Would you report this to CPS?

[sanityonleave]

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http://scienceblogs.com/insolence/2012/05/25/selling-bleach-as-a-cure-for-autism/

The whole quackery movement has one-upped themselves this time -- a new group is advocating bleach solutions (both PO and enemas). Apparently the vomiting, diarrhea, and fevers as a side effect are signs that the "body is waking up to the fact that autism is in the house" and "cleansing itself." For those to lazy to read the article, here's one of the anecdotes mentioned:

My 14YO son has autism. ... He is nonverbal and fairly low-functioning, so I don't get any feedback from him as to how he is feeling. Last week, I started him on 1 drop of MMS then upped the dose to 1 drop, 2x a day this week. After about 4 days at 2 drops/day, he vomited once and had diarrhea all day. I am assuming it is the MMS. I decided to drop down to 1 drop/day again until he gets beyond this. He tends to have loose stools anyway, which I am guessing is related to this ongoing battle with the parasites. His gut tends to be very sensitive to anything I give him, so I have to go very carefully with anything new like the MMS. I am still giving him the other parasite cleanse (Systemic Formulas VRM 1-4). I would love to hear anyone's ideas or insight into this. ...

My question -- if you had a parent come in and tell you as a physician that they were doing this sort of therapy to their child, could you report them to child protective services? This without a doubt constitutes physical and psychological abuse.

 

[seelee]

http://scienceblogs.com/insolence/2012/05/25/selling-bleach-as-a-cure-for-autism/

The whole quackery movement has one-upped themselves this time -- a new group is advocating bleach solutions (both PO and enemas). Apparently the vomiting, diarrhea, and fevers as a side effect are signs that the "body is waking up to the fact that autism is in the house" and "cleansing itself." For those to lazy to read the article, here's one of the anecdotes mentioned:

My 14YO son has autism. ... He is nonverbal and fairly low-functioning, so I don’t get any feedback from him as to how he is feeling. Last week, I started him on 1 drop of MMS then upped the dose to 1 drop, 2x a day this week. After about 4 days at 2 drops/day, he vomited once and had diarrhea all day. I am assuming it is the MMS. I decided to drop down to 1 drop/day again until he gets beyond this. He tends to have loose stools anyway, which I am guessing is related to this ongoing battle with the parasites. His gut tends to be very sensitive to anything I give him, so I have to go very carefully with anything new like the MMS. I am still giving him the other parasite cleanse (Systemic Formulas VRM 1-4). I would love to hear anyone’s ideas or insight into this. ...

My question -- if you had a parent come in and tell you as a physician that they were doing this sort of therapy to their child, could you report them to child protective services? This without a doubt constitutes physical and psychological abuse.

The most unfortunate thing is that this mom likely would not be bringing her child into the pediatricians office. She would likely not ask his advice or even admit that she is doing this. These holistic websites not only promote their own quackery but try to engender distrust of the mainstream medical community.

If she did admit it to me, I would try to talk her out of it. Perhaps order some labs for good measure (check lytes at least to rule out pH imbalance, maybe a CBC and stool path to set mom's mind at ease if she thinks that he has parasitic infections (what the what???)). Then schedule a quick follow up. If the behavior persists, and if the child is having vomiting and diarrhea as a result of this then yes I would contact CPS.

 

[Wheatley]

These idiot parents may not see a pediatrician, but they did have to see a psychiatrist to get the autism diagnosis in the first place. The best way to squash this is to inform all psychiatrists to denounce quackery like this at the very beginning.

 

[BigRedBeta]

http://scienceblogs.com/insolence/2012/05/25/selling-bleach-as-a-cure-for-autism/

The whole quackery movement has one-upped themselves this time -- a new group is advocating bleach solutions (both PO and enemas). Apparently the vomiting, diarrhea, and fevers as a side effect are signs that the "body is waking up to the fact that autism is in the house" and "cleansing itself." For those to lazy to read the article, here's one of the anecdotes mentioned:

My 14YO son has autism. ... He is nonverbal and fairly low-functioning, so I don't get any feedback from him as to how he is feeling. Last week, I started him on 1 drop of MMS then upped the dose to 1 drop, 2x a day this week. After about 4 days at 2 drops/day, he vomited once and had diarrhea all day. I am assuming it is the MMS. I decided to drop down to 1 drop/day again until he gets beyond this. He tends to have loose stools anyway, which I am guessing is related to this ongoing battle with the parasites. His gut tends to be very sensitive to anything I give him, so I have to go very carefully with anything new like the MMS. I am still giving him the other parasite cleanse (Systemic Formulas VRM 1-4). I would love to hear anyone's ideas or insight into this. ...

My question -- if you had a parent come in and tell you as a physician that they were doing this sort of therapy to their child, could you report them to child protective services? This without a doubt constitutes physical and psychological abuse.

As a peds resident, my general viewpoint is that if I have to ask myself "should I?" then it needs to be reported. Let CPS evaluate, and they'll make a decision. Certainly this mother you quoted isn't doing this because she wants to hurt her child, but because she's tried everything else. In her mind, she's doing it out of love, however misguided the advice she's following may be. But our duty is to protect those who can't protect themselves, and certainly this non-verbal child can't do that.

 

[pkwraith]

These idiot parents may not see a pediatrician, but they did have to see a psychiatrist to get the autism diagnosis in the first place. The best way to squash this is to inform all psychiatrists to denounce quackery like this at the very beginning.

