• Email:
  • Password:
  • Remember Me
 
Print   Subscribe    Share
MBA,MD,PhD
Is overfeeding child abuse?
Section:  General Diabetes

I just saw a young man in the hospital. He is 26 years old and has Asperger’s syndrome. He was hospitalized for a subdural hematoma, but I got to see him for his type 2 diabetes. Upon entering his room, I found his mother feeding him rice. Lots of it. His tray is full of potato chips, full-sugar sodas and other goodies. He weighs 188kg, or 413 lbs and is happily eating what his Mom is feeding him.


Going by his A1c of 10%, the young man must have had uncontrolled diabetes for quite some time. It is pretty clear that he needs to leave the hospital on insulin, a new treatment for this patient. I sent my star dietician-CDE and our NP-CDE to educate the mother about food choices and insulin injection technique, but she adamantly refused: “I have diabetes myself, so I know what to do”.


What is the best way of going about this? Is this child abuse?   


Tell us what you think in our eTalk!

MEMBER COMMENTS
Re: Is overfeeding child abuse?

Hi Ron, 

In my opinion, I see this as child abuse at the very core, meaning from a wide-angle lense perspective (i.e, not slicing and dicing it), with the Mom being 100% responsible for the abuse.

BUT, from a microscopic view (slicing and dicing it), it can be argued that although it is child abuse, the MOM cannot be held 100% responsible for these POSSIBLE reasons:

1)  It's the family's culture to feed/eat this way

2)  The Mom is psychologically ill.  And here again, this can take MANY forms, including out-right denial of the effect of over-eating on BG control, and also the seriousness of the situation (the risk of complications that she is exposing her son to).

What jumps to mind immediately is:

        >  Does the Mom have Münchausen syndrome?

        >  Is the Mom guilt-ridden about the fact that she may have caused the Asperger's,

            that this is how she deals with her guilt:  self-soothing the child allows her also to

            self-sooth her guilt.

3)  She has not received proper DSME or diabetes MNT.

IF there is any substance to 2) above, have you considered a psych consult on the Mom?  I don't know if this is possible since she is not a patient.

Mary Ann Hodorowicz, RD, CDE, MBA, Certified Endocrinology Coder
PresentDiabetes Author of MNT and DSMT Reimbursement Audio Lectures

Eat Well, Laugh Often, Love Much

Re: Is overfeeding child abuse?

Persons with Asperger's syndrome may be very sensitive to taste and texture.  He may refuse to eat anything else.  This is a possibility.

Re: Is overfeeding child abuse?

My son has Asperger's.  Like many on the spectrum, he likes things which are familiar.  His diet has always been what I have termed "Pickatarian."  He has been a very picky eater, often refusing to eat anything if he detected something not on his list of foods in his meal.  He is better now after much hard work expanding his palate.  And he has had a lot of therapy.  But it is extremely harsh to suggest that a mother is abusing her child when all she has done is what every normal mother does with their child.  Sure, maybe she is not a model parent, with a Phd in cognitive behavioral therapy and nutrition, but that doesn't make it abuse.  Until one stands in her shoes, you really don't understand having an autistic child.

Re: Is overfeeding child abuse?

Thanks for sharing your personal story, Brian. I worked with families of kids on the spectrum a few years ago, and I was daily moved by the amount of time and effort that went into taking care of their children. There are often a variety of issues that these families have to deal with, and we can't expect that food is going to always be at the top of the list.

If I can be so bold as to guess what's going on in this case, it may be a combination of the mom feeling pressed to feed her son differently and fear that she's a 'bad' parent. I'm sure she's heard many times in the past, from medical folks, school personnel, and perhaps even family that how she feeds her son is wrong. But on some level it's working for both of them. It would be interesting to find out how she feels about her diagnosis of diabetes, her son's diagnosis and need for insulin, and her goals for both of them.

Re: Is overfeeding child abuse?

It's an interesting discussion. In my practice there are some parents that don't have skills to manage behaviour issues in children without Autism, so I can imagine that it's even more of an issue with those children with Autism - where communication can be challenging.  Forgive my not knowing much about the "spectrum" of Autism.  Since I work in the mostly adult world, I'm not that familiar.

I don't think I would call it abuse.  If only these babies (who grow up!) came with training manuals! 

