A. Culture versus class and minority status. In many industrialized countries individuals from minority cultural groups are overrepresented in low-socioeconomic strata of society. This socioeconomic and material disadvantage results in differential access to services. The effects of (1) traditional cultural beliefs, (2) poverty and access to material goods, and (3) being a minority on health and healthcare are distinct but often interlinked. The clinician needs to be aware of these distinctions and try to tease out whether clinical issues that come up may be, in part, related to any or all of these three separate but interrelated issues.

B. Intracultural variability. There is as much variability in beliefs and practices within cultural groups as between cultural groups. Any one individual’s approach to parenting and child development is an amalgamation of personal beliefs, past experiences, media and expert influence, and traditional cultural beliefs (as well as other factors). Nonetheless, it is important to have a general understanding of traditional beliefs and practices as a background and a starting point for discussion and communication.

C. Cultural change. One source of intracultural variability is the effect of acculturation, or the changes that take place over time in individuals and groups due to continuous contact with other cultures and living environments. Modern theories of acculturation stress that it is not a unidirectional process; individuals do not acculturate “from” a traditional culture “to” the host culture. Instead, the process is one better described as becoming “bicultural” or “multicultural.” Individuals retain certain aspects of their traditional culture while incorporating beliefs and values of other groups, including the majority culture. Cultural change occurs in areas such as traditional practices, ethnic pride, self-identity, and language use. Not all of these dimensions change at the same rate or degree.

A. Parenting practices and beliefs about childrearing. For example, norms regarding sleeping arrangements (e.g., co-sleeping), discipline practices, infant and child feeding practices, parental interactions with teachers and the role of the parent in a child’s education, specific parenting roles of the father and the mother, and discussions about topics such as sexuality, all may be influenced by traditional beliefs and practices.

B. Family composition/structure. In some cultural traditions, different family structures may be the norm, such as the reliance on or cohabitation with extended family or fictive kin (e.g., godparents or nonrelated cousins).

C. Culturally normative values. A major aspect of child development includes the learning of acceptable and “normal” behaviors, values, and ideals. This includes the foundations of beliefs that may not be specific to parenting or child development but nonetheless create the milieu in which children live, grow, and learn. They comprise the “models” of behavior to which children are taught to conform. Styles of communication and interaction among individuals, for example, are culturally constructed to some extent. Some cultures put high value on an interactive style that is warm and personal, whereas others prefer styles that are more reserved during interpersonal communication and interaction. Sometimes the style of interaction is based on the relative social position of the individuals involved, and different cultures employ different “rules” to do this.

The value system that underlies proper personal behavior is in part culturally mediated as well. For example, some cultures put a high value on individualism (e.g., independence, self-confidence), whereas other cultures put a higher value on the attainment of social competencies based on collectivism (e.g., interdependence, respectfulness). Acceptable physical distance between individuals in different social settings, physical touch, and eye contact are other examples of belief systems that are in part culturally mediated.

D. Perceptions about normal child behavior. The Victorian concept of “children should be seen but not heard” is an example of one such culturally derived model of child behavior. A physically active child may be seen as “a problem” in one system and “naturally inquisitive” in another. A quiet child may be seen as “slow, dull, or unmotivated” in one context but “quiet and respectful” in another. These different expectations about child behavior may become an issue as the growing child begins spending time in multiple settings (such as at home, at school, and in the community) where the cultural beliefs may clash.