While Child Protective Services (CPS) allegation terms differ across states, they all cover medical child abuse and medical child neglect in some manner. However, to many, it’s not clear how the allegations differ. There could be substantial overlap, for example, with physical abuse and there are questions as to who defines what medical treatments are and are not necessary. In some states, the consequences of substantiated abuse allegations may be more severe than neglect allegations and with abuse allegations, CPS may be more likely to act more drastically than with neglect. When dealing with potential medical allegations, this distinction is crucial to understand in order to plan your actions accordingly.
First, let’s break down how abuse and neglect are defined in the simplest terms: Abuse is an excessive action that results in negative consequences, such as physical injury, sexual assault or other damage. Neglect, on the other hand, is a lack of action that results in negative consequences, such as not enough food, withholding of necessary medical treatment, withholding of education, etc. The Child Abuse Prevention & Treatment Act (CAPTA), the law that sets the majority of the general framework states and municipalities must follow in establishing and operating CPS agencies, specifically defines child abuse and neglect in this way:
- “Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation”; or
- “An act or failure to act which presents an imminent risk of serious harm.”
Therefore, medical child abuse, being a form of abuse, is an action. It’s an allegation that you’ve committed an action that has resulted in injury to your child(ren), rather than something you’ve failed to do or withheld. In the context of CPS, this can look like the following:
- Multiple previously healed fractures that show up on an X-Ray suggestive of physical abuse.
- Giving a child with a diagnosed medical condition alternative remedies that specifically make the condition worse.
- Intentionally making your child(ren) sick for attention (Munchausen’s Syndrome by Proxy).
Medical child neglect, on the other hand, is a lack of action. It’s an allegation you failed to take a certain action or actions and this has resulted in injury to your child(ren), rather than an action you specifically took. In the context of CPS, this can look like the following:
- Withholding or refusing to allow for necessary services such as physical therapy, occupational therapy, speech therapy, psychotherapy, etc., which has or could result in harm to the child(ren).
- Withholding or refusing to allow for necessary medical treatment such as medication, surgery, or other intervention.
- Withholding, refusing or otherwise failing to obtain routine medical and dental care for your child(ren), which has or could result in harm to the child(ren).
- Recognizing a potential medical or dental problem and withholding, refusing, delaying or otherwise failing to obtain emergency care in a timely manner, which has or could result in harm to the child(ren).
- Consuming illicit drugs while pregnant (such as marijuana, cocaine, heroin and other Schedule I substances as outlined in the Controlled Substances Act), which result in a newborn positive toxicology screen (drug test).
Medical child abuse allegations most often look like medical mimics of child abuse resulting from physical abuse, actual physical abuse and Munchausen’s Syndrome by Proxy. These allegations are almost exclusive to medical professionals and are most commonly made in community outpatient clinics and hospitals. They’re also more likely to include exceptions to the reasonable efforts requirement to avoid involuntary placement, which makes it more likely that involuntary placement may occur.
Medical child neglect allegations, on the other hand, are more diverse in the types of reporters and how severe the allegations can be. For example, schools often provide services like physical therapy, occupational therapy, speech therapy and psychotherapy. Sometimes, refusal to provide those services may be reported by school staff as medical neglect. Other allegations, such as withholding medically necessary treatment, may be made by medical professionals, nosy neighbors or extended family members. A newborn positive toxicology screen, more often than not, results in involuntary placement and is a known exception to the reasonable efforts requirement.
At Heartwork Defense, we emphasize the importance of choosing a pediatrician you trust for your child(ren), nurturing that relationship and making sure the children have annual medical and dental checkups consistently. For childbirth, we recommend a home birth when possible and if not possible, to give birth at a private hospital. Public hospitals, otherwise known as community-run hospitals or government-run hospitals tend to be the most aggressive reporters to CPS and avoiding using them for your children is recommended when possible to reduce the likelihood of CPS involvement. Most important, however, is the quality of the relationships you maintain with your child(ren)’s medical and mental health professionals, as well as school staff. They’re the ones with the discretion to report or not and the most likely to listen to context. They can be some of your biggest allies in avoiding CPS involvement to begin with and if it happens, to satisfy CPS enough to get the allegations unsubstantiated, close the case and move on.