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Children at the Intersection of Pediatric Palliative Care and Child Maltreatment: A Vulnerable and Understudied

Ross William Cleveland1, Christina Ullrich2, Brett Slingsby3

  • 1Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.

Journal of Pain and Symptom Management
|November 16, 2020
PubMed

Insights

Pediatric palliative care (PPC) patients have a 10.4% rate of child protective services (CPS) or child protection team (CPT) involvement, with medical neglect being a common concern. Enhanced collaboration can improve care for these vulnerable children.

Area of Science:

  • Pediatric Palliative Care
  • Child Maltreatment
  • Child Protective Services

Background:

  • Child maltreatment concerns can complicate pediatric palliative care (PPC).
  • Limited understanding exists regarding children with life-threatening conditions receiving PPC and involved with Child Protective Services (CPS) or Child Protection Teams (CPTs).
  • Optimizing collaborative care requires more information on this vulnerable population.

Purpose of the Study:

  • To define and describe the population of children receiving PPC who also had concerns for maltreatment.
  • To analyze the characteristics and outcomes of children with concurrent PPC and CPS/CPT involvement.

Main Methods:

  • A single-center retrospective chart review was conducted.
  • The study included children with PPC involvement and documented CPS/CPT contact between 2005 and 2017.
  • Medical and demographic variables were analyzed using descriptive statistics and association measurements.

Main Results:

  • Out of 1804 children in PPC, 189 (10.4%) had CPS/CPT involvement.
  • Medical neglect was a concern in 47% of these cases, and 53% had simultaneous CPS/CPT and PPC involvement.
  • The frequency of CPT involvement and concerns for physical abuse varied based on the child's clinical characteristics.

Conclusions:

  • Pediatric palliative care practitioners frequently encounter children with CPS/CPT involvement.
  • Medical neglect is a relatively common concern in children receiving PPC, necessitating awareness among practitioners.
  • Improved collaboration between PPC and CPS/CPT can optimize the evaluation and care of children at risk for maltreatment.
Abstract

Keywords:
Maltreatmentchild abusechildrenlife-threatening conditionpediatric palliative care

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