With millions of kids affected by divorces and separations each year, pediatricians can play an important role in helping them through stressful transitions.

Few pediatricians probably imagined that their medical practice would involve helping families going through a breakup.

But with more than 1 million children each year experiencing the divorce of their parents — sometimes with high levels of interparental conflict — this has become a common role for pediatricians.

“These situations are very challenging to the pediatrician and family doctor, and in fact, these situations are typically beyond their training,” Gary Direnfeld, M.S.W., R.S.W., a social worker in Canada who specializes in helping separated and divorced parents, told Healthline.

A breakup between parents can affect children in a number of ways, including changes in behavior, eating habits, or academic performance. In younger children it can show up as problems with toilet training or bedwetting.

Teenagers whose parents are going through a divorce or separation may develop depression, anxiety, suicidal thoughts, or other mental health concerns.

Sometimes, though, the ultimate cause of these issues lies beyond the symptoms observed by a child’s pediatrician or family doctor.

“Problems that, on the one hand, may look physical in nature, are actually psychological and social,” said Direnfeld.

To better support these families, a new report published today in the journal Pediatrics provides advice for pediatricians on how to help families through a stressful transition.

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When parents are able to handle a divorce or separation amicably between themselves — or with the help of a counselor, mediator, or family lawyer — a pediatrician may not even be aware of the breakup.

But when a separation becomes acrimonious — with parents fighting over decisions that affect the child or how much time the child will spend with each parent — the effects on the child come to the fore.

“It’s in these situations that children are most affected by parental separation,” said Direnfeld, who was not involved with the new report. “It’s in these situations that the conflict between the parents befalls the child and stresses the child.”

The report suggests that pediatricians stay alert for family tension whenever talking to parents about their child’s development and behavior.

This can start even before a breakup.

“Being aware of these stressors and referring [parents] for marital counseling are appropriate and may preserve the marital relationship,” write the authors of the report.

Once a separation appears definite, pediatricians can refer parents and children to a counselor, psychiatrist, or social worker — ideally someone with experience working with parents going through a separation or divorce.

Pediatricians can also educate parents about how parental conflict can impact their child’s well-being.

“The pediatrician can play a pivotal role in helping parents to appreciate that the degree to which they can control themselves — and not the other parent — and manage conflict improves the prognosis for their child,” said Direnfeld.

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The report recommends that pediatricians try to maintain a “positive, neutral relationship with both parents after a divorce.”

This is not always easy.

In some cases, a parent may try to get a pediatrician or family doctor “on their side” — and not always in the most pleasant way.

“Parents will lie in these circumstances. They will make things up. They will try to induct their service providers for letters of support in court actions,” said Direnfeld. “And it’s not because they’re necessarily bad people. It’s because they’re hurt and they’re scared and they’re worried about their kids.”

In some cases, pediatricians may be asked to testify in court or provide testimony in a child custody hearing.

Because a doctor’s report can carry a lot of weight in these situations, Direnfeld said it is even more important for a doctor to avoid being inducted by one parent into their cause.

“I frequently see physicians who offer one-sided reports based on one parent’s description of events to the doctor,” said Direnfeld. “Then when I am assessing the situation I see that the report provided by the physician doesn’t accurately reflect the real situation.”

This may not be intentional on the part of the doctor but can result from talking to only one of the parents.

Direnfeld gave the example of a 3-year-old child “on the cusp of being toilet trained” who developed loose stools and a terrible diaper rash after the parents separated.

In a high-conflict separation, each parent may blame the other for poor child care. Parents may even “run to the pediatrician to complain about parental treatment or neglect by the other,” said Direnfeld.

But if a child frequently witnesses parents yelling and screaming at each other — or is caught in a physical tug-of-war with one parent pulling the child from the other — loose stools may just be a physical response to a terrifying situation.

“The issue isn’t neglect,” said Direnfeld. “It is unresolved parental conflict, with the child directly in the fray.”

Without knowing both sides of the story — and the extent of the conflict between the parents — a pediatrician may inadvertently take the side of one parent over the other.

Along with seeking the help of a mental health professional, pediatricians can also look at the family’s bigger picture.

“Rather than accepting at face value that the other parent is neglectful,” said Direnfeld, “the pediatrician would seek to understand more fully and more broadly what’s going on in the life of the child.”

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