increased child tax
credits. According to a study of recipients of the first round of pandemic aid, many of those who got those checks reported more positive parent-child interactions than those who didn’t get checks.16
But here’s the rub: Parents were able to engage in conversations with
their kids, to be there for their children and nurture their young
brain cells, because the world had just about come to a complete
stop. That is not real life. And the family conversations sometimes
came at the cost of paychecks and financial security. That is not
tenable. Eventually, most of the parents who were working remotelywould have to return to the oﬃce, at least part-time, and the parents
who were out of work would find new jobs. They had to. What would
happen to family time and parent-child interaction then?
We can no longer deny how thoroughly entangled our private family lives are with our economic lives. Parents cannot work if theirchildren do not have a safe place to spend the day. In the pandemic,
schools closed and our already inadequate childcare system all but
disintegrated. Two-thirds of childcare centers were closed in April
2020 and one-third remained closed in April 2021.17 Even the Federal Reserve began to worry that childcare might be the broken legof the economic stool that would make it impossible for the country
to right itself.18
Parents were left on their own. Anxious and exhausted, they
were called on to manage every aspect of their children’s lives—tobe teachers, coaches, therapists, and camp counselors—all day every day for the better part of a year in many places, longer in others.
Even among those who didn’t lose their jobs, millions ended up quitting (mostly mothers) or cutting back on work hours (again mostly
mothers).19 Doing it all was unsustainable. The pandemic was like a• T O WA R D A N E W N O RT H S TA R •17powerful earthquake with lingering aftershocks that showed just
how shaky our nation’s infrastructure of support for parents and,
therefore, for children really was.
COVID was a crystallizing moment for me. As I watched its eﬀects
reverberate through the long months of distancing and diﬃculty, I
was reminded that extreme situations can be clarifying. They show
you what works, they show you where the weaknesses are, theyshow you what really matters. You cannot push pause on the work inprogress that is a child’s brain. And the pandemic was a forceful reminder that no one is meant to parent entirely alone. It really was theworst-case scenario from OR4, as if the power had failed, there wasno oxygen or light, and the A-team had left me. (Gary nearly did!)
The pandemic also made plain that our current approach to children and families is both shortsighted and expensive. There wasalready plenty of evidence of that before the pandemic if you looked
for it. Not investing in early childhood is estimated to cost our country billions. There is a cost to children, a cost to parents, and a costto society. Economist and Nobel Laureate James Heckman of the
University of Chicago has calculated that investments in programs
supporting children from birth to age five (even programs that arevery expensive in the short term) deliver a 13 percent annual return
to society through better education, health, social, and economic
outcomes well into the adulthood of the children served.20 A failure
to invest, on the other hand, means society ends up losing money
because, without the preemptive protection of strong early childhood development, it must ultimately spend more on such things as
health care, remedial education, and the criminal justice system. In
short: If we don’t invest in children from the earliest days of theirlives, we—and they—do not just lose out on reaping the rewards ofthat investment, we pay a severe penalty for our failure. Consider
this: A much-cited report by ReadyNation found that the overall

18• PA R E N T N AT I O N •cost to society of childcare issues is $57 billion a year and that thedirect cost to employers is $12.7 billion. It has also been estimatedthat if American women stayed in the workforce at a rate similar to
Norway’s, which has government-subsidized childcare, the UnitedStates could add $1.6 trillion to the GDP.21 Parents cannot work if
there is no one to care for their children.

The Myth of Going It Alone
How did we get to this wholly untenable situation, where each parent stands alone on the dark riverbank? Where the dangerous currents and inadequate boats of my dream are made manifest in thehard realities of daily life? Where each parent’s shoulders sag under
the weight of the load? Somehow the centrifugal force of our societal choices flings children and parents to the outer reaches of ourpriorities instead of putting them at the center.
A string of deliberate political decisions, sins of omission and unintended consequences are to blame. But one consistent theme runs
through the choices we have made as a society: the mythic idea of
American individualism. The roots of this idea reach to the nation’s
founding, to the colonial settlers and western pioneers who had togo it alone. Tough and independent, they made their own way because there was no alternative. We have been celebrating them eversince, even though our circumstances today are very diﬀerent. Individualism perpetuates going it alone as a virtuous ideal. Expecting
societal help is seen as a form of weakness, an admission of failure.
And since the ideal of individualism is bound up with our ideas
about the sanctity of our right to make our own decisions about ourfamilies and how we want to parent, such support is deemed inimical to liberty and freedom. At least that is how the story goes.
A key element of such thinking is the concept of parental “choice,”
which has been held up as sacrosanct, as the source of all parental

