Addressing a child's health needs can become complex when the parents are no longer together.

By Theola Labbé-DeBose
Washington Post Staff Writer
Tuesday, April 14, 2009

Sean Smith knows his two children, ages 5 and 7, eat balanced meals. Still, he wanted to make sure they got all the right nutrients. So when the Rockville resident heard about special kids' vitamins, chewable like Gummi Bears, he wanted his children to take them.

Their mom disagreed. Carolyn Rutsch also knows the kids eat healthy. So, she said, why would they need vitamins?

A typical difference of views, one of many small disagreements in parenting. But Smith and Rutsch are divorcing, and nothing about raising their children is as simple as it used to be.

Decisions about children's health, the small, everyday choices intrinsic to child-rearing, take on an added complexity when parents are split up.

Experts say that with legal questions of child custody focused on safety, visitation schedules and child support, how to handle health care for children without serious medical problems often becomes a lower priority on the long list of issues to settle -- if it comes up at all.

Along with such minor issues as taking vitamins or not, there are larger questions: Will co-pay costs be shared? Should doctor's appointments be at a time that works for both parents, or go by the schedule of the parent who's with the child the majority of the time?

The answers depend on several factors, experts say, including the kinds of custody and financial arrangements that have been reached, either informally or through a court order. The divorce decree may spell out which parent will carry the insurance and how medical bills are to be split. For divorced parents, as well as for parents who never married, states such as Oregon require parenting plans that can be as detailed as how often a child is supposed to brush his teeth.

No matter what health-care arrangement may exist on paper, the biggest contributing factor to successful coordination between separated parents is the quality of their co-parenting relationship, said Brette McWhorter Sember, a former divorce lawyer and mediator who has written several books on divorce and co-parenting.

"In general, I've found that when parents are fighting over health decisions, it is generally indicative of some other underlying conflict," McWhorter Sember said.

Courtney Blair, an allergist based in Sterling and McLean, said the importance of coordination between households is seen in what happens when it fails. Children with serious asthma arrive sick in her office on a Monday because the medication schedule wasn't precisely followed during a weekend visit with the other parent. In one instance, she recalled, a child with a peanut allergy had a reaction because the parent in charge that weekend allowed the child to eat a cookie from a gift shop without checking the ingredient list.

When that happens, a heated blame game ensues, she said. "When there's one parent that's not on the ball and not as vigilant, it's something that drives a wedge through even the most stable couple," Blair said. "If the parents aren't together and one parent isn't being as vigilant, the anxiety for the other parent goes through the roof."

There are also such issues as insurance plans that allow for just one asthma inhaler at a time, she said, which means that the device must go between houses. If it's clear that parents aren't getting along, Blair said, she sometimes gives extra samples for the other parent's house, or she tries to talk to the child about making sure he or she takes the proper dose. "But that gets tricky, because you're putting a lot of responsibility on a child."

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