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.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.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.
Belsky, J. (1980). Child maltreatment: An ecological integration. American Psychologist., 35, 320–335.
Bick, J., & Nelson, C. A. (2016). Early adverse experiences and the developing brain. Neuropsychopharmacology, 41(1), 177–196.
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.
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.
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.
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.
Friedman, E., & Bilflick, S. B. (2015). Unintentional neglect: Literature review and observational study. Psychiatry Quarterly, 86(2), 253–259.
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.
Jaudes, P. K., & Diamond, L. J. (1986). Neglect of chronically ill children. American Journal of Diseases of Children, 140(7), 655–658.
Jenny, C. J. (2007). Recognizing and responding to medical neglect. Pediatrics, 120(6), 1385–1389.
Kolhatkar, G., & Berkowitz, C. (2014). Cultural considerations and child maltreatment: In search of universal principles. Pediatric Clinics of North America, 61(5), 1007–1022.
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.
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.
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). New York, NY: Guilford Press.
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.
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.
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.
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.
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.
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.
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.
Teutsch, C. (2003). Patient-doctor communication. Medical Clinics of North America, 87(5), 1115–1145.
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.
Author information
Authors and Affiliations
Corresponding author
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
About this article
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
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40653-019-00260-6