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Messsge from the EditorEditor's Corner

Why are Pediatricians in the US Military?

By Robert G. Locke, DO, MPH, FACOP

Why would we need pediatricians here…? ” 
Dr. William Winkenwerder, Jr., Assistant Secretary of Defense of Health Affairs, 2003


Even top Pentagon officials, such as Dr. Winkenwerder, are occasionally confused about the need of pediatricians in the US military. But pediatricians serve as essential members of the US military. Forty-three percent of the military is under 25 years of age. Forty-two percent of active military, including reserve and guard members, have children, with nearly one-half of those having at least one child under 5 years of age.  Including spouses and dependents, military medical care covers 1,783,037 individuals under 18 years of age, or roughly one in four of the total military population.

The single most common inpatient diagnosis

in the military health system is a “live newborn.”


“Sixty Papa”  -- Army code for a Pediatrician


“Sixty Victor Zero” -- Navy code for a Pediatrician


“Forty-Four Kids X-ray” – Air Force code for a Pediatrician


Dependents ≤17 years of age of military personnel


% of military children who are ≤ 5 years of age


% of military with children


Women among military reserve and guard units


Number of medical encounters to military dependents ≤ 17


% of total Afghanistan military hospitals admission days attributed to pediatric patients

43 – 34 – 24

% of pediatric combat trauma, noncombat trauma and nontrauma military hospital admissions 2002-2012 in combined Iraqi-Afghanistan wars

2 for 2

Number of pediatricians among the first two physicians to enter Iraq during the Iraqi War

250,000 and 37,000

Number of human and veterinary encounters respectively in Pacific Partnership Humanitarian mission

Pediatricians have a mixed formal connection with the military services. Although many famous pediatricians have served in the military through the history of the services, the relationship was not codified until the Vietnam War. In the 1880’s, the concept was the physicians would provide care to children and family members “whenever practical.” In World War II, with the rapid expansion of the military from a standing army of 0.5 million to 12 million, and role of the government in providing social support following the Great Depression, Congress passed the Emergency Maternity and Infant Care Act. This mandated that the military services provide care for spouses and children, including medical, hospital and newborn care. Osteopathic physicians increased their role on this home front.

Following WWII, the Geneva Convention stated, “To the fullest extent of the means available to it, the Occupying Power has the duty of ensuring and maintaining, with the co-operation of national and local authorities, the medical and hospital establishments and services, public health and hygiene in the occupied territory” (Article 56).

Consistent with this mandate, the role of the overseas military physician during the Vietnam War was formally expanded to include care to children in war-inflicted communities. This was further expanded during the Afghanistan and Iraqi wars. During the Iraq war, one-third of active-duty Army physicians were pediatricians. The first two military physicians to enter Iraq were pediatricians. “Stability operations are a core US military mission…given priority comparable to combat operations.” (DOD Directive 3000.05, 2005).  In the Afghanistan conflict, 15% of admissions were to under 18-year-old children accounting for 25% of hospital days. Admission diagnoses were approximately equally divided between nontrauma, noncombat trauma and combat trauma.   

Because of logistical challenges, capacity and mission-orientation, the world’s largest responder to humanitarian crises is the US military. During any natural or wartime disaster, children are instantaneously exposed and disproportionately vulnerable. U.S. military has, in the last several decades, stepped up to alleviate the immediate burden of care. A recent, non-combat example, of the humanitarian role of the military physician and support staff is the US Navy’s Pacific Partnership. This directly involves eight Pacific nations and ten partner nations. The Pacific Partnership was formed in response to Asian tsunami in which the US military’s swift response saved countless lives.  Since that time greater than 250,000 patients have received medical care, 37,000 animals have received veterinary care and 170 engineering projects have been completed.  Pediatricians comprise 25% of the medical staff. Forty percent of the medical interactions are within the pediatric age group.  Training for humanitarian response is now incorporated into medical curriculum at the Uniformed Services University of the Health Sciences and provides a medical service model worthy of expansion to our osteopathic medical education.

A fascinating review of history of the legacy of pediatric service in the US military by Mark Burnett, MD, and Charles Callahan, DO, can be accessed for free HERE. (Please also see the article by Dr. Callahan in this issue of the PULSE HERE)

Coppola book coverFor a blunt wartime perspective of a pediatric surgeon who served in Iraqi, a good read is Coppola, A Pediatric Surgeon in Iraq by Dr. Chris Coppola. Dr. Coppola is now a pediatric surgeon at Geisinger Medical Center in Danville, PA.

Military service and deployments do not come without consequences for families. Nearly half of military families move three times in a five-year period. Re-entering a household after periodic deployment absence of 8-12 months is fraught with difficulties. A quarter of combat-engaged deployed personnel report post-traumatic stress and psychological dysfunction. One-third of school-aged military family children suffer from clinically significant psychosocial morbidity. These, among other factors, should increase pediatricians’ sensitivity to the family and child’s needs. One of many good screening resources that are freely available is “A Toolkit for the Well Child Screening of Military Children."

Another good resource is Military Kids Connect. This Department of Defense sponsored online community is for 6-17 year old military family kids to connect directly in a constructive and age-appropriate environment. Resources that help guide children through pre-deployment, deployment, and parental return are age-appropriate and screened. Online peer-to-peer discussions are also available. There are also resources for parents and teachers and are available HERE.

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