Skip to main content

Advertisement

Log in

Understanding Medical Neglect: When Needed Care Is Delayed or Refused

  • Treatment Approach
  • Published:
Journal of Child & Adolescent Trauma Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • AAP Comm on Bioethics. (2013). Conflicts between religious or spiritual beliefs and pediatric care: Informed refusal, exemptions, and public funding. Pediatrics, 132(5), 962–965.

    Article  Google Scholar 

  • Belsky, J. (1980). Child maltreatment: An ecological integration. American Psychologist., 35, 320–335.

    Article  Google Scholar 

  • Bick, J., & Nelson, C. A. (2016). Early adverse experiences and the developing brain. Neuropsychopharmacology, 41(1), 177–196.

    Article  Google Scholar 

  • Dharmapuri, S., Best, D., Kind, T., Silber, T. J., Simpson, P., & D’Angelo, L. (2015). Health literacy and medication adherence in adolescents. Journal of Pediatrics, 166(2), 378–382.

  • Diekema, D. S., & American Academy of Pediatrics Committee on Bioethics. (2005) Responding to parental refusals of immunization of children. Pediatrics, 115(5), 1428–1431.

  • Dubowitz, H. (2002). Neglect of children’s health care. In J.E.B.Myers, L. Berliner J., Briere, C. Jenny, C.T. Hendrix, T. Reid, (Eds.), The APSAC Handbook on Child Maltreatment (pp. 262–292). Thousand Oaks, CA:Sage.

  • Dubowitz, H., Black, M., Starr, R., & Zuravin, S. (1993). A conceptual definition of child neglect. Criminal Justice and Behavior, 20(1), 2–26.

    Google Scholar 

  • Dyche, L., & Swiderski, D. (2005). The effect of physician solicitation approaches on ability to identify patient concerns. Journal of General Internal Medicine, 20(3), 267–270.

    PubMed  PubMed Central  Google Scholar 

  • Farrell, M. H., & Kuruvilla, P. (2008). Assessment of parental understanding by pediatric residents during counseling after newborn genetic screening. Archives of Pediatric and Adolescent Medicine, 162(3), 199–204.

    Google Scholar 

  • Fortin, K., Kwon, S., & Pierce, M. C. (2016). Characteristics of children reported to child protective services for medical neglect. Hospital Pediatrics, 6(4), 204–210.

    PubMed  Google Scholar 

  • Friedman, E., & Bilflick, S. B. (2015). Unintentional neglect: Literature review and observational study. Psychiatry Quarterly, 86(2), 253–259.

    Google Scholar 

  • Hickey, K. S., & Lyckholm, L. (2004). Child welfare versus parental autonomy: Medical ethics, the law, and faith-based healing. Theoretical Medicine and Bioethics, 25(4), 265–276.

    PubMed  Google Scholar 

  • Jaudes, P. K., & Diamond, L. J. (1986). Neglect of chronically ill children. American Journal of Diseases of Children, 140(7), 655–658.

    PubMed  Google Scholar 

  • Jenny, C. J. (2007). Recognizing and responding to medical neglect. Pediatrics, 120(6), 1385–1389.

    PubMed  Google Scholar 

  • Kolhatkar, G., & Berkowitz, C. (2014). Cultural considerations and child maltreatment: In search of universal principles. Pediatric Clinics of North America, 61(5), 1007–1022.

    PubMed  Google Scholar 

  • Kroger, A. T., Atkinson, W. L., Marcuse, E. K., Pickering, L. K., & Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention. (2006). General recommendations on immunization: Recommendations of the advisory committee on immunization practices (ACIP). MMWR Recommendations and Reports, 55(RR-15), 1–48.

