Parent feeding children w/ CELIAC DISEASE gluten. What do I do?!

[peaceloveandPA]

Hey guys. I have been a PA for less than a year and am facing a dilemma at my primary care office.

 

Like clockwork, I get 2 patients in my office every other Monday after they have been with their father. 2 boys, ages 7 and 10, both diagnosed with celiac disease and their dad refuses to abide by a gluten-free diet. They get pizza, pasta, subs, hot dogs, soda, etc. all wknd. They then come into the office with abdominal pain, headaches, fatigue. etc. that lasts for a few days... until they go back to their dads. Mom follows a 100% gluten-free diet and they're never sick at her house. I've tried to convince mom to talk to dad, and she says she has but he is non-compliant because "its just too expensive" to follow a gluten-free diet. There is also some mental illness in dad, and am not sure if he is non-compliant because he doesnt care, or just really doesnt understand. Dad refuses to come into the office with the kids. I just feel so horrible for the children, because they know what they cant eat and at that young age they try to stick up for themselves but are shot down by their own father. When I talk w/ my physicians about it, they kinda just laugh at me and tell me to keep documenting. (I don't get it, but they're not huge believers of celiac.. still think its a "designer disease.) I've counseled mom extensively and given multiple handouts to give to dad. But, my question is... what else can I do?! Isn't this some form of neglect?! I feel that it's abuse and some legal action should be taken. Mom voices understanding, but doesnt seem to want to take any legal action. What is my responsibility in this matter as their primary care provider? I am just so distraught over this case.

 

Thank you for your advice. :ohnoes:

[rev ronin]

1) You're a mandatory reporter of child abuse.

2) While there's some leeway in what constitutes child abuse, if you believe an action to be harmful to the children, it is your obligation to report it, and the obligation of the organization designated by law to receive such reports to evaluate them and act appropriately upon them.

3) By asking here, rather than reporting the parent via the mechanisms established by your state, you are probably in violation of your reporting requirements under your state law.

 

Report the inappropriate action NOW. It's the only legal option.

[mmcampbell]

Likely this has been resolved, yet I thought you all should know that if the children have been diagnosed with celiac disease, the cost of gluten free food can be deducted as an expense on income tax. This might help incentivize treatment for young celiac sufferers.

 

Michelle Campbell

Pre- PA

[SocialMedicine]

if a child has confirmed celiac and the child keeps coming in reporting health issues related to poor diet I would consider contacting child prot services. If anything the investigation might wake him up. There is no harm in contacting them if you have good reason to believe the children are in danger. Does this constitute danger ?? How much discomfort are the children in .... are they underweight ? anemic ? What does the mother say about this, why is she not more aggressive ? Before I contacted child prot services I would want to communicate how serious this is to the father. In written form I would alert him that uncontrolled celiac can cause series chronic symptoms and in some rare cases life threatening. I would not mention child prot services to him. Honestly before you report you may even want to call your malpractice company ... run the idea by them.

[Acebecker]

A direct phone call to dad might be a good idea. He needs to know straight from the horse's mouth that the crap he's feeding his kids is making them sick. I agree, though - if he's not listening, a call to CPS as a "wake up" might be a good idea.

[peaceloveandPA]

Thank u guys for the advice. CPS initiated investigation and he longer visits his father, as father refused to comply.

 

 

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[discogenic]

I think this was a good call. Gluten issues, particularly full blown celiac, is more than just stomachaches. I'm quite surprised the OP's SP blew this off.

 

This case brings up another, albeit more complex issue: childhood obesity. Now that the AMA has declared obesity a disease, should parents who willingly and knowingly contribute to their child's obesity be held liable? Will CPS be getting involved in these cases? (There have been some cases in the past.) How would we define "willingly and knowingly"?

[ventana]

Thank u guys for the advice. CPS initiated investigation and he longer visits his father, as father refused to comply.

 

 

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well done

 

ALWAYS put the health of child first.....

 

you are not the judge and jury, you are merely a reporter and if you have a doubt - report it and let the professionals handle it from there...... we simply do not have the time, resources, training or means to be the cops of world...

 

well done

[peaceloveandPA]

Thank you. They originally denied the claim, (I think from lack of understanding the medical complications), until I fought it and they finally accepted it. I feel a lot better and He hasn't been sick since.

 

Yes, the obesity debate is quite interesting and I agree that feeding ur kid junk is in fact a form of neglect.... But there are so many variables. And there would be a LOT of CPS cases if this were to start happening.

 

 

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[whoRyou]

Thank u guys for the advice. CPS initiated investigation and he longer visits his father, as father refused to comply.

Good work!

 

well done

 

ALWAYS put the health of child first.....

 

you are not the judge and jury, you are merely a reporter and if you have a doubt - report it and let the professionals handle it from there...... we simply do not have the time, resources, training or means to be the cops of world...

 

well done

YES!!!