underfed and other neglect issues

[TexasRose]

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I was wondering just how often the issue of underfed infants and other neglect issues come up for other people in peds. In my first week on the wards at a county hospital, we admitted one baby with marasmus (yes, marasmus), one who had only had watered down pedialyte for over a week (formula too $$, waiting for WIC), and one who had apparently only been fed sometimes (she gained a lb in 3 days with us). All 3 of these babies were between 6 and 12 weeks of age.

Is this as common as it would seem from my experience so far? I expected to see some cases of abuse and neglect, but this boggles my mind. My teenage patient whose family let a bad case of ingrown toenail go for over 2 months without treatment and is now waiting for us to rule out osteo is less of a surprise.

On the one hand it's very upsetting and I'm having a hard time not thinking about the particular baby in my care when I'm not at the hospital. OTOH, at least I feel like even the little bit I do as a med student is really helpful for these children

 

[TexasRose]

I'm replying to my own thread, how sad is that?

One of the patients I wrote about the other day went home with a new foster family today. In the last week with us she has gained a pound, learned to smile, and gotten a family who will hopefully take much better care of her.

 

[Hard24Get]

I'm replying to my own thread, how sad is that?

One of the patients I wrote about the other day went home with a new foster family today. In the last week with us she has gained a pound, learned to smile, and gotten a family who will hopefully take much better care of her.

I think it is very sad these days that people are having children without any thought for how they will care for them. On one hand it's a shame that it comes down to a money issue, but people really need to be more responsible, especially with all the free contraception available these days. I remember on my peds rotation there was this 1 yr old who basically hadn't been discharged because his mom barely visited - we weren't even sure she'd be back for him. They kept his stroller in the nurses area so he wouldn't be lonely, and everytime I had a break I would go there and just hold him and tell him I loved him. 🙁 It's just so cruel, and even though it has been years tears still come to my eyes when I think of it. Our hospital had a child abuse center- does yours or was it handled by your team?

 

[TexasRose]

Our hospital has a very good social work team, psych team, and a CPS liason. Things went pretty smoothly on our end. I think the hardest part was just finding placement for her. (medical issues)

It's hard not to get attached to the kids who obviously haven't had enough love and attention. I guess I'll get a little more used to it with time.

 

[LADoc00]

I was wondering just how often the issue of underfed infants and other neglect issues come up for other people in peds. In my first week on the wards at a county hospital, we admitted one baby with marasmus (yes, marasmus), one who had only had watered down pedialyte for over a week (formula too $$, waiting for WIC), and one who had apparently only been fed sometimes (she gained a lb in 3 days with us). All 3 of these babies were between 6 and 12 weeks of age.

Is this as common as it would seem from my experience so far? I expected to see some cases of abuse and neglect, but this boggles my mind. My teenage patient whose family let a bad case of ingrown toenail go for over 2 months without treatment and is now waiting for us to rule out osteo is less of a surprise.

On the one hand it's very upsetting and I'm having a hard time not thinking about the particular baby in my care when I'm not at the hospital. OTOH, at least I feel like even the little bit I do as a med student is really helpful for these children

I blame liberal politicians who closed down the orphanages and instituted the mad government welfare system that tries to keep babies with obviously unfit mothers. I have no sympathy for these parents, they are criminals. You should take the moral high ground and call the police or perform a citizen's arrest.

 

[oldbearprofessor]

I was wondering just how often the issue of underfed infants and other neglect issues come up for other people in peds. In my first week on the wards at a county hospital, we admitted one baby with marasmus (yes, marasmus), one who had only had watered down pedialyte for over a week (formula too $$, waiting for WIC), and one who had apparently only been fed sometimes (she gained a lb in 3 days with us). All 3 of these babies were between 6 and 12 weeks of age.

A couple comments for you. First, malnutrition among full-term, appropriate for gestational age infants is uncommon in the first 6 months of life anywhere in the world. In the US, it is uncommon because the WIC program, which provides free infant formula to families who need it, is the most successful such program anywhere in the world at virtually eliminating early infancy malnutrition. The cost of doing this, among other costs, is a decreased use of breast-feeding among lower income families who often have little motivation to breast feed when the formula is being delivered for free and they don't have access to adequate lactation support.

When infants in the US are malnourished in early life, it represents either a failure of the system or a very severe parenting issue. In some cases, especially among those not legally in the US or who have other legal, psychological or other issues, they may not be signed up properly for WIC. In other cases, they may simply, through ignorance or whatever, not have enough parenting skills to figure out how to feed their baby or be around enough to do it. Usually this doesn't happen because someone in the household will feed the baby to keep the baby quiet. Later in infancy this leads to overfeeding. Sometimes as the babies get older some families will dilute the formula inappropriately as the baby may be taking more than they are getting from WIC or the family is otherwise not properly using or mixing the formula. This is one reason why the iron content in infant formula is higher in the US than is needed or is used in Europe - to deal with the possibility of formula-dilution.

Among breast-fed babies, there can be early growth failure (and dehydration) late in the first week of life due to feeding issues (mom's milk not coming in, latch-on problems, severe jaundice, etc). After that, especially in developing countries, growth failure usually occurs after 6 months of age due to problems with recurrent infections and inappropriate or inadequate weaning foods.

I predict you will have the chance to learn about these sometime in the next year .

Regards

OBP