Stupidity vs abuse

[squad41]

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Had a question for the SDN familly. Im a 3rd year med student, the lady of the house is a PT. She has to deal with her fair share of difficult pts in her role as a Peds PT. I remember reading a story a few years ago on SDN about a seemingly well intentioned mom who was advised on d/c from the ED to treat the kid's cough with a hot humidifier. she's broke, so decides to boil a vat of water next to the kid. The kid falls into the vat of boiling water and suffers severe burns. Clearly an idiot, clearly something that should have been seen coming but.....where's the line? So the question I have is...

Where is the line between someone who means well but is just a total ***** and someone that must get reported? We're not talking about the folks who are sociopaths that clearly must be removed from their children---but I can think of case after case from the ED before starting med school of parents who seemed to be good people but just unbelievably stupid and their kids suffer one way or another.

Thoughts?

 

[pseudoknot]

If a case is borderline, just report it and move on. Reporting something to social services does not mean automatic removal. They will talk to everyone involved and try to come up with a solution to ensure the child's safety while preserving the family if possible. Removal is a very rare measure that is used only in extreme circumstances.

 

[halethsonofhama]

I like the "things I learned from my patients" thread where apparently Yoo Hoo chocolate drink (not milk, but drink) is not an effective and recommended baby formula.

 

[Stitch]

Had a question for the SDN familly. Im a 3rd year med student, the lady of the house is a PT. She has to deal with her fair share of difficult pts in her role as a Peds PT. I remember reading a story a few years ago on SDN about a seemingly well intentioned mom who was advised on d/c from the ED to treat the kid's cough with a hot humidifier. she's broke, so decides to boil a vat of water next to the kid. The kid falls into the vat of boiling water and suffers severe burns. Clearly an idiot, clearly something that should have been seen coming but.....where's the line? So the question I have is...

Where is the line between someone who means well but is just a total ***** and someone that must get reported? We're not talking about the folks who are sociopaths that clearly must be removed from their children---but I can think of case after case from the ED before starting med school of parents who seemed to be good people but just unbelievably stupid and their kids suffer one way or another.

Thoughts?

Most people should have been born sterile. 😛

In the case you describe, it's pretty stupid, but not abuse, if that's really what happened. The kid should have splash marks and a burn pattern consistent with that story (rather than a kid who was dipped into hot/boiling water). That line can be difficult to define however. How about a 13 year old diabetic that keeps coming in with DKA? Most of these cases are teased out on an individual basis, and there's an entire boarded pediatrics fellowship dedicated to sorting out abuse cases.

I once had a one year old who weighed what a two month old weighs at the 50th percentile. Parents claimed stupidity; they 'didn't know' how much to feed the kid. That's neglect/abuse and they got jail time accordingly.

If you have any concerns, the case needs to be reported and social work/CPS may investigate. You are protected (at least in the U.S.) from retaliation for reporting, and can even be charged for NOT reporting.

 

[Perrotfish]

At least in Louisiana, the problem is not how to keep CPS from over reacting.

 

[EctopicFetus]

In the end CPS's job is to protect kids not just from abusive parents but really dumb ones too. For the most part for the dumb ones they try to educate them and help them out cause the states dont want or need more foster kids.

 

[bartleby]

If you have any concern for abuse or neglect, you are mandated by law in nearly all states to report the case to protective services. Your job is not to be judge and jury at 3am when you half half the story (at best) and often incomplete collateral evidence. The personal and legal fallout from failing to report a case which turns out to be abuse is severe. A local family physician has gotten so jammed up from a case of failing to report based on a mother's statement to him that he has actually been charged criminally for failing to report. If you think that a malpractice case will cramp your style, try getting your picture in the newspaper on that charge. The department of public health hasn't even started in on him yet.

There are other means to address the failings of protective services which are more effective and less hazardous to your license and liberty such as direct lobbying of the legislature, research, and professional advocacy.