Malnutrition and Medical Neglect
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BRIEF REPORT
Malnutrition and Medical Neglect Alexander Burford 1,2
&
Randell Alexander 3 & Carol Lilly 4
# Springer Nature Switzerland AG 2019
Abstract Anomalies found during the assessment of nutrition in children are common in pediatric practice, yet few articles address the intersection between malnutrition and medical neglect. The diagnosis of medical neglect requires several components including a) harm, or risk of harm due to lack of recommended health care, b) recommended care provides benefit significantly greater than potential risk, c) caregiver understands the medical recommendations; and d) has access to the recommended care, but fails to utilize it. Through the application of this definition to cases of malnutrition, considerations for diagnosing medical neglect when presented with malnutrition are reviewed. Cases include children with special healthcare needs, children exposed to selective diets, previously well children with severe malnutrition, and treatment-resistant failure to thrive. Obesity is a state of malnutrition, which may also involve neglect; in this instance, the “neglect” involves failure to supervise nutritional intake necessary for optimal functioning. Because many cases involve interactions with medical providers, the subsequent failure to follow medical advice regarding obesity management may also be considered medical neglect. This article reviews the relationship between medical neglect, nutritional deprivation, and over-nutrition to explore when a diagnosis of medical neglect may be applicable. Keywords Medical neglect . Nutrition . Children
The assessment of a child’s nutritional status, growth, and development are cornerstones of effective pediatric care. However, the relationship between abnormal nutrition and medical neglect is infrequently discussed in the literature. It is the obligation of caregiver(s) to provide adequate nutrition to children. From birth throughout childhood, caregivers work with health professionals to understand the goals and boundaries of adequate nutrition. Anomalies of nutrition and growth are commonly addressed in pediatric practice and occur for a myriad of reasons. When does treatment failure and
* Alexander Burford [email protected] 1
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
2
Present address: Oregon Health & Science University’s Pediatric Residency Program, 3181 SW Sam Jackson Park Rd. L-579, Portland, OR 97239, USA
3
Division of Child Protection and Forensic Pediatrics, University of Florida, Jacksonville, FL, USA
4
Department of Pediatrics Child Protection Team, University of South Florida, Tampa, FL, USA
persistence of these abnormalities constitute nutritional neglect? When do they constitute medical neglect? Malnutrition due to neglect is often characterized as failure to thrive in younger children where failure to provide adequate nutrition and nurturing results in the risk of poor health outcomes (Asano et al. 2015; Fellitti et al. 1998; Kerr et al. 2000; Lissau and Sørensen 1994; Mackn
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