There should be an intervention though to help parents/careers learn these skills.  I've got a few friends that have worked with families and her stories about her clients are amazing when they LEARN.

 

 

Re: Is overfeeding child abuse?

Ron, there are so many thoughts that come to mind in this very sad case.

 

First of all, I would like to know why her son had a subdural hematoma...and if he has had other admissions for what could be injuries related to physical abuse. The overweight from overfeeding may be viewed by others as abuse, but the mother may feel it is bringing her child some happiness as she may feel helpless to help in  any other way. It is a sad situation no matter what angle you look at it from.

In an acute health care institution, it is not a plus being the consult trying to figure out how to help this very complex situation. The subdural hematoma may resolve, but there is still an elephant in the room, so to speak.

Life experience has taught me that book knowledge is nothing like walking in someone else's shoes. I agree with Brian in that regard.

I also agree with the comments that Asberger's is very difficult for parents to handle...so so stressful...and the prognosis is really not very encouraging. It may be that the mother is depressed herself and her way of coping is to feed the child what seems to bring him some joy...and may give her some feeling that she is helping him be happy. Regarding his weight...she may actually feel there is a benefit to him being so heavy because it could prevent him from being constantly physically hyperactive. Regarding the mother ignoring her diabetes, and resisting advice in that regard. She could be in denial as a defense mechanism because she has more than she can handle with her son's condition.

Here's how we handled it

Thank you to everybody for your comments and thoughts on this tough matter. In this case, I decided to take a non-confrontational approach and kept offering the mother nutritional education. After 4 or 5 days, she was finally willing to give us a chance and listen to what my excellent nutritionist had to say. And I think it made a difference. I agree that people with Asperger's or similar conditions can be very picky eaters and may be sensitive to any change of routine, but in this particular case, the patient ate whatever was put in front of him - and did not eat what was not put in front of him. I do not know what will happen now that the patient has been discharged, but at least during his hospitalization, we did make a difference.

Re: Is overfeeding child abuse?

Congratulations on your decision to be persisten with offering her some nutritional help!  She may have been too overwhelmed at first to consider any alternatives. I This is a success story at least in the short term

Re: Is overfeeding child abuse?

Thanks Ronald for keeping us updated on this situation. Often planting a seed and showing folks a different alternative is the best that we can hope for in short interactions.

Re: Is overfeeding child abuse?

I am glad that there was a resolve to this concern. It is indeed challenging to handle situations such as this. I also believe that we can resolve matters without any conflict by being subtle and letting someone understand that it is for their own good rather than insist on what we think is right. It is true that we will never know what a parent is going through unless we walk in their shoes.

Re: Is overfeeding child abuse?

Before it can be abuse, the mother has to know she is causing harm. Clearly, she is not educated.  Also, she is going to be difficult to educate as she already know it all.


I would try to discuss with her what is and is not working as well as the truth--her child is over 400 lbs and is so obese that he is at risk of death.  If she still does it, then, it is abuse.

Great situation to discuss.

Re: Is overfeeding child abuse?

It was interesting reviewing previous comments and the range of opinions, shocked by some and in agreement with others.  I have a patient who has type 1 diabetes and Asperger's and agree with the moderate approach.  I have family members and close friends who have children of varying ages with different degrees of Autism as well, so I would caution those with "harsher" responses to be respectful of the challenges the parents with autism face, especially with feeding and behavior issues.  Clearly from some of the responses, some (respectfully) "do not have a clue!"  I agree with the intervention taken and others of you responsible for patient care, I hope that you will be very cautious before you jump on the "abuse" path so quickly

Re: Is overfeeding child abuse?

Hi Becky,

 

I'm probably the person you are referring to with the "harsher" response, as a lean toward an opinion of child abuse....but I do say this with a microscopic viewpoint...meaning a very nitpicky and detailed look-see.


What I do mean and should have said is that this is NOT intentional child abuse by the mom.  I define abuse as causing harm to someone.  This is the key to my opinion.  


The mom has simply not had sufficient MNT or nutrition education to know what's is good nutrition for her son vs. what is poor nutrition.  And the very poor nutrition is causing serious harm to her child.    So I do NOT hold the mom 100% responsible for intentional abuse. 

But unintentional, yes, I do stand by my opnion.  


