Understanding Medical Neglect: When Needed Care Is Delayed or Refused
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TREATMENT APPROACH
Understanding Medical Neglect: When Needed Care Is Delayed or Refused John Stirling 1
# Springer Nature Switzerland AG 2019
Abstract Though the most common form of child maltreatment, neglect can prove among the hardest to diagnose, and intervention is equally difficult. In considering neglect of a child’s medical needs, a number of factors play important roles. Diagnosis should be motivated foremost by the intent of providing the best ongoing care for the patient, supplying what the child has not been able to receive from the caregiver. Characteristics peculiar to the patient, the parents, the pathologic condition, its possible treatments, and the mutual understanding between the child’s caregivers and the treating professionals all help determine why the therapeutic relationship has failed and which interventions will be most effective. Religious and cultural considerations may lead a family to refuse medical treatments, occasionally to the child’s detriment. The caregivers’ wishes must be taken into account, but legal precedent has affirmed that the patient’s welfare remains the paramount concern. Sorting through the opinions and providing clarity can be a challenge. Finally, good medical care can help prevent medical neglect in many cases. Clear communication and empathy remain hallmarks of good medical practice. Keywords Neglect . Medical neglect . Child abuse . Child maltreatment . Refusal of medical care . Refusal of vaccination
The parent’s responsibility to care for a dependent child is one of the earliest and most universal mandates of civilization, but not all parents can provide everything that their offspring need. For some, the omission is involuntary and even unavoidable, as after natural disasters or incapacitation; for others, it may appear as if the neglect could have been avoided, had the parent acted differently. If a child’s suffering can be avoided, something must be done. Neglect is the most common form of child maltreatment, constituting 3 of every 4 calls to Child Protective Services (CPS) and a similar percentage of substantiated cases. Though it rarely involves a deliberate attempt to harm a child, neglect is not a benign form of abuse. The 2016 survey by the U.S. Children’s Bureau’s National Child Abuse and Neglect Data System (NCANDS) survey (US Department of Health and Human Services 2016) identified 75% of child abuse fatalities as the outcome of caretaker neglect. Nor are the long-term consequences minor. Early neglect has been
* John Stirling [email protected] 1
Chadwick Center for Children and Families, Rady Children’s hospital, 3665 Kearney Villa Rd, San Diego, CA 92123, USA
associated with widespread impairments in language, emotional self-regulation, cognition, and even in later adult physical health (Bick and Nelson 2016; Spratt et al. 2012). When medical needs are neglected, the deleterious consequences are often more immediate, and more often fatal. In 2016, while medical neglect accounted for only 2% of calls to CPS, it accounted for 5.7% of all c
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