Home

Pediatricians and health care professionals need to encourage an atmosphere in which parents with questions about divorce actively look to the office as a valuable resource. In order to establish and successfully fulfill the role as advocate for the rights of children with parents who are understandably and undeniably stressed, feeling judged, and treated unfairly, pediatricians and their office staff should consider these guidelines:

Respond to the news professionally not personally:

The subject of divorce often arrives without warning and out of context. Typically, while walking down the hall to have the child weighed, the parent casually remarks, "Oh, and by the way, Johnny's father and I separated six months ago." It is easy to hear this type of statement as though it is purely social information and respond with a "Oh, I'm sorry to hear that", but it should also be received and responded to as medical information which is as important as if the parent had said, "Oh, and Johnny passed out at school last week," or "He's been urinating more recently."

Maintain an advocacy role:

Establish the office as a sympathetic, nonjudgmental resource that will help both mother and father provide for the welfare of their children. At times this is a tough role as it requires giving divorcing fathers and/or mothers advice that they may not want to hear, especially when their children's needs are at variance with their own. While the traditional advice has been that adults often need a few years to recover from the divorce and are understandably focused on their own needs, parents need to be reminded that they do not have the luxury of being able to put their children's needs aside while they "recover" If the parent is feeling angry and resentful, or depressed and hopeless, it is tempting to respond by merely listening to all the details/justification of the break-up and trying to be supportive of the adult's plight. If the adult is calm and matter-of-fact, perhaps relieved that their spouse is out of the house, then the temptation for the listener may be to let well enough alone. But divorce, although common, is a significant red flag. While not ignoring the immediate emotional status of the parent, those who care about children have to bring the divorcing parents back to reality and use the visit as a time to provide anticipatory guidance and the offer to work together in the children's best interests.

Invite the parents to return to discuss their children's needs:

A series of future visits is needed to understand the family's situation and what help is needed to plan a schedule of parent-child time together. At the next visit, giving the children an opportunity to express their point of view is important. If possible this should be achieved without their parents present, so they are not inhibited by fears they are being disloyal to one parent or the other, or fears they will provoke an angry backlash when they get home.

Assess the quality of parenting:

It is not unusual for the parent's own emotional needs to compromise their ability to function well as parents. A clinically depressed or chronically angry parent cannot respond to his/her children's needs. Asking parents about discipline problems and sleep disturbances will usually provide sufficient insight into their current parenting style and how recent events have altered their own and their children's behavior. Whether acting out of guilt or an effort to be the "nicer" parent, adults often let discipline become lax, which can lead to increasing parent-child friction at home, or provocative behavior in school or with peers. Parents need the assurance from professionals that rules and limits that they felt were beneficial to their children before the separation are just as valuable after.

Maintain the child's support network:

Children cope better with divorce when they have a broad support network. Encourage parents to maintain their children's valuable friendships and extracurricular activities, like sports teams, music, ballet, Girl Scouts etc., even if that means some financial compromises, and limits parent-child time together--it will pay big dividends in the long run. Find out whether there are coaches, or other non-family adults, who could be recruited to offer valuable stability to the children, especially if their parents are consumed with financial and emotional adjustments.

Don't over-identify with one parent:

It is a mistake to jump to conclusions based on only one person's story. No matter how sympathetic or empathetic, taking sides with one parent makes the health care professional ineffective as the children's advocate. To best serve the children the pediatrician needs to be an unbiased listener to all concerned and, unless there is a real risk of child abuse, maintain the position that both parents should remain actively involved in the children's lives.

Encourage parents to tell the school:

No one likes to disclose personal difficulties, but finding the right person at the school (and depending on the institution it may the teacher, the principal or a guidance counselor) may reveal valuable resources for the children, e.g. special lunch groups that discuss a wide range of problems, but undoubtedly include other kids of divorce. A timely parent-teacher conference can prevent a misinterpretation of the reasons for the child's deterioration in academic performance or behavior. Also remind the parent to begin having the school send out a copy of all report cards, announcements, etc. to each parent, so they both stay informed of progress and activities.

Contact the other parent:

As child advocate the pediatrician needs to foster the continued involvement of both parents since that is a crucial factor which in determining a healthy outcome for the children following a divorce. If the parent in the office objects to the other parent being contacted, get an explanation. Abuse may have played a part in the separation, but reluctance to involve the other parent is more likely to be a reflection of general parental hostility. When faced with comments like, "He doesn't care about them or he wouldn't have done what he did," do not take that statement at face value. The one constant in divorce is that parents do care about their children even if they no longer care about each other, so the estranged parent will likely appreciate the contact. If the parent being contacted does not know or have prior connections with the pediatric office he or she may feel defensive at being called. Make sure the call establishes a positive supportive link and is not an interrogation. Both parents need to see the nurse, the pediatrician, and the medical office staff as a resource.

Divorce directly effects the families of more than a million children every year and indirectly impacts their peers and the families of their peers. Little active support or child-centered guidance is available, offering pediatricians an opportunity to take steps to prevent many of the dire outcomes documented in the research we have reviewed in this article. By establishing the office as a resource for these families while maintaining the role of child advocate the pediatrician can then address the pertinent issues we outline in the second part of the article which occur, and recur, for these children.