• T O WA R D A N E W N O RT H S TA R •19authority. Anything else is considered un-American. The result has
been to convince parents that they should be able to shoulder theenormous responsibility of early childhood care, development, andeducation on their own without formal support. Indeed, they should
want to do so, should see it as a manifestation of their freedom tomake decisions about their family life without interference.
As parents, we (especially moms) have internalized this propaganda. Burdened by guilt, most are managing a delicate balancing
act, struggling to make it work, yet forever feeling inadequate, unable to live up to the ideal we imagine we should achieve. Occasionally, we get glimpses of an alternate universe when one of our own
escapes the madhouse of the United States to another, saner country and finds that it really doesn’t have to be this way. The popularity of Perfect Madness by Judith Warner and Bringing Up Bébé byPamela Druckerman, both bestselling books that note the ample
state-financed resources for parenting in France, reveals a desire forthings to be diﬀerent. And they could be.
In many other countries, support for family and parenting is increasingly recognized as an important part of social policies andinvestment packages aimed at reducing poverty, decreasing inequality, and promoting positive parental and child well-being. UNICEF
is advocating for at least six months’ paid leave for all parents, safe
and comfortable public and workplace locations for women tobreastfeed, and universal access to quality, aﬀordable childcarefrom birth to the first day of first grade.22 But here in the UnitedStates, we seem to have bought into the status quo idea. That, andperhaps our personal sense of failure as parents, keeps us from demanding more support from society. We are convinced we shouldbe able to do this on our own and feel guilty about asking for help.
I see this among my fellow physicians, my patients and friends, andthe TMW families. I see it on the left and on the right, among the
aﬄuent and the poor. Few are spared.
In reality, choice and individualism for parents are myths—

20• PA R E N T N AT I O N •convenient for those who wish to abdicate responsibility for oﬀering support, horribly inconvenient for those who buy into the mythand suﬀer as a result. “Individualism” in parenting is more fantasy
than reality, and “choice” borders on being an outright falsehood,
implying as it does the availability of multiple options. In truth,
most parents have few options and therefore not much to choose
from, so how can we call that “freedom of choice”? Without support, there is no such thing as true choice. And you know what? Inreal life, except in a pandemic, almost no one actually parents alone.
The reason the proverb “It takes a village” resonates is because it istrue. Caring for children with zero help or community support ispractically unheard of. There have always been grandparents, andaunts and uncles, and older siblings. There have always been neighbors and friends. There have always been other parents. Even pioneers circled the wagons to keep each other safe. We have oﬀeredeach other advice, babysitting, moral support, and commiseration.
We have been in it together. But valuable though they are, these
private sources of support are not enough. Support systems are wonderful, but publicly financed and society-wide supportive systems
are critical. We need more, and we should expect more, of oursociety.

Our Guiding Stars
Today we are in the midst of a public health crisis—one that goes
far beyond the pandemic and will long outlast it unless we do something about it. Unlike COVID-19, it’s a problem for which there is novaccine. The lifelong impacts of early brain development are an invisible fault line running through society, magnifying and threatening to make permanent the disheartening inequities we see in ourworld. Multiple interwoven power structures, of economics, class,• T O WA R D A N E W N O RT H S TA R •21and race, ignore or actively undermine the ability of millions of parents to provide the stimulating, language-rich early learning environments they so desperately want their children to have.
In other words, the disparities that plague our nation begin far
earlier in a child’s life than most people realize. We are suﬀeringfrom an invisible epidemic in the form of unequal opportunities forthe early brain development that all children need to achieve theirinnate promise.
Sometimes the enormity of this crisis, the same one that pulled
me from the operating room, is overwhelming. I once again feel as
I did in my old dream, that I am standing on the dark riverbank.
That we all are. But I’m also reminded of the words of Dr. Martin
Luther King Jr. in the midst of the battle over civil rights that gripped
this country in the 1960s: “Only when it is dark enough can you see
the stars.”23 And I do see. I see with clarity two separate but inextricably intertwined ideas that allow us to move forward.
First, science gives us a road map. Just as it tells us what to prioritize individually as parents, it can show us where to go societally as
well. It can lay out the coordinates that will lead us toward healthy
brain development for all children. That goal, laying the foundationfor optimal brain development, should be our constant guide. It willkeep us focused on where we want to go as we set out to transform
our society into one that makes its future citizens its focal point.
The science of brain development tells us to begin when learning
begins, not on the first day of school but on the first day of life. Evenin the womb, babies learn to recognize their parents’ voices.24 Timing is everything. Neuroplasticity, the brain’s incredible ability toorganize itself by forming new neural connections throughout life,
is at its peak between birth and the age of three. Brain circuits area use-it-or-lose-it proposition. While our brains remain plastic
throughout our lives, they will never be more so than in the magicaland essential early years.25 To capitalize on this time, the all-22

