Pearls:

After a divorce, stressing to the family that consistency with their routines pre-divorce is key to helping the children feel secure.

The average divorce rate in the United States is 42%. Often, children of families going through divorce will present with psychosomatic complaints.

Are there health effects seen in children of divorced parents? Like many social stressors, divorce tends to affect children as they present with many vague complaints, such as abdominal pain, headaches, poor sleep, fatigue and/or over- or under-eating.

What is the role of the pediatrician in divorce? The first thing to remember is that you may never know unless you ask. At every well child visit, ask “Any big changes at home?” If you have a family going through a divorce, it is important to stress some important points:

Regardless of age, children feel vulnerable and we must emphasize that it was not the child’s fault.

Emphasize talking to the children and explaining the situation. Being open and honest and at the same time, understanding that the child should not be used as the parents confidant or sounding board.

Discuss with the family that the most trying time might be when the separation happens and that, with time, the situation will hopefully improve.

The child’s routine should stay the same; even after the parent’s are separated and living in different situations.

Consistency makes children feel secure and they tend to thrive when they feel this way.

If a new partner comes into the situation, good communication between the former spouses, even if it is uncomfortable, is key. Perhaps encourage an interaction between the former spouse and the new partner if that person is going to be a consistent part of the child’s life.

How about for infants and toddlers? Again, consistency is key. For example, nap times should stay the same at both parent’s houses and, if possible, keeping the crib in the same location in the rooms in the respective living situations.

For toddlers, saying something like “We are going to be living apart. We’ve decided that is what is going to work best for our family.”

How do you handle parents who are having a difficult divorce? Without the child, as the pediatrician, you can speak to the parents and set some ground rules. This should be framed as strategies to help the child thrive: routine, structure and consistency. This can lead to a lot of open discussion.

To avoid having the child being used against one parent, which only leads to internalized stress and anxiety in the child, try encouraging a relationship between the former spouses using parenting as the connection.

What if the child has a preference for one parent? This may occur after any infidelity. These children may need to be referred for family counseling. In these situations, it is important to encourage the parent with whom the child prefers to not speak poorly of the other parent. Having the parents play off one another creates a lot of conflict for the child. Try to have the parent think long term and ask what he/she wants for their child long term with their former spouse.

Should therapy be recommended to every family? Deblasio generally refers these families to either a psychologist or family therapist. Family therapists can work through the family dynamics during the clinic visits. For younger children, red flags include more acting out, escalating temper tantrums and attention seeking behavior. For older children and teenagers, red flags include becoming withdrawn, weight changes, increased anxiety and/or school performance. Any red flags should prompt a counseling referral.

How do you mitigate school performance issues? As the general pediatrician, you can engage with the teacher. It might also be helpful to advise the family to look for falling grades; if they notice this occurring, it is better to intervene with counseling sooner rather than later.