By Santa J. Bartholomew M.D. FAAP, FCCM and Betsy Katsak DNP
See Corresponding Journal Article: Medical Child Abuse
The Child Abuse Team at a midwestern children’s hospital was called to consult in the case of a 10-year-old boy who presented with diarrhea, vomiting, fever, and malaise. The patient had a complete septic workup and was found to have sepsis from a variety of bacteria which is very unusual. The patient has had the diagnosis of sepsis 3 other times in his life which is also unusual for a child with a normal immune system. During the second episode 4 months ago, the surgery team had placed a single lumen central line in his chest to have better, easier venous access when he was admitted.
During the hospital stay, the patient received consultations from the infectious disease team, surgery, pulmonology, neurology, rheumatology, and cardiology departments. All the results of this extensive diagnostic workup were negative. However, the bacteria in his bloodstream would not fully clear. Additionally, the psychiatry team was brought in to see if there were any psychiatric issues with the patient or his family because the medical team members felt that the dynamic between the mother and father and the mother and son was “odd”.
The mother, who was a certified respiratory therapist, was reluctant to see any psychiatric services and therefore was not very cooperative with them. She was, however, very engaged with all the other medical teams. Additionally, the medical team received outside information indicating that the mother had taken her son to three different states over the last few months with similar presentations so he in fact had positive blood cultures a total of 6 times.
In suspected cases of medical child abuse, separating the parent from the child is an excellent way to assess if the parent is involved in injuring the child. If the child starts improving with separation from the parent, the diagnosis of medical child abuse should be strongly suspected. In this case, the mother had become quite defensive and refused to leave the child’s bedside. The father was involved but he worked and felt that to keep the family’s insurance intact, he should go to work daily.
The mother attempted to sign the patient out of the hospital against medical advice however, the Child Abuse Team at the hospital called Child Protective Services who explained that since this was a pediatric tertiary care center and her son was quite ill, she could not sign him out only transfer to another facility. No other hospital would accept the transfer.
The child had his central line removed and was transferred to the Pediatric ICU in the open area and curtains were kept open at all times. After the child had received 5 days of IV antibiotics he was switched to oral medications. The nursing staff brought chocolate syrup to mix with the bad-tasting medications and within 5 days the child’s blood cultures were cleared of bacteria and he was much better.
The mother and father were confronted with the facts of the case and after much discussion, the mother admitted to injecting water mixed with vaginal flora into her son’s central line. Prior to that, she was giving him IM injections of the same substance. CPS granted full custody to the father until further notice. The mother was arrested and incarcerated awaiting adjudication.