J. Lane Tanner

The Effects of Marriage, Civil Union, and Domestic Partnership Laws on the Health and Well-being of Children

In 2005, the American Academy of Pediatrics (AAP) Board of Directors commissioned the Committee on Psychosocial Aspects of Child and Family Health, the Committee on Early Childhood, Adoption, and Dependent Care, the Committee on Adolescence, the Committee on State Government Affairs, the Committee on Federal Government Affairs, and the Section on Adoption and Foster Care to develop an analysis examining the effects of marriage, civil union, and domestic partnership statutes and amendments on the legal, financial, and psychosocial health and well-being of children whose parents are gay or lesbian. In developing this analysis, the involved committees and section held before them the AAPs core philosophy—that the family is the principal caregiver and the center of strength and support for children. Together with this philosophy, contributors recognized the reality that our gay and lesbian patients grow up to be gay and lesbian adults. Because many pediatricians are fortunate to care for 2 or more generations of a family, we are likely to encounter and remain involved with our patients, regardless of sexual orientation, as they mature and mark the milestones of establishing a committed partnership with another adult, deciding to raise a family, and entrusting the health and well-being of their own children to us. This analysis explores the unique and complex challenges that same-gender couples and their children face as a result of public policy that excludes them from civil marriage. In compiling this report it became clear to the contributing committees and section that the depth and breadth of these challenges are largely unknown to the general public and perhaps even to many pediatricians. As such, the AAP Board of Directors approved the broad dissemination of this analysis to assist pediatricians with addressing the complex issues related to same-gender couples and their children. It is important to note at … Address correspondence to James G. Pawelski, MS, 141 Northwest Point Blvd, Elk Grove Village, IL 60007. E-mail: jpawelski{at}aap.org

Organic or psychosomatic? Facilitating inquiry with children and parents

CASE. Eric (12 years old, sixth grade) saw a new pediatrician with concern about fatigue and intermittent abdominal pain for the past 2 to 3 months. His mother observed that he appeared more tired and that the whites of his eyes are more cloudy than usual. He continued to be active, however and reported that he played basketball and football without any problems. He slept 8 hours each night without a problem either initiating or maintaining sleep. When asked about the abdominal pain, Eric reported that it was usually in the left upper quadrant, more noticeable after running, and subsided after 1 to 2 minutes of rest. He denied any physical trauma, constipation, hematochezia, joiht symptoms, fever, night sweats, or weight loss. His mother inquired about whether he could have hepatitis because a family friend, who was at their home cleaning the garage, had been diagnosed with hepatitis. However, she stated that neither she nor her son had any casual or intimate contact with this person and that he was in the garage for only a few hours. Eric and his mother lived alone. For several years, he saw his father only occasionally. Eric was struggling academically in school this year; his grades changed from As and Bs down to Cs and Ds. He had not changed schools and denied any problems getting along with either peers or teachers. When the pediatrician asked why Erics grades changed, his mother reported that she thinks it is because he is missing a lot of school and not keeping up with his homework. She reported that recently he missed 1 to 2 days weekly because he is too tired in the morning. Intrigued by the constellation of symptoms and concerns, the pediatrician asked Erics mother to wait in her office while she examined the patient. The physical examination was normal and further questioning of the patient without a parent in the room did not elicit information to explain his school problems other than his insistence that he is often tired. Leaving the patient to dress, the pediatrician returned to her office. She asked the mother if there was anything that she wanted to share that she was uncomfortable discussing with her son in the room. At this point, the mother appeared anxious and disclosed that she was diagnosed with hepatitis C a few months ago. She stated that she felt well but was terrified that she gave the infection to her son, because they shared a glass immediately after she had undergone dental work and may have had blood in my mouth. Erics mother stated that she was so troubled after this event that she stopped any form of physical contact with her son including kissing, hugging, or snuggling as they watched television together for fear that she would pass the infection. The pediatrician spent considerable time explaining the usual mode of transmission of hepatitis C and the unlikelihood that her son could have contracted the disease from her with the contact described. In addition, she pointed out that the mothers complete withdrawal from her son may be contributing to his apprehension about being away from her when it is time to go to school. Arrangements were made to perform baseline laboratory tests and hepatitis markers, and an appointment for a repeat visit was scheduled. After a few days, the pediatrician contacted Erics mother with a report of the normal laboratory results. When asked, the mother said that she has given Eric an occasional hug since the office visit.

Organic or Psychosomatic? Facilitating Inquiry With Children and Parents

Eric (12 years old, 6th grade) saw a new pediatrician with concern about fatigue and intermittent abdominal pain for the past 2 to 3 months. His mother observed that he appeared more tired and that the “whites of his eyes are more cloudy” than usual. He continued to be active, however, and reported that he played basketball and football without any problems. He slept 8 hours each night without a problem either initiating or maintaining sleep. When asked about the abdominal pain, Eric reported that it was usually in the left upper quadrant, more noticeable after running, and subsided after 1 to 2 minutes of rest. He denied any physical trauma, constipation, hematochezia, joint symptoms, fever, night sweats, or weight loss. His mother inquired about whether he could have hepatitis because a family friend, who was at their home cleaning the garage, had been diagnosed with hepatitis. However, she stated that neither she nor her son had any casual or intimate contact with this person and that he was in the garage for only a few hours. Eric and his mother lived alone. For several years, he saw his father only occasionally. Eric was struggling academically in school this year; his grades changed from As and Bs down to Cs and Ds. He had not changed schools and denied any problems getting along with either peers or teachers. When the pediatrician asked why Erics grades changed, his mother reported that she thinks it is because he is missing a lot of school and not keeping up with his homework. She reported that recently he missed 1 to 2 days weekly because “he is too tired” in the morning. Intrigued by the constellation of symptoms and concerns, the pediatrician asked Erics mother to wait in her office while she examined the …