Medical Neglect Allegations in the Context of Conflicted Divorce/Separation Child Custody: What Should the Health Care P
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TREATMENT APPROACH
Medical Neglect Allegations in the Context of Conflicted Divorce/Separation Child Custody: What Should the Health Care Provider Do? John Esper Wright 1,2 & Rachel K. Heinze 3 & Mary Ellen Wright 4
# Springer Nature Switzerland AG 2020
Abstract Pediatricians and child health providers face with situation in which families disagree about recommended treatments. Managing these disagreements is more challenging during periods of divorce or separation particularly when parents are in dispute over custody or medical decision-making. Parental disagreement exists along a continuum. General principles apply 1) the worse the conflict, the worse the outcome for children, 2) when conflict is combined with other factors such as separation, the outcome is often worse, and 3) the pediatrician/primary health care provider can mitigate this. This manuscript provides a review of the subject and suggestions for the practicing provider. Keywords Divorce . Custody . Medical neglect . Parental alienation . Cooperative co-parenting . Pediatric office policy . Communication
Parental divorce is undoubtedly one of the most significant events in a child’s life and may have `consequences on both immediate, and long term, growth, physical, emotional, and mental health. There has been a lot of research in this area, but children are never randomized to divorce/no divorce. Divorce has been discouraged by religion, political systems, and society for a long time because marriage has been thought of as the core for building a family. Consequently, divorce has in the past been accompanied by social stigmatization that may in turn contribute to negative effects. In the latter half of the twentieth century, divorce has begun to be accepted as a social normality (Auersperg et al. 2019).
* John Esper Wright [email protected] 1
Department of Pediatrics, East Carolina Brody School of Medicine, Greenville, NC, USA
2
TEDI BEAR CAC Brody School of Medicine, East Carolina University, 2303 Executive Circle, Mail Stop 687, Greenville, NC 27834-435A, USA
3
Department of Pediatrics, University of Wisconsin School of Medicine, Madison, WI, USA
4
Clemson University School of Nursing, Clemson, SC, USA
Pediatricians and Child Healthcare Providers encounter families with varying degrees of security vs. conflict. We should be very sensitive at detecting conflict and attenuating its effect on the child’s experiences. Divorce and separation are so common that we should be very skilled at taking a relationship history and assessing the current risk for conflict. Additionally, we should be sensitive to the effects of conflict on the child’s emotional and physical/medical wellbeing. Just like other adverse childhood experiences, parental divorce has been shown to have a negative association on depression, anxiety, distress, suicide (attempts and ideation), alcohol, drug consumption and smoking (ibid). However, the trend is that more recent studies show a weaker effect. Only a small number of studies in the meta-analysis reported the timing
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