Caregivers may cite religious beliefs as the reason for not seeking care for an ill child. While adults may decline lifesaving care for themselves, they may not do so for minor children. As noted in Prince v Massachusetts, “The right to practice religion freely does not include the liberty to expose the community or child to communicable disease, or the latter to ill health or death.”³ In cases such as this, the courts may require a caregiver to permit medical treatment for their child, regardless of their religious beliefs.

Health care providers are mandatory reporters of child abuse and neglect. In most jurisdictions, physicians or child protective service agencies are able to work with law enforcement and the judicial system to take custody of a child who requires emergent medical care if the caregivers cannot or will not permit that care. Because various types of child abuse may co-exist, emergency physicians need to do a thorough evaluation of the child to rule out concomitant injuries. Additional laboratory and radiographic evaluations (skeletal survey) may be required.

Case Conclusion

The patient’s mother is tearful and states, “I lost my job a few months ago and just can’t afford his insulin.” Following appropriate medical treatment in the ED, the patient is hospitalized. The hospital social-work team works with the county Children, Youth, and Families office to obtain insulin for the child and to ensure that the family has transportation to medical appointments.

Dr. Rozzi is an emergency physician, director of the Forensic Examiner Team at WellSpan York Hospital in York, Pennsylvania, and chair of the Forensic Section of ACEP.

Dr. Riviello is chair and professor of emergency medicine at the University of Texas Health Science Center at San Antonio.

References

1. U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. Child maltreatment 2021. HHS website. https://www.acf.hhs.gov/sites/default/files/documents/cb/cm2021.pdf. Published February 9, 2023. Accessed October 11, 2023.
2. Rozzi HV, Riviello R. Spotting and reporting child neglect cases. ACEP Now website. https://www.acepnow.com/article/spotting-and-reporting-child-neglect-cases/. Published May 1, 2018. Accessed October 11, 2023.
3. Rutledge WB, Supreme Court of the United States. Prince v Massachusetts. 32 US 158, 64 SCt 438, 88 LEd 645 (1944). Online version scanned from original. Available at: https://tile.loc.gov/storageservices/service/ll/usrep/usrep321/usrep321158/usrep321158.pdf. Accessed October 11, 2023.