Addressing Over-Medicalization in Children with Medical Complexity

  • Colleen MartyEmail author
  • Justin C. Alvey
  • Kilby Mann
  • Nancy A. Murphy
Pediatric Rehabilitation Medicine (A Houtrow and M Fuentes, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Pediatric Rehabilitation Medicine


Purpose of Review

Children with medical complexity (CMC) are at risk for over-medicalization and medical child abuse. Their multiple diagnoses, medical complexities, and functional limitations require providers to partner with parents in their care. Even in the context of shared decision-making, over-medicalization and medical child abuse can occur.

Recent Findings

We define over-medicalization and medical child abuse as related to the care of CMC, present strategies to prevent, identify, and address shared provider-parent decision-making, and review ethical principles that can guide care decisions.


Complex pediatric care programs designed specifically for CMC promote care of the highest value for CMC through longitudinal documentation of comprehensive assessments and detailed care plans. Goal-directed care—focused on the child’s function and quality of life and the family’s values and preferences—offers opportunities to prevent, identify, and manage over-medicalization and medical child abuse.


Children with medical complexity (CMC) Over-medicalization Medical child abuse (MCA) 



Antoinette Laskey, MD [1] is acknowledged for her contribution to the concept for this paper.

Compliance with Ethical Standards

Conflict of Interest

Colleen Marty, Justin Alvey, Kilby Mann, and Nancy Murphy declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Cohen E, Berry JG, Sanders L, Schor EL, Wise PH. Status complexicus? The emergence of pediatric complex care. Pediatrics. 2018;141(Suppl 3):S202–11.CrossRefGoogle Scholar
  2. 2.
    Kelly AF, Hewson PH. Factors associated with recurrent hospitalization in chronically ill children and adolescents. J Paediatr Child Health. 2000;36(1):13–8.CrossRefGoogle Scholar
  3. 3.
    Donohue PK, Williams EP, Wright-Sexton L, Boss RD. “It’s relentless”: providers’ experience of pediatric chronic critical illness. J Palliat Med. 2018;21(7):940–6.CrossRefGoogle Scholar
  4. 4.
    •• Bass C, Glaser D. Early recognition and management of fabricated or induced illness in children. Lancet. 2014;383(9926):1412–21 This article discussed risk factors and red flags for fabricated and induced illness in children with and without medical complexity.CrossRefGoogle Scholar
  5. 5.
    •• Coon ER, Quinonez RA, Moyer VA, Schroeder AR. Overdiagnosis: how our compulsion for diagnosis may be harming children. Pediatrics. 2014;134(5):1013–23 This article explores the contribution of medical care providers in overdiagnosis and over-medicalization.CrossRefGoogle Scholar
  6. 6.
    Ralston SL, Schroeder AR. Why it is so hard to talk about overuse in pediatrics and why it matters. JAMA Pediatr. 2017;171(10):931–2.CrossRefGoogle Scholar
  7. 7.
    Coon ER, Young PC, Quinonez RA, Morgan DJ, Dhruva SS, Schroeder AR. 2017 update on pediatric medical overuse: a review. JAMA Pediatr. 2018;172(5):482–6.CrossRefGoogle Scholar
  8. 8.
    •• Petska HW, Gordon JB, Jablonski D, Sheets LK. The intersection of medical child abuse and medical complexity. Pediatr Clin N Am. 2017;64(1):253–64 This article offers an approach to identifying and addressing medical child abuse in children with medical complexity, including offering guidance on case review strategies and documentation.CrossRefGoogle Scholar
  9. 9.
    Yates G, Bass C. The perpetrators of medical child abuse (Munchausen syndrome by proxy) - a systematic review of 796 cases. Child Abuse Negl. 2017;72:45–53.CrossRefGoogle Scholar
  10. 10.
    Marty CM, Carter BS. Ethics and palliative care in the perinatal world. Semin Fetal Neonatal Med. 2018;23(1):35–8.CrossRefGoogle Scholar
  11. 11.
    •• Adams RC, Levy SE, Council on children with D. Shared decision-making and children with disabilities: pathways to consensus. Pediatrics. 2017;139(6). Offers the American Academy of Pediatrics position on the importance of shared decision-making in pediatrics and strategies for implementation in children with disability. Google Scholar
  12. 12.
    Gillam L. The zone of parental discretion: an ethical tool for dealing with disagreement between parents and doctors about medical treatment for a child. Clin Ethics. 2015;11(1):1–8.CrossRefGoogle Scholar
  13. 13.
    Hauer J. Caring for children who have severe neurological impairment: a life with grace. Baltimore: Johns Hopkins University Press; 2013.Google Scholar
  14. 14.
    Adams S, Cohen E, Mahant S, Friedman JN, Macculloch R, Nicholas DB. Exploring the usefulness of comprehensive care plans for children with medical complexity (CMC): a qualitative study. BMC Pediatr. 2013;13:10.CrossRefGoogle Scholar
  15. 15.
    Jurgens V, Spaeder MC, Pavuluri P, Waldman Z. Hospital readmission in children with complex chronic conditions discharged from subacute care. Hosp Pediatr. 2014;4(3):153–8.CrossRefGoogle Scholar
  16. 16.
    Barnert ES, Coller RJ, Nelson BB, Thompson LR, Chan V, Padilla C, et al. Experts’ perspectives toward a population health approach for children with medical complexity. Acad Pediatr. 2017;17(6):672–7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Colleen Marty
    • 1
    Email author
  • Justin C. Alvey
    • 1
  • Kilby Mann
    • 1
  • Nancy A. Murphy
    • 1
  1. 1.Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUSA

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