At-War Soldiers' Kids Suffer at Home

all showed increases."

This isn't happening because the left-at-home moms are terrible mothers --
it's happening because they are mothers stressed to the breaking point, says
Wendy Lane, MD, MPH, chairwoman of the child protection team at the University
of Maryland School of Medicine.

"The parents who do this are not bad people. This is the case in most
situations of abuse and neglect," Lane tells WebMD. "People want to do
the right things for their kids, but often there are stressors that keep them
from doing what they want to do."

The main stressor is the "impact of continuous deployment on our
soldiers and families," says Delores Johnson, director of family programs
for the U.S. Army's Family and Morale, Welfare and Recreation Command.

"Because of the continuous deployment of troops, this is much more
common than it had been before," Johnson tells WebMD. "We know that
neglect tends to increase during deployments, although we have not seen these
high rates before. This seems to be coming from families dealing with
back-to-back and extended deployments. Mothers are functioning very much alone
and dealing with schedules and new babies and all the demands that go with
that."

Tip of Military Child Neglect/Abuse Iceberg?

Gibbs and colleagues studied reported cases of child maltreatment in 1,771
families of enlisted U.S. Army soldiers deployed at least once between
September 2001 and December 2004. During these deployments, more than 80% of
the cases of maltreatment were due to child neglect. Over two-thirds of these
cases were reported as moderate or severe.

"An example of a mild child neglect case would be the parent's lapse in
supervision of a child that did not meet the army's criteria for leaving
children alone but which did not result in any harm and was not blatantly
inappropriate -- such as leaving an 8-year-old home for a short period of
time," Gibbs says. "A severe case of child neglect would be more along
the lines of a parent not providing supervision to a young child for an
extended period of time, not meeting the child's basic needs for food, or not
maintaining a livable household."

The study looked only at families with reported episodes of child
maltreatment. Four times as many children likely are affected, as only about
25% of cases of child neglect or abuse actually is reported, says John
Fairbank, PhD, co-director of the National Center for Child Traumatic Stress,
sponsored by the U.S. Substance Abuse & Mental Health Services
Administration.

"This could be the tip of an iceberg," Fairbank tells WebMD.
"There are probably many more Army families out there suffering. And other
members of the armed forces, such as the Army Reserve and National Guard, are
much more isolated than are those on military bases. ... This really is a
problem we need to be addressing thoughtfully and carefully and
urgently."

The Army's Johnson disagrees with the tip-of-the-iceberg analogy, although
she says maltreatment of children in military families has become "much
more common than it had been before." And Johnson says the findings of the
Gibbs study remain relevant today.

"I don't think a snapshot taken today would be different from the
2001-2004 period in the study. We would see same level of neglect," she
says. "This is something we were able to detect in our own research
analyses. It has highlighted the impact of continuous deployment on our
soldiers and our families."

Help for Military Families

The problem of child maltreatment is solved not by punishing families but by
helping them, says child-protection expert Lane.

"There should be an assessment of the family: Are there risks in
addition to the fact the parent is deployed? Is it just increased stress -- or
could there be lack of social support? Could there be substance use or abuse?
Could it be financial?" Lane says. "You work with the famil to find
out what kind of support the family needs to avoid future neglect -- and give
parents better skills so the child is safe."

The U.S. Army is doing just that, Johnson says.

"The question we are addressing is, do we have a way of picking up on
these families at risk and following them as the baby develops?" Johnson
says. "We have a 24/7 help line families can call to ask for in-depth
counseling support. We have new-parent support programs that are especially
helpful with the areas that generate most concern, such as feeding. We have a
special-emphasis effort on 'do not shake babies.' And then we have a normal
range of parenting classes."

Sometimes, however, a family's problems are deeper than simple lack of
support or know-how.

"The deeper problem might be something more serious. For example, a
parent may have depression that needs to be treated, in which case you have to
make a referral to a mental health specialist," Lane says.

"The Army has put a lot of money into adding more social workers and
psychologists and psychiatrists to be available to our families, particularly
with the levels of depression we are beginning to see," Johnson says.
"We think we have the right programs in place. The chief of staff and the
secretary [of defense] with their infusion of dollars are saying we are there
for families. This means we are adding more home visitors to our new-parent
support, and making more of a move for child care to give parents a break, in
addition to other services we have available."

The current study does not address another problem for military families --
the stress of returning veterans with physical or psychological problems.

"What we know is, if they come home with a war-related psychological
disorder such as PTSD, there is a substantial increase in risk for additional
family conflict such as domestic violence or emotional problems with the
children," Fairbank says. "The unknown is of how this will play out in
terms of the newer aspects of this war -- such as high rates of traumatic brain
injury -- and what risk this will pose for child maltreatment. So it is very
important for these issues to be addressed now, both by providing services and
by studying what is going on so we can learn from it."

By Daniel DeNoon
Reviewed by Louise Chang
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