Maybe. I wouldn't be terribly surprised if parents like that self-"diagnose" their kids based on internet or media.

 

[jcu]

If she did admit it to me, I would try to talk her out of it. Perhaps order some labs for good measure (check lytes at least to rule out pH imbalance, maybe a CBC and stool path to set mom's mind at ease if she thinks that he has parasitic infections (what the what???)). Then schedule a quick follow up. If the behavior persists, and if the child is having vomiting and diarrhea as a result of this then yes I would contact CPS.

When it comes to this particular scenario, as a physician, it's NOT your job to try to change an abusive parent's behavior. You can (and should) order labs and work up the patient but if a child is in danger, intentional or otherwise, it is your obligation to report it. Immediately. That's it. Because if you give the mom a chance (and the behavior does persist), and the child comes into the ED with severe dehydration or worse, you can lose your license. Like BRB above said, CPS makes their own evaluations and decides whether or not the parents are fit. It's not our job to do so.

 

[Rothbard]

nm

 

[jcu]

Just like diagnostic tests and medical interventions, reporting to CPS is not without side effects. The juvenile protection system in this country is atrocious, and should only be used as a last resort. Children removed from their houses and taken into custody are regularly abused and suffer lasting psychological and physical harm.

If there's evidence that the child is suffering permanent injury, then I would report. Otherwise, simply continue to monitor the situation. The child may not be in an ideal environment, but that doesn't mean that you have the power to change things for the better.

How exactly would you define permanent injury? Should neglect or verbal abuse be permissible since the damage isn't "permanent" or overt? I know CPS isn't a perfect system, but we're doctors. We're not law enforcement or government officials. As such, it isn't our job to quantify levels of abuse - it's THEIRS. And is a child better suited to stay with a neglectful family vs. the potential for an abusive foster family? We simply don't have the means to investigate these matters. Nor should we. Just report in the best interest of the child and let the appropriate agencies do their jobs.

 

[seelee]

When it comes to this particular scenario, as a physician, it's NOT your job to try to change an abusive parent's behavior. You can (and should) order labs and work up the patient but if a child is in danger, intentional or otherwise, it is your obligation to report it. Immediately. That's it. Because if you give the mom a chance (and the behavior does persist), and the child comes into the ED with severe dehydration or worse, you can lose your license. Like BRB above said, CPS makes their own evaluations and decides whether or not the parents are fit. It's not our job to do so.

Obviously it's a judgement call. I would try to gauge the parent's thought process and rationale. It is entirely plausible that this is something that she heard about and decided to try, and was unaware of possible side effects. If that is the case, then educating her could resolve the situation.

If this is someone who is being dogmatic about these treatments, and is unwilling to heed sound medical advice, then I would contact the ethics committee, legal department and contact CPS if necessary.

 

[Alvarez13]

As a peds resident, my general viewpoint is that if I have to ask myself "should I?" then it needs to be reported. Let CPS evaluate, and they'll make a decision. Certainly this mother you quoted isn't doing this because she wants to hurt her child, but because she's tried everything else. In her mind, she's doing it out of love, however misguided the advice she's following may be. But our duty is to protect those who can't protect themselves, and certainly this non-verbal child can't do that.

👍

 

[BigRedBeta]

Just like diagnostic tests and medical interventions, reporting to CPS is not without side effects. The juvenile protection system in this country is atrocious, and should only be used as a last resort. Children removed from their houses and taken into custody are regularly abused and suffer lasting psychological and physical harm.

If there's evidence that the child is suffering permanent injury, then I would report. Otherwise, simply continue to monitor the situation. The child may not be in an ideal environment, but that doesn't mean that you have the power to change things for the better.

Most states have mandatory reporting laws for healthcare professionals who have suspicions or reasons to believe abuse is occurring. That may also include knowledge that conditions would reasonably result in harm - whether that can be proven or not is irrelevant. What Rothbard has advocated opens physicians to criminal and civil liability if further injury happens. While the foster care system has many, many flaws, none of the risks are absolute and our duty is to the patient to remove them from a suspected harmful situation. Peds residents typically learn early on that admission to the hospital is always an option if you're worried about a child.

 

[link2swim06]

The even more interesting thing is if you take custody of the child right then.

I remember when listening kaplan review for step 1, they said the "correct" thing if you suspect abuse is to literally pick the kid up, take him/her out of the exam room and take custody until CPS arrives.

 

[SpecterGT260]

Great.... now I go to bed depressed... thanks OP.

 

[SpecterGT260]

These idiot parents may not see a pediatrician, but they did have to see a psychiatrist to get the autism diagnosis in the first place. The best way to squash this is to inform all psychiatrists to denounce quackery like this at the very beginning.

I can't take anything you say seriously... and yes it is your name and avatar...

 

[Wheatley]

I can't take anything you say seriously... and yes it is your name and avatar...

Is this a hate crime? I feel like a victim of a hate crime. Thanks for the hate crime Specter!

 

[seelee]

Obviously it's a judgement call. I would try to gauge the parent's thought process and rationale. It is entirely plausible that this is something that she heard about and decided to try, and was unaware of possible side effects. If that is the case, then educating her could resolve the situation.

If this is someone who is being dogmatic about these treatments, and is unwilling to heed sound medical advice, then I would contact the ethics committee, legal department and contact CPS if necessary.

On second thought, if it was clear that the parent was going to continue treatment. I would admit the child to the hospital for work up and get a social work/cps consult.