The parent of a school-age child reports that the child’s father was killed while deployed, and the child is skipping school and getting poor grades. The pediatrician should:

• A. Prescribe short-term antidepressants for this situational depression.
• B. Refer the child to a mental health specialist for evaluation and treatment.
• C. Schedule extended appointments for counseling and mental health intervention.
• D. Suggest that the child have close follow-up by a school counselor.

Answer: (B)

When a school-age child experiences the loss of a parent in a traumatic context and begins skipping school with declining grades, this signals distress that may progress to an adjustment-related or mood/trauma-related disorder if not evaluated. The best step for the pediatrician is to refer the child for evaluation and treatment by a mental health professional who can assess severity, screen for safety concerns, and determine an appropriate plan. Early specialist assessment helps distinguish normal grief from a condition that requires targeted therapy and possibly family involvement, guiding evidence-based interventions such as child-focused or family psychotherapy. Medications are not the first-line answer for situational distress in children and should be considered only after careful evaluation by a specialist. While ongoing support from the pediatrician and coordination with the school are important, a mental health expert’s evaluation ensures a comprehensive, individualized approach to address the child’s functioning and healing in this context.