Is My Child Racist? Supporting Caregivers in Conceptualizing Race for Children

M is a 4-year-old White girl whose parents contact their primary care pediatric clinician with a behavioral concern: over the course of several months, M has insisted that she is pregnant with quintuplets. Although some of the quintuplets have light skin tones, others have darker skin tones. When elaborating about the fantasy, M often explains that the babies fight in her tummy, and the Brown babies are "acting badly" by spitting, scratching, and hitting the others. Although M can sometimes provide an explanation for why the Brown babies misbehaved (i.e., they ate chocolate), often she is not able to produce an answer. The child frequently reiterates the same story to her parents, which has left M's parents uncertain how to react.In terms of her life course thus far, M has had typical development and behavior. She has attended all her well-child visits and met the usual developmental milestones. Beyond general development, her exposure to diverse people has been ample because she is from a multiethnic household in which 2 languages are regularly spoken. Outside of her home, she has close Brown and Black friends in her preschool, and the school has discussed race and skin color in an affirming way with the children. At home, she has books that feature children of different skin tones.What advice can M's pediatric clinician offer? How can parents and pediatric clinicians support children who present with race-based thoughts or actions that seem discriminatory?