The Medical Toll on Children

Stories are all over the internet today about an article in the December 2010 issue of Pediatrics. The article, “Parental Wartime Deployment and the Use of Mental Health Services Among Young Military Children,” by Beth Ellen Davis presents the results of a study led by Dr. Gregory H. Gorman of the Uniformed Services University of the Health Sciences, which analyzed the health records of 642,397 children ages 3 to 8 with parents in the military.

It compared the frequency of health visits from 2006 to 2007 when a parent was deployed with those when the parent was home. It is the most comprehensive study conducted to date of military families’ use of health insurance during wartime. Children from ages 3 to 8 were chosen in part because they were developmentally at the stage where Gorman had seen an increase in parental concern about their children’s behavior among patients in his pediatric practice.

The researchers found that the children saw a doctor or other health professional about six times a year and about once every two years for a mental health reason. During deployment of a parent, however, the visit rate dropped by about 11 percent for physical problems but rose by 11 percent for psychological complaints. Stress, anxiety and attention-deficit problems were among the more common diagnoses.

Children at the upper end of the age group studied, the 7- and 8-year olds, had the most marked problems. The causes of stress include frequent moves, prolonged parent absences, and fear of a parent’s death. The study also revealed larger increases in mental and behavioral visits among older children, children with military fathers and children of married military parents.

Many researchers and practitioners have noted the stresses on today’s military families, and so the findings of increased visits for behavioral and mental health problems was no surprise. What did surprise Dr. Gordon was to find that the rates of visits for all other medical conditions dropped. "I have no direct evidence, but we hypothesize that when a parent is deployed... and the other parent has to do all of the duties, they may want to handle other problems at home," Gorman said. "These parents who remain at home need to multi-task even more." This is a matter for some concern, since presumably illnesses or injuries for which a parent might seek medical attention in calmer times are not receiving the same level of vigilance now. This could harm both the child and the parent, who may be feeling guilty about not being able to do what he or she once did for the child.

In Gorman's study, the most frequent primary diagnosis during visits for mental or behavioral issues was attention-deficit disorder (ADD). Adjustment and autistic disorders came next, followed by mood and anxiety disorders, oppositional defiant disorder, developmental delays, post-traumatic stress disorder, bedwetting and separation anxiety. In cases of ADD and autism, Gorman says that those conditions may worsen during deployment and become harder to manage for the remaining parent.

These findings are particularly important for nonmilitary pediatricians, because they provide almost two-thirds of the outpatient care for military children. “It’s not clear yet whether kids are in fact suffering more mental problems when a parent is deployed, or that mothers are more attendant to any shift in behavior,” one of the researchers says. “That’s the next question we have to ask.”