Health Care Providers' Perspectives on COVID-19 and Medical Neglect in Children with Life-Threatening Complex Chronic Conditions

Child maltreatment in children with medical complexity and disability

Child maltreatment is common and pediatric healthcare providers are becoming increasingly aware of risk factors and signs of abuse.1-4 Children with disabilities and those with special medical needs are recognized as a population at increased risk of child maltreatment. Understanding this risk and recognizing that not all disabilities confer the same risks can provide deeper insight for pediatric providers regarding the supports these children and their families need to prevent maltreatment.

[Medical Child Abuse - A Guideline to Detecting this Particular Form of Child Maltreatment]

The term Medical Child Abuse (MCA) describes a form of child abuse in which the medical system is "abused" by carrying out unnecessary medical procedures on a child. This abuse of the medical system occurs through misrepresentation, non-disclosure, fabrication, misinterpretation or active causation of symptoms by a parent. In this article, the construct ofmedical child abuse is defined and predisposing and motivational factors are examined. It also provides an overview of terms that are used synonymously or comparably in the literature and discusses the connection between MCA and Munchausen-by-proxy-syndrome.The core of the article is the presentation of an internal guideline, which was created by the interdisciplinary working group on MCA of the Clinics for Paediatric and Adolescent Medicine, the Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, the Child Protection Outpatient Clinic and the Social Services at the Charité. It also outlines possible interventions.

The Role of Pediatric Palliative Care Following Nonaccidental Trauma

All children experiencing child maltreatment/neglect require child abuse experts to offer the complex care needed, and for the child with potential life-limiting injuries, both child abuse and palliative care experts are integral to the team. The current literature describes the involvement of child abuse pediatrics after patients are already engaged with pediatric palliative care (PPC). Here we describe a case of an infant who suffered injuries after nonaccidental trauma (NAT) and the subsequent role of PPC. In the case described, PPC was consulted in the context of a grave neurological prognosis after NAT. The mother retained full decision-making rights, and she wanted to protect her daughter from a life dependent on others and medical technology. Our team supported the mother in the face of multiple layers of loss-her daughter, her relationship with the perpetrator, her home, and the threat of job loss due to time away.

Revisiting medical neglect concerns in children with life-threatening complex chronic conditions

BACKGROUND/OBJECTIVES

Life-Threatening Complex Chronic Conditions (LT-CCCs) increase the complexity of medical neglect concerns. Clinicians' perspectives are central in concerns for medical neglect, yet little is currently known regarding clinicians' understanding of and approach to these situations. We explored how clinicians who care for children with LT-CCCs understand medical neglect.

METHODS

We conducted a semi-structured qualitative interview study with 20 clinicians of varying disciplines from critical, palliative, and complex care services about medical neglect in children with LT-CCCs. We used inductive thematic analysis to generate themes.

RESULTS

Three primary themes emerged: Relationship between family and medical community, family overwhelmed with medical demands, and insufficient support. Taken together these themes suggest that concerns for medical neglect are directly related to clinician perception of family inability to meet medical needs.

CONCLUSION

Clinicians report that concerns for medical neglect in children with LT-CCCs often arise from a mismatch of medical expectations and the perception of familial ability to provide said medical care. Given the complex and delicate medical and psychosocial environments of care for children with LT-CCCs, these medical neglect concerns are more accurately described as Medical Insufficiency, a new term. By reframing this entity, we can reframe the dialogue surrounding this issue, and reconsider approaches to studying, preventing, and resolving it.

Does Fear of COVID-19 Prolongation Lead to Future Career Anxiety Among Adolescents? The Mediating Role of Depressive Symptoms

The outbreak of the COVID-19 pandemic has influenced the lives of individuals from all different age groups. In particular, the prolongation of COVID-19 and the emergence of virus variants, such as Omicron, Delta and Alpha, have caused trauma to university students amid expectations that the associated economic, social, and psychological outcomes could affect their future careers. The current study, therefore, examines how the fear of COVID-19 prolongation may affect future career anxiety (FCA) among adolescents and to what extent depressive symptoms may determine such a relationship. Using a cross-sectional design, a survey was conducted to assess depressive symptoms, FCA, and fear of COVID-19 prolongation among 605 university students in Oman, an Arabic-speaking country located in the Gulf region. Using structural equation modeling, the results showed that there were significant standardized direct effects (unmediated) of fear of COVID-19 on depression from COVID-19 and of depression from COVID-19 on FCA. Additionally, depression from COVID-19 mediated the relationship between fear of COVID-19 and FCA. The results are discussed within the Omani context of mental health service accessibility challenges and the dominant culture of perceiving mental health services with social stigma.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-022-00506-w.