Dr.
Stevens was nearing the end of a 30-hour shift in the emergency room when he
walked into Charlie’s room. Before even conducting a physical examine, Dr.
Stevens immediately recognized this as a case of malnutrition. He knew that
after his examination, he would have to contact Child Protective Services.
Charlie
was a five-year-old African American boy. He sat listlessly on the bed
surrounded by his parents and grandmother. Dr. Stevens first noted the child’s
size: he was dramatically smaller than an average 5 year old. His hair was thin
and dull, his skin appeared dry and pallid, especially in comparison to his
parents rich, dark tones. Upon examination, the child was indeed drastically
underweight: he was in the 3rd percentile for age (26 lbs) and in
the 3rd percentile for linear growth (24”). His abdomen was
distended, he suffered from diarrhea, his nails were thin and ridged, and his
hair was brittle and falling out. Charlie did not have a pediatrician and had
not received routine care. Dr. Stevens also noted that Charlie was irritable
and was not responding socially as would a typical child his age. Physically
and socially, Charlie seemed more like a 2 or 3 year old.
Dr.
Stevens then turned to the child’s parents to confirm what he had already
diagnosed. The mother adjusted the La Leche League tote on her shoulder as she
glanced nervously from the nurse, to the doctor, to her son. The parents
were both tall and thin, though healthy looking. They had immigrated to the US
from Ghana about 10 years ago and retained much of their cultural garb. Not
surprising to Dr. Stevens, they also spoke little English. One glance from the
nurse confirmed what he had already suspected – noncompliance and defiance! He
sighed, realizing that his shift would be even longer than anticipated.
A brief
discussion with the parents revealed that Charlie was exclusively breast-fed. That
was enough for Dr. Stevens. Clearly the problem was that Charlie was not
getting the nutrients he needed because his parents were not feeding him. A 5
year-old child cannot survive on only breast milk! Dr. Stevens quickly demanded
that Charlie’s parents cease breastfeeding immediately, “...or we’ll have to
involve the authorities!”
Dr.
Kidley, a pediatric clinical psychologist, was brought in for a consultation
before Child Protective Services were called. Walking into the room, she could
feel the tension. She had been forewarned that this was a case of malnutrition
and that the parents were noncompliant, and she was expecting something quite
different from what she encountered. Both the parents and the grandparents,
though weary of the medical staff, were clearly greatly concerned over the
health of their son. They appeared loving and distraught – not the behavior of
parents who were starving their child. Dr. Kidley suspected something deeper
was going on here and suggested an ethics consultation.
*Written by Heidi Pieroni
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