• PA R E N T N AT I O N •important first step is rich conversation. It is often called serveand-return, the back-and-forth of parents interacting with theirchildren. Talking, smiling, pointing, responding—that nurturing
interaction is powerful enough to help children move forward anddevelop two critical sets of skills that will allow them to succeed inschool and in life. It delivers cognitive skills, the kind found on intelligence and aptitude tests: reading and writing, numeracy, pattern recognition. And it builds noncognitive, or “soft,” skills like gritand resilience. In other words, nurturing interaction builds thewhole brain.26
Neuroscience shows us that environment matters, too. Stable,
calm environments foster socioemotional skills and executive function; disruptive environments impede their development.27 Our society robs too many families of the opportunity to provide healthy
environments. Illness. Poverty. Homelessness. These aﬄictions andothers can trigger instability, and the resulting toxic stress becomesa risk factor endangering healthy brain development. When the ultimate development of a child is hampered, we all lose. Our futuresociety will be made up of the children being reared today; therefore
society should be helping to lay the foundation for optimal development of all its children.
If the science of the brain is our road map, it is parents who dothe steering. That is the second critical point. Parents are the captains of their families’ ships, manning the helm. But every captainneeds a crew. It is time to reject the myth of individualism as justification for failing to provide societal support. That makes about asmuch sense as my walking into OR4 without my A-team. Havingthat A-team there does not diminish my control of the room. When
parents hand me their child at the red line, they know exactly who
is holding the scalpel. They are also glad to know that I have backup.
Working together with me at the helm, my team and I get the job
done. Having backup doesn’t make me any less a surgeon, just as• T O WA R D A N E W N O RT H S TA R •23living in a society with family-friendly supports doesn’t make a momor dad any less a parent or any less in charge. Parents need truechoice. They need authority and backup.

Building a Parent Nation
That’s why this book about the importance of foundational brain
development is called Parent Nation. Parents are the guardians of
our future well-being. They should be recognized as the guardiansof our present as well. Mothers and fathers are ordinary people—
not one is endowed with superpowers—yet they accomplish something extraordinary when they raise children successfully. Parents
are the architects of their children’s brains and thus also the architects of society’s future. It is only when we create a movement tosupport parents on their journey that we as a society can support
the needs of early childhood. Loving mothers and fathers do notneed a PhD or expensive gadgets to do an excellent job at supporting
early brain development and building our future citizens. They needeasily acquired, basic knowledge about how best to foster criticalneural connections. They need time with their children to nurture
those connections. They need high-quality childcare that complements their eﬀorts. They need to be able to provide children withstress-free homes. And they need support for this formative endeavor from employers, from communities, and from policy
makers—that’s who I mean by “society.”
When I wrote my first book, I thought that just knowing andunderstanding, and having others know and understand, the powerful brain science would be enough to bring about meaningfulchange. I was wrong. Real, essential change will occur only when
there is a concerted, collective, national eﬀort to bring it about.
What we need is to recognize that we can lighten the parenting load

24

• PA R E N T N AT I O N •by sharing it, by demanding what we require, and by asking society
to help. What we need is to see the power in coming together as
parents and as a nation to help all children. What we need is to put
children’s brain development at the heart of our thinking andplanning.
By giving children the opportunity to achieve whatever their natural gifts allow, we fulfill the promise of their promise. Everything
we do that aﬀects families must begin there. In essence, we mustreverse the spin and set up a society that pushes our focus inward,
to the children—and their caregivers—at the center. We need tochange the way society views an entire segment of the population:
parents. Not just low-income parents. All parents. And in turn weneed to change the way parents view themselves and elevate their
expectations of support.
But how do we do it? By lifting our voices as one. There are tensof millions of us. Together, we can fight for our needs and our children’s needs—for high-quality childcare, paid family leave, a childallowance. We can fight to address childhood poverty. We can demand that prenatal and pediatric care be holistic and include information about brain development. We can call on employers to
institute family-friendly policies that are also good for their bottom
line. If we form a coalition of parents, we can work together for thechanges we need.
To create fundamental change, to ameliorate society’s most entrenched problems, we must help all Americans to see that healthy
brain development should be the North Star that guides us to amore productive, just, and equitable society. Addressing the issuesof children and, therefore, their families doesn’t help only those individuals; it is a necessary piece of addressing civil rights, genderequality, and the strength of our economy. So far, we have failed tosee it that way. The ramifications of that critical failure are becoming more impossible to ignore with each passing day and werebrought into the highest relief during the pandemic.

• T O WA R D A N E W N O RT H S TA R •25

As a physician caring for children for over twenty years, I canattest to the fact that there are no fiercer advocates for children thantheir parents. I’ve seen it, time and time again. It is a beautiful thing
to behold. Parents want to give their children what is rightfully
theirs, the promise of their promise, even in the face of extreme
obstacles. What if we could harness that passion, persistence, anddetermination into a movement that would compel society to deliver on children’s unalienable right to realize their potential? What
if we could convince society to make foundational brain development our guiding principle, our new North Star?
The beauty of this approach lies in its capacity to benefit each andevery one of us, even non-parents. Undoubtedly, it will help to level
the playing field and ensure that all children have a better shot atreaching their full potential and matching the achievements of theirpeers. The fate of each child, no matter how well nurtured, is, ultimately, intimately intertwined with the fates of all children. The
strength of our country is based on ensuring that all our children
have the same opportunity.
Being a parent has the power to bring us to our knees. But whatbrings us to our knees must also rouse us to our feet. Change doesn’t
happen spontaneously. These days, I dream of parents lined up next
to me on the shoreline, millions of us setting out together, with ourchildren, in sturdy boats capable of navigating even the most torrential river. I hope this book will remind parents that there is morethat unites us than separates us; that it will help parents see thatthey are not alone in their struggles or aspirations for their children;and that it will make clear to parents that we are stronger together.
I hope it will give parents and their allies what they need to succeed.
And that, together, we will build a parent nation.