Here's a parallel:  A mom beats her child with wooden spoon on this bare arms and legs when he disobeys her.  This is how she was raised, and she believes this is the right thing to do.  Or she withholds food from her son as punishment, as this type of discipline is part of her culture.  Is this child abuse at the very core?    Yes, if viewed against our current morals and values in today's society.  


BUT the mom could argue/defend herself in court, saying she did not see this as child abuse, but simply as punishment, as this how she was raised and how she was trained to be a parent.  So what she is doing IS abuse in our society's terms, BUT, not in HER terms or viewpoint.


Hope this is making sense!


Mary Ann Hodorowicz, RD, CDE, MBA, Certified Endocrinology Coder
PresentDiabetes Author of MNT and DSMT Reimbursement Audio Lectures

Eat Well, Laugh Often, Love Much


Re: Is overfeeding child abuse?

I don't know if I call it child abuse in the traditional sense of the word but it is something that needs to be addressed.  I see parents a lot that allow their children to eat (for lack of a better word) crap.  The children are suffering from obesity, high blood pressure, and diabetes.  But the parents don't realize that their own behavior needs to be modified, not the child's.  I have only had one case when the parent refused to change their behavior for the benefit of their child once the situation was presented to them in that light.  Most parents simply do not REALIZE the connection.  And once they do, they change or at least begin to make changes.  It's a sad situation but really I feel the best we can do is gently open the parents eyes to what is happening and usually they will see the light so to speak and begin to change.  

 

This IS child abuse

This IS child abuse--get the doctor's okay to back you up and notify social services for your county--go through the social services director at you facility if there is one!

Re: Is overfeeding child abuse?

Ok, if this is child abuse, then what do you call it when folks that are on food assistant programs are allowed to purchase CRAP.  The GOVERNMENT is supporting this lifestyle, then they complain that health care costs are too much!

 I can't belive how frustrated I am when I stand in line behind folks in the local market with GALLONS of soda, along with the sausages, chips and other items we know are contributing to the obesity problem.  I'm often held back by my hubby as I want to take a picture of these folks and post them on the obesity forums.

UGH!

Re: Is overfeeding child abuse?

while many dietary habits accepted in childhood in family and may overfeeding be a culprit for obesity and later metabolic syndrome, but your look to that special patient family was interesting. It remind a kind of disorder in parents who never let their child get mature and be responsible for their right nutrition and life styles.It was nice to introduce more about complications of DM besides family and behavior therapy in that subject. I liked to investigate relation between fatty liver in prediabetes and retinopathy. Do you think it is any benefit to assess NAFLD, eye exam, lipid profile, insulin resitance homostasis and other tests as TGF beta and IGF-1 and else routinely in young diabetics whose diabetes has begun at childhood?

Re: Is overfeeding child abuse?

I read this story yesterday in USA Today:

http://www.usatoday.com/news/health/story/2012-05-21/teens-heart-disease/55101006/1

"Diabetes and pre-diabetes have skyrocketed among the nation's young people, jumping from 9% of the adolescent population in 2000 to 23% in 2008, a study reports today."

Wow.  How disturbing is that?  

If we as a nation don't 'wake up and smell the coffee' our children are going to be dead before they reach their 50's.  

What is more disturbing is this quote from that same story:

"To get ahead of this problem, we have to be incredibly aggressive and look at children and adolescents and say you have to make time for physical activity," says pediatric endocrinologist Larry Deeb...

It's almost like we are saying to the kids this is YOUR problem...get up and do something!  These kids have been raised in an obesigenic society!  Everywhere they turn they are presented with poor choices!  And it is THEIR fault?  I don't think so.  It is our fault for allowing them to grow up with such lousy lifestyles.  We should be ashamed of ourselves (for lack of a better saying).

I can really get on a rant here but I won't.  We need to restructure the city's to include more activity friendly areas (like sidewalks) and encourage children to PLAY OUTSIDE!!!!  We need to present them with wholesome foods, fruits, vegs, REAL food that tastes good and is good for you.  Once we raise them on french fries and apple pies its a little late to turn the tables on them and say...you need to start eating healthier-and do it now!  We have all got to change.  Almost every aspect of society will need to make the change.  The schools, the citys, the food industry, our family's, etc., etc., etc.