Docs more likely to suspect abuse in poor kids

By Amy Norton - Reuters

(Reuters Health) - When a toddler has a broken bone, pediatricians may be more likely to suspect abuse if the family is lower-income, a new study finds.

Researchers found that pediatricians who read a fictional case report of a toddler with a leg fracture were more likely to suspect abuse if the child was described as coming from a lower-income family.

The hypothetical child's race, on the other hand, did not appear to influence doctors' opinions.

The second finding is somewhat surprising, according to the researchers. Studies looking at real-world cases have found that minority children are more likely to be evaluated for abuse than white children are.

And it's well known that the child welfare system in the U.S. has a disproportionate number of minority kids.

"There's very strong evidence of a racial difference in how patients are handled," said lead researcher Dr. Antoinette L. Laskey, a pediatrician at the Indiana University School of Medicine in Indianapolis.

But, she told Reuters Health, the reasons for that have not been clear -- including whether doctors may act based on unconscious racial stereotypes.

The current results suggest "there's more than race involved," Laskey said.

She was also quick to say, however, that the study doesn't mean pediatricians are consciously "classist" or otherwise biased when evaluating children's injuries.

The study, reported in the Journal of Pediatrics, included 2,100 U.S. pediatricians who responded to a survey that described one of four hypothetical cases.

All cases included an 18-month-old with an "ambiguous" leg fracture -- a type that can be caused by abuse or an accident.

But the cases varied by the child's race (black or white) and the family's economic situation; parents were described as having either professional jobs (accountant and bank manager) or working-class jobs (grocery clerk and factory worker).

Race had little effect on the doctors' responses. The study found that when the child was black, 45 percent of doctors believed there had "possibly" or "almost certainly" been abuse; another 32 percent were "unsure." If the child was white, 46 percent of pediatricians suspected abuse, with 28 percent saying they were unsure.

In contrast, there was evidence that parents' job descriptions swayed doctors' opinions.

When the child's family was lower-income, 48 percent of pediatricians thought there'd been abuse, versus 43 percent when the family was higher-income.

It's hard to know whether doctors' responses to a fictional case would be the same in real life.

And it's not clear, according to Laskey, whether attitudes about socioeconomic status might explain some of the racial differences in child abuse reporting seen in earlier studies.

She also stressed that she does not think pediatricians are consciously basing their diagnoses on parents' job titles. But in general, unconscious stereotypes can influence anyone's thinking.

"People tend to think that child abuse, or domestic violence, doesn't happen in upper-middle-class families, but of course it does," Laskey said.

It's important, she said, for doctors to be aware that unconscious generalizations could get in the way of diagnosing child abuse -- either missing it in kids from affluent families, or over-diagnosing it in children from poorer or minority families.

"My big take-home message for doctors is that we need to rely on the objective data," Laskey said.

It is true that studies have found children in poorer families to be at greater risk of abuse. But the poverty, itself, is not a "causative factor," Laskey said.

"Race and socioeconomic status shouldn't be things used in a diagnosis of abuse," she said.

SOURCE: Journal of Pediatrics, online January 5, 2012.

Source http://www.reuters.com/article/2012/01/20/us-docs-abuse-idUSTRE80J1WK20120120

Obese Third Grader Taken From Mom, Placed in Foster Care

A Cleveland third grader who weighed more than 200 pounds was taken from his mother after officials reportedly said she did not do enough to help the boy, who suffered from a weight-related health issue, to lose weight.

“They are trying to make it seem like I am unfit, like I don’t love my child,” the boy’s mother, who was not identified, told the Cleveland Plain Dealer. “It’s a lifestyle change and they are trying to make it seem like I am not embracing that. It is very hard, but I am trying.”

Officials first became aware of the boy’s weight after his mother took him to the hospital last year while he was having breathing problems, the newspaper reported. The child was diagnosed with sleep apnea and began to be monitored by social workers while he was enrolled in a program called “Healthy Kids, Healthy Weight” at the Rainbow Babies & Children’s Hospital.

The boy lost a few pounds, but recently began to gain some back, the Cleveland Plain Dealer reported. At that point, the Department of Children and Family Services asked a juvenile court for custody of the boy, citing his soaring weight as a form of medical neglect, according to the newspaper.

Taking obese children from their families has become a topic of intense debate over the past year after one high-profile pediatric obesity expert made controversial comments in the Journal of the American Medical Association advocating the practice in acute cases.

“In severe instances of childhood obesity, removal from the home may be justifiable, from a legal standpoint, because of imminent health risks and the parents’ chronic failure to address medical problems,” Dr. David Ludwig co-wrote with Lindsey Murtagh, a lawyer and researcher at Harvard’s School of Public Health.

A trial is set for the boy’s ninth birthday next month to determine whether his mother will regain custody.

But one family who has been in the same position as the Ohio family told ABC News they disagreed with the practice when “Good Morning America” spoke with them in January.

“Literally, it was two months of hell. It seemed like the longest two months of my life,” mother Adela Martinez said.

Her daughter, 3-year-old Anamarie Regino, weighing 90 pounds, was taken from her parents and placed into foster care a decade ago.

Anamarie didn’t improve at all in foster care, and she was returned to her parents. The young girl was later diagnosed with a genetic predisposition.

“They say it’s for the well-being of the child, but it did more damage than any money or therapy could ever to do to fix it,” Martinez said.

Anamarie Regino, who is now a teenager, agreed.

“It’s not right, what [Dr. Ludwig] is doing, because to get better you need to be with your family, instead of being surrounded by doctors,” she said.

When told of the Regino case, Ludwig said his solution of state intervention did not always work.

“Well, state intervention is no guarantee of a good outcome, but to do nothing is also not an answer,” he said.

ABC News’ Dan Harris and Mikaela Conley contributed to this report

Source http://abcnews.go.com/blogs/health/2011/11/27/obese-third-grader-taken-from-family-placed-in-foster-care/