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‘Medical child abuse’ lacks adequate standards, guidelines

One of the highest responsibilities medical professionals hold is to recognize and report child abuse. An in-depth Globe series, however, exposes how little guidance and assistance doctors and nurses receive from the state about keeping young patients safe from “medical child abuse,” an ill-defined umbrella term used when parents are suspected of acting against the best interests of their child in a medical setting.

Medical child abuse is the modern-day equivalent of what was once known as Munchausen by proxy, a mental disorder in which a parent may intentionally sicken a child in a bid for attention or sympathy. The Globe series focused on Justina Pelletier, a 15-year-old Connecticut girl who has been in state custody at Children’s Hospital for 10 months, much of that time in a locked psychiatric ward, after doctors accused her parents of endangering her by seeking treatment for a rare metabolic disorder. Children’s believes she needs psychiatric help instead. The hospital alerted the state’s child protection agency after Justina’s parents threatened to discharge her.


In this difficult case, few details add up — not the least why Justina has been kept from her doctors at Tufts Medical Center, who referred her to Children’s in the first place; one of them is now on staff at Children’s. A juvenile court judge ruled on Friday that the state will retain temporary custody of Pelletier, but an additional hearing is scheduled to take place on Jan. 10.

What is now evident, though, is how very few guidelines exist for the handling of such cases. Given an apparent rise in the number of children being removed from their parents’ custody due to suspicions of medical child abuse, this is the rare situation in which assembling a blue-ribbon panel of medical and child-protection experts as well as attorneys could help dramatically in providing standards for ensuring a child’s best interest. A good start would be establishing a clear, systematic approach for identifying medical child abuse. Such cases will always involve some subjectivity, but right now medical professionals are left to blindly use their own judgment. Parents feel powerless.

More immediately, however, the state Department of Children and Families must expand its medical expertise, which is severely lacking. Because of this deficit, the agency is forced too often to rely on recommendations of prominent hospitals like Children’s without independent confirmation. DCF is currently depending on slapdash consultations on a case-by-case basis and a part-time staff of one pediatrician, one psychiatrist, and a handful of nurses to cover the entire state. Lawmakers in 2006 approved $1 million in spending to bolster DCF’s Health and Medical Services team, including the hiring of a physician to serve as medical director. That position should now be fast-tracked. In the meantime, Justina Pelletier and other children like her wait in limbo.