Helping Children Cope with Divorce, Death, and Deployment

During the past decade, pediatricians have increasingly incorporated the social-ecological model of health into their practices, recognizing the profound interactions between environmental and individual factors in child health outcomes. Despite a growing awareness of the social determinants of health, comparatively little attention has been given to the impact of a child being separated from a parent, despite the fact that more than 1 million American children experience divorce, death of a parent, or deployment of a parent each year.

Although divorce, parental death, and deployment arise from dramatically different family circumstances, each of these events can have lasting effects on involved children. For pediatricians, routine health supervision visits should include surveillance of stressors associated with either a current or impending separation, as well as the social and familial changes that can occur before, during, and after such experiences. When assessing a child undergoing a temporary or permanent separation from a parent, a pediatrician should be aware of the health risks experienced by the child, as well as being prepared to offer an appropriate palette of options for support to the child and caregiver(s).

Special attention should be given to a patient’s developmental stage because children of different ages will present with sequelae of varying types and severities. For example, developing secure attachment to caregivers is an important feature of infancy and early childhood; thus, a change in a child’s day-to-day routine or the presence or absence of particular caregivers may result in increased fussiness or irritability, regression of developmental milestones, or disturbance in sleep and feeding patterns. As children mature, their understanding of parent separation likewise evolves. For example, in the context …