Child Maltreatment

Incident Overview

• Mother expressed concern about infant vomiting while at the nurse's station.

• Observations made revealed mother was pouring formula onto the floor without regard for the infant.

• Evidence captured showing formula hitting the floor, indicating neglect in feeding.

Observation of Caregiver Behavior

• Caregiver was observed to not dress the infant properly, leaving only a diaper.

• Infant was found to be crying and left unattended for periods.

• When the caregiver interacted with medical personnel, her demeanor changed to be overly caring.

Diaper Management

• Caregiver was instructed to keep track of the infant's diapers due to reported urinary concerns.

• Observed disposing of a wet diaper into trash despite claims of dry diapers.

• Nurses noted a discrepancy in caregiver's reporting of wetness and actual condition.

Response to Concerns

• A report was made to the Department of Child Services (DCS) regarding potential neglect.

• Infant underwent monitoring in the hospital for two days for medical evaluation and testing.

• Both the infant and an older sibling were detained for safety reasons.

Understanding Medical Child Abuse

• Medical child abuse defined as providing unnecessary or harmful medical care instigated by a caregiver.

• Associated with false information or induced symptoms.

• Recognized by DSM-5 as fictitious disorder imposed on another.

Guidelines and Procedures

• Current guidelines were updated in 2017; applicable to healthcare providers, law enforcement, and childcare professionals.

• Clinical presentations can vary widely, emphasizing the need for suspicion and thorough investigation.

The Importance of Accurate Documentation

• Stress on the necessity of clear and accurate medical records.

• Medical professionals need to correlate caregiver reports with objective findings from medical evaluations.

• Highlighted the significance of reviewing social media to gather additional context about caregiver behavior.

Collaborative Efforts with Child Services

• Challenges faced by Child Protective Services (CPS) in distinguishing between medical neglect and medical child abuse.

• Example provided of a reporting template developed to organize findings for better understanding.

Identifying and Understanding Cases

• Recommendations for identifying potential medical child abuse include assessing credibility and necessity of care.

• Importance of being aware of potential caregiver confusion versus intentional deception.

Resource Recommendations

• Suggested listening to a podcast on Munchausen syndrome for further insight, shared among nurses for educational purposes.

• Mention of support resources available for families and professionals facing similar situations.

Focus on Child Safety

• Emphasis on prioritizing child safety over diagnosing caregiver behavior.

• Suggested that healthcare professionals consult with child protection experts when suspicions arise.

• Importance of differentiating objective medical findings from subjective caregiver reports to protect vulnerable children.