Журнал «Здоровье ребенка» 6 (49) 2013

Medical neglect is the postponement or denial of necessary medical care for child by the parents, whichmaycause substantialharm tothe health ofthe child andthreatenedhis life.Medical neglect includes not only serious, but mild and moderate medical neglect as well. There are 3 forms of medical neglect: 1)delaymedical care- the parentsare oblivious to theobvious symptomsof severe illnessin the childordon’t bring the childto the doctorfor regularmedical check-up, or do not provide preventive care for child; 2)irregularmedical careof chronicallyill children- nonadherence(the parentsdo not comply withthe treatment regimen for child, do not give him medicineon the specified time or full dose, do not fulfill the recommendationson nutritionand storage ofmedications); 3)denialofmedical care- the parentsdeliberatelyrefuse toperform medicaladviceor not able tofollow the recommendationsfor the treatment ofa child orensure the provision ofappropriate assistance in thedeterioration of thehealth of the child.

Medicalneglectis often observedin children with severeincurabledisease,in childrenwith congenital malformations or in children who have psychomotororcognitive developmental delays. Medical neglect canbe caused bypsychological crisisand frustration in parentsas a result ofan untreated serious physical or psychological illness or injuryillness in a child. Risk factors of medical neglect: highly stressful family situations, single parent family, multi-child family, recent marital problems, isolation of family, parents with alcohol or drugaddiction,mental retardation, social immaturity, depression, mental or psychologicaldisorders thatare characterized byindifferenceorinabilityto empathize. There are othercauses ofmedicalneglectlike lack of awareness ofparents about theproblem, the lack of sufficientgeneral knowledge andculture(including the lack of knowledgeabout hygieneandhealth), distrust ofdoctorsand lack ofpartnershipwith medical professionals.

Diagnosis of medical neglect in children always requires convincing evidence according to the following criteria: 1) lack of medical care is harming a child or is a potential risk to the health or life; 2) the recommended medical care is obvious or proven positive effect on the health of the child; 3) it is proved that the proposed medical care is available, but not used;4) is obvious, including the parent of that treatment (prophylaxis) has more advantages than the natural course of the disease; 5) the doctor has given to the parents clear and understandable medical advice.

National standardsof care andclinical protocolshaveproved thatmedical interventionis really necessary(it hasan obviousor proveneffect).Localclinical protocolsprovide an indication ofaccess to health care. Urgentmedicalproblemisthe establishment of clearcriteria /indicatorswhichaidin certain diseases, provided byparents,should be considered asinsufficient. Health professionals shouldadviseparents.The counselingshouldberecordedin the medicaldocuments.In somecases, physiciansshould get aparents’signaturesconfirming thatthey are informedandaware of theirresponsibility to provide the certain care andtreatment to their child.

In thecollectionof evidence, thatparents do nothaveadequate medical careof children’s chronic diseases, shouldbe involved notonlymedical professionals, but also social workers-members of themultidisciplinary team.

Prevention of medical neglect involves the use of clear algorithms of counseling. Parents need to understand that their child needs help, and be able to provide their assistance. Algorithms need help parents at different stages of the medical management of the disease (diagnosis, early treatment, support adherence to treatment, etc.). Physicians should be having different algorithms of counseling at different stages of the medical management of the disease (diagnosis, early treatment, support adherence to treatment, etc.). Medicalstaff needs to teach parents how to treat chronically ill children at home. The start oftreatment of the childcan be performedunder the direct supervisionat home orin the hospital(Directly Observed Therapy - DOT). The multidisciplinaryteam shouldprovide parents withpsychologicalhelp and supportto ensure accessto medical specialists. In thehospitalmustbean effective systemofreferring tothe required specialists.Health professionalsshould be aware ofthe possibilities ofnon-medicalassistance to familiesaffected child, include social resourcesof governmentaland non-governmentalorganizations, parents' associationsand others.

Medicalneglectis a medicaland social problem. The algorithmincludes socialassistance to the childto protect him. Pediatriciansandfamily physiciansshould alwaysactin the interests ofthe child.If parentsdo not provide adequatechildcare, the health care providers shouldtake a number ofactions aimedat identifying andaddressing the causesof medicalneglect. Physicians should consider the optimal options for managing cases of medical neglect that ensure the health and safety of the child.