    PubMed  Google Scholar 

  • Lansford, J. E., Godwin, J., Alampay, J. P., Tirado, M. U., Zelli, A., Al-Hassam, S. M., Bacchini, D., Bombi, A. S., Bornstein, M. H., Chang, L., Deater-Deckard, K., DiGunta, L., Dodge, K. A., Malone, P. S., Oburu, P., Pastorelli, C., Skinner, A. T., Sorbring, E., & Tapanya, S. (2015). Individual, family, and culture level contributions to child physical abuse and neglect: A longitudinal study in nine countries. Development and Psychopathology, 27(4 Pt 2), 1417–1428.

    PubMed  PubMed Central  Google Scholar 

  • Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). New York, NY: Guilford Press.

    Google Scholar 

  • Napoles-Springer, A. M., Santoyo, J., Houston, K., Perez-Stable, E. J., & Stewart, A. L. (2005). Patients’ perceptions of cultural factors affecting the quality of their medical encounters. Health Expectations, 8, 4–17.

    PubMed  PubMed Central  Google Scholar 

  • Omer, S. B., Salmon, D. A., Orenstein, W. A., deHart, M. P., & Halsey, N. (2009). Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. New England Journal of Medicine, 360(19), 1981–1988.

    PubMed  Google Scholar 

  • Opel, D. J., Heritage, J., Taylor, J. A., Mangione-Smith, R., Salas, H. S., DeVere, V., Zhou, C., & Robinson, J. D. (2013). The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics, 132(6), 1037–1046.

    PubMed  PubMed Central  Google Scholar 

  • Rhoades, D. R., McFarland, K. F., Finch, W. H., & Johnson, A. O. (2001). Speaking and interruptions during primary care office visits. Family Medicine, 33(7), 528–532.

    PubMed  Google Scholar 

  • Rule, A. R. L., Reynolds, K., Sucharew, H., & Volck, B. (2018). Perceived cultural competency skills and deficiencies among pediatric residents and faculty at a large teaching hospital. Hospital Pediatrrics, 8(9), 554–569.

    Google Scholar 

  • Salmon, D. A., Dudley, M. Z., Glanz, J. M., & Omer, S. B. (2015). Vaccine hesitancy: Causes, consequences, and a call to action. American Journal of Preventive Medicine, 49(6 Suppl 4), S391–S398.

    PubMed  Google Scholar 

  • SCOTUS, 1944, Prince v Massachusetts: 321 US 158. 170 (1944).

  • Sedlak, A.J., Mettenburg, J., Basena, M., Petta, I., McPherson, K., Greene, A., and Li, S. Fourth annual National Incidence Study of child abuse and neglect (NIS-4): Report to congress. Washington DC: US Department of Health and Human Services, Administration for Children and Families; 2010.

  • Spratt, E. G., Friedenberg, S., LaRosa, A., et al. (2012). The effects of early neglect on cognitive, language, and behavioral functioning in childhood. Psychology, 3(2), 175–182.

    PubMed  Google Scholar 

  • Teutsch, C. (2003). Patient-doctor communication. Medical Clinics of North America, 87(5), 1115–1145.

    PubMed  Google Scholar 

  • U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2016). Child maltreatment 2014. Available from https://www.acf.hhs.gov/sites/default/files/cb/cm2014.pdf. Accessed 3 May 2019.

  • UN Convention on the Rights of the Child. (1993) Available at www.unicef.org/crc (accessed May 30, 2018).

  • Williams, A.A., Wright, K.S. (2014). Engaging families through the techniques of motivational interviewing. Pediatric Clinics of North America, 61, 909–921. Retrieved from www.stopmandatoryvaccination.com (accessed May 30, 2018).

  • Zhang, N. J., Terry, A., & McHorney, C. A. (2014). Impact of health literacy on medication adherence: A systematic review and meta-analysis. Ann Pharmacotherapy, 48(6), 741–751.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to John Stirling.

Ethics declarations

Conflict of Interest

The author denies any conflicts of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stirling, J. Understanding Medical Neglect: When Needed Care Is Delayed or Refused. Journ Child Adol Trauma 13, 271–276 (2020). https://doi.org/10.1007/s40653-019-00260-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40653-019-00260-6

Keywords

Navigation