Report updates guidance for clinicians caring for U.S. military children
Cmdr. Chadley R.Huebner, M.D., M.P.H., FAAP
AAP Clinical Report
Pediatric health care providers serve an instrumental role in caring for children
in U.S. military families. Despite the presence of military treatment facilities throughout
the world, up to 50% of military-connected children receive care in the civilian sector.
Many clinicians, however, have limited exposure to military culture and encounter
challenges in navigating the Military Health System.
An updated AAP clinical report, Health and Mental Health Needs of Children in U.S. Military Families, offers practical guidance to assist pediatric health care providers caring for military
children and includes resources to help families, especially during transitions and
Military personnel are ethnically and geographically diverse and comprise a relatively
young workforce. Nearly 60% of the 2.2 million active duty and National Guard/Reserve
members have families, and 40% have at least two children. Of the estimated 1.7 million
military children, almost 40% are 5 years of age or younger.
Military children often share common experiences, such as living on military installations,
frequent relocation and parental deployments, which can build a sense of camaraderie
and can serve as a sense of identity throughout their lives.
Research exploring the impact of stressors experienced by military families shows
evidence of emotional-behavioral challenges, increased mental and behavioral health
visits, and more frequent health care utilization in children during parental deployment.
Furthermore, increased psychosocial stress and poor mental health of the non-deployed
parent have been associated with more challenges for children dealing with deployment.
Emerging research also has examined resiliency in military families. There are multiple
factors associated with resiliency, including social connections through shared experiences
and effective support networks. Several interventions have been designed to promote
increased resilience, combat stress and improve family functioning before and after
deployment. Pediatricians can help families connect with military support networks
and community resources.
Military Health System
The Military Health System serves 9.4 million beneficiaries. Each service branch is
responsible for ensuring medical readiness of its operational forces and provides
health care to beneficiaries in military treatment facilities throughout the world.
TRICARE is the health care program for uniformed service members, retirees and their
families. The Defense Health Agency manages regional TRICARE insurance contracts while
integrating direct and purchased health care systems. Multiple TRICARE insurance plans
are available to service members, and eligibility may be determined by service status
and geographic location.
Various Department of Defense programs assist families who have children with special
health care needs, including the Exceptional Family Member Program. The program provides
services to active duty families and helps ensure that the child’s medical and educational
needs can be met when service members are considered for duty stations.
Children with autism spectrum disorder can receive applied behavioral analysis therapy
through the TRICARE Autism Care Demonstration, although contractor requirements may
depend on the family’s TRICARE plan.
Physicians in military residency programs receive early exposure to military culture,
leading to awareness of the needs of service members and their families. However,
programs addressing military cultural competency in U.S. medical schools and civilian
graduate medical education programs remain limited.
Competency training in medical schools as well as enhanced collaboration between military
and civilian pediatricians may improve health care delivery to children in military
The clinical report provides recommendations to assist providers caring for military-connected
children, including the following:
Establish a clinical process to identify children who are connected to the military,
and take a thorough military history that includes parental deployment and relocation
Connect families with community-based resources and support networks during deployment
and family relocation.
Work with local schools to identify military children and provide resources to assist
with school transitions.
Familiarize the medical home with programs available to military children and families,
including resiliency interventions and programs for children with special health care
Dr. Huebner, thelead author of the clinical report, is a member of the AAP Section on Uniformed Services.
Disclaimer: The views expressed herein are those of the author and do not necessarily
reflect the official policy or position of the Department of the Navy, Department
of Defense or the U.S. government.