One of the best predictors of children’s adaptation to divorceis whether the physical separation is associated with adecrease in the child’s exposure to parental discord. In mostcases, divorced parents still must interact with each otheraround the child’s schedule, child custody and support, andother parenting issues. These types of issues create the potential for the child to have ongoing exposure to significant discord between the parents. For example if one parent tends tokeep the child up much later than the bedtime at the otherparent’s house, sleep problems may develop. When childrenfeel caught in the middle of ongoing conflicts between theirdivorced parents, behavior or emotional problems are muchmore likely. Regardless of how angry parents are with each other, the parents should be counseled that they must shieldtheir child from this animosity. Clear rules about schedules,discipline, and other parenting roles is ideal, but in cases ofconflict it can also be helpful for the pediatrician to help aparent accept that he or she can only control his or her actionsand decisions related to the child. When parents have trouble resolving these issues, mediation may be helpful. Pediatricians need to be wary of parents’ attempts to recruit theminto custody battles to substantiate claims of poor parenting,unless the pediatrician has first-hand knowledge that the concerns are valid.
Although the primary physical residence for most children is still with the mother, the court’s bias toward preferring mothers in custody decisions has decreased, and there is more emphasis on including both parents in the child’s life. In the early 1980s, 50% of children had no contact with their fathers 2 or 3 years after a divorce, whereas today only 20% to 25% of children have no contact with their father. Most states now allow joint physical or legal custody. In joint physical custody, the child spends a significant amount of time with each parent, and in joint legal custody, parents share authority in decision making. Although joint custody arrangements may promote the involvement of both parents in the child’s life, they also can be a vehicle through which parents continue to express their anger at each other. When parents have severe difficulty working together, joint custody is an inappropriate arrangement and has been associated with deterioration in the child’s psychological and social adjustment.
Divorce often creates financial difficulties. Family income usually declines in the first year after the divorce. Only about half of mothers who have child support awards receive the full amount, and one fourth receive no money at all. These financial changes may have multiple adverse affects on the child. A move to a new house may require the child to attend a new school disrupting peer relationships and other potential supports. The child may spend more time in child care if one or both parents have to increase work hours.
Role of the Pediatrician
Pediatricians may be confronted with issues related to marital discord before the divorce, may be consulted around the time of the divorce, or may be involved in helping the family to manage issues in the years after the divorce. The pediatrician can be an important voice in helping the parents understand and meet the child’s needs (Table 26-1). Before the divorce, parents may wonder what they should tell their children. Children should be told of the parents’ decision before the physical separation. The separation should be presented as a rational step in managing marital conflict and should prepare the child for the changes that will occur. Parents should be prepared to answer children’s questions, and they should expect that the questions will be repeated over the next months. Once parents have told children of the separation, it may be confusing to the child if the parents continue to appear to live together and may raise false hopes that the parents will not divorce.
Many parents report not feeling like their life had stabilizeduntil 2 to 3 years or more after the divorce, and for some thedivorce remains a painful issue 10 years later. The child’s emotional adjustment to divorce is closely predicted by the parents’adjustment so parents should be encouraged to get help forthemselves if they are struggling emotionally after a divorce.
Table 26-1 General Recommendations for Pediatricians to Help Children During Separation, Divorce, or Death of a Close Relative
Acknowledge and provide support for grief that the parent/ caregiver is experiencing.
Help parent/caregiver consider child’s needs.