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Child Health Guideline Identifier

Neglect of Medical Care

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This is a child focussed practice framework which is intended to be used as a guide.
This is a brief introduction to a national inter-agency guideline (Schedule 3 to the MOU between DHB, Oranga Tamariki and the Police)

Definition

Several factors are considered necessary for the diagnosis of medical neglect:

  1. a child or young person [age 0 - 16] is harmed or is at risk of harm because of lack of health care
  2. the recommended health care offers significant net benefit to the child
  3. the anticipated benefit of treatment is significantly greater than its morbidity, so that reasonable caregivers would choose treatment over non-treatment
  4. it can be demonstrated that access to health care is available, but not used
  5. the caregiver understands the medical advice given

Medical neglect usually takes one of two forms and either of these situations has the potential to be fatal or lead to chronic disability:

  • Failure to heed obvious signs of serious illness or
  • Failure to follow the health care plan from the Health Care Team, once medical advice has been sought. 

An effective response requires a comprehensive assessment of the child's needs, the parents' resources / understanding of basic health information and services to make appropriate health decisions (Health Literacy Kōrero Mārama, 2010), cultural/religious beliefs, parental effort to provide for the needs of the child and options for ensuring optimal health for the child. Such an assessment requires clear communication between parent / caregiver / family and involved health care providers / other professionals.

Principles for best practice when assessing neglect of medical care

Health Professionals (HP) must ask some key questions - is the child's health severely compromised by neglect of medical cares and what are the potential consequences for the child? Focussing on a child's needs rather than parental / caregiver omissions, is considered less blaming and more constructive.

Adequacy of care falls on a continuum from optimal to grossly inadequate. Neglect of medical care can place a child at minor risk of harm or at the other extreme high risk of severe disability or even death. Child, Youth and Family (CYF) are most often involved when the threshold has crossed into the severe end of this continuum. Neglect of medical care may become apparent over time and it is for this reason consideration of severity includes assessing and documenting all the contributing factors, including missed appointments for chronic/serious conditions and identifying a pattern when there are repeated episodes of neglect of medical care.

Assessment/Checklist tool for Health Professionals

It has been decided to use a 3 category 'Traffic Light' review process to assist Health Professionals (HPs) to collectively decide if neglect of medical care is occurring and when action is required.

GREEN: indicates parent/s or caregivers are currently meeting child's medical needs, but support is required for them to fully understand child's health needs -this section flags that there could be concerns, if appropriate support is not implemented.

Orange and Red are less common.

ORANGE: indicates all actions in Green have been implemented but there continues to be an on-going need for HPs to pay attention, assess and monitor situation

RED: indicates a need for action, consistent with your District Health Boards (DHB's) Child Protection Policy. 

References

  1. Jenny C; Committee on Child Abuse and Neglect, American Academy of Pediatrics. Recognizing and responding to medical neglect. Pediatrics. 2007 Dec;120(6):1385-9. 
  2. Memorandum of Understanding between Child Youth and Family, New Zealand Police and District Health Boards, August 2011 
  3. Powell C, Appleton J. Children and young people's missed health care appointments: reconceptualising "Did Not Attend' to 'Was Not Brought'. J. Res. Nurs. 2012;17(2):182-192
  4. Roe MF, Appleton JV, Powell C. Why was this child not brought? Arch Dis Child. 2015 Jun;100(6):511-2

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Document Control

  • Date last published: 13 June 2017
  • Document type: Clinical Guideline
  • Owner: Laurel Webb
  • Editor: Greg Williams
  • Review frequency: 2 years

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