Medical neglect at a tertiary paediatric hospital |
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| Institution: | 1. Sydney Children’s Hospital Network, c/o Child Protection Unit, Sydney Children’s Hospital, High Street, Randwick, NSW 2031 Australia;2. UNSW School of Women’s and Children’s Health, c/o Department of Community Child Health, Sydney Children’s Hospital, Cnr Avoca and Barker Streets, Randwick, NSW 2031 Australia;1. Parenting and Special Education Research Unit, University of Leuven (KU Leuven), Leopold Vanderkelenstraat 32, Box 3765, 3000 Leuven, Belgium;2. Clinical Psychology, University of Leuven (KU Leuven), Faculty of Psychology and Educational Sciences, Tiensestraat 102, Box 3720, 3000 Leuven, Belgium;3. Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium;4. Center for Family Intervention Science, College of Nursing and Health Professions, Drexel University, 3020 Market Street, Suite 510, Philadelphia, PA, 19104, USA;1. Department of Psychology, University of Konstanz, 78567 Konstanz, Germany;2. Department of Educational Psychology and Curriculum Studies, Dar es Salaam University College of Education, 2329 Dar es Salaam, Tanzania;3. Vivo International, 78430 Konstanz, Germany;4. Department of Psychology, University of Bielefeld, 33501 Bielefeld, Germany;1. Centre for Child and Family Studies, Leiden University, The Netherlands;2. Clinical Psychology Unit, Leiden University, The Netherlands;3. Faculty of Law, VU University Amsterdam, The Netherlands |
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| Abstract: | Medical neglect is under-researched and the extent of the problem in Australia is unknown. We conducted a review of the referrals for medical neglect to the Child Protection Unit (CPU) at a tertiary children’s hospital in Sydney over a 5 years period, from 2011 to 2016, to determine what medical conditions are being referred, the reason for the medical neglect concern and whether cases are managed in line with American Academy of Pediatrics (AAP) guideline on medical neglect.61 cases of medical neglect were identified, constituting 4.1% of all referrals to the Child Protection Unit for physical abuse and neglect. There was a wide variety of medical conditions. Most were chronic medical conditions (87%). The top two medical conditions were chronic and complex multi-system disorders (37.7%) and endocrine disorders (18%). The majority of medical neglect were related to concerns that the caregivers were unwilling to follow medical advice (45.9%) or unable to provide necessary medical care (26.2%). In line with the AAP guideline on medical neglect, all cases were managed by addressing communication difficulties (100%) and resource issues were addressed in 80% of cases. A report to statutory child protection agencies was made in 50% of cases. Directly observed therapy and medical contracts were used in 30% and 26% of cases. We conclude that children with chronic medical conditions may be at risk of medical neglect. Communication difficulties were a factor in all cases. Statutory agency intervention is often required. |
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| Keywords: | Child maltreatment Child neglect Medical neglect Treatment nonadherence Caregiving burden Patient-physician relationship Child protective services |
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