Children in ED when parent is patient

  1. What do you guys do with kids brought by EMS because the parent is the patient and the child can't be left alone? What if the parent is unable to speak/arrange care? if the parent is intoxicated or psych (psychotic or a suicide attempt)?

    I recently ran across a baby brought in with a mom who had attempted suicide. She was unresponsive. She had sole custody. Baby was 5 weeks. We don't have the security systems/bands to keep a baby, our staff has minimal experience with infants and that kid is vulnerable to infection and shouldn't be cared for in the middle of an adult ED by staff caring for adults sick with whatever. We tried sending the babe to well baby but they wouldn't take a kid who had been home (infection control.) CPS took hours to come. The police had been on scene. There was no concern of abuse (and if there had been a neighboring hospital has a forensic child abuse team that would have been more appropriate). We were wondering if the police should have kept the baby until CPS could take custody.

    Also what if the patient is psych and aggressive or intoxicated, or there is an allegation of abuse/neglect but CPS hasn't made a decision yet-and the patient demands to see the child or breastfeed. Staff feels this is dangerous but the parent still has custody. What are our responsibilities?

    Finally what do you do with conscious/oriented patient-parents being admitted whose kids are there and parent insists no one can pick up the kids? I would think its illegal to require parent to setup child care before admission but what do you do with the kids? (A baby could maybe stay with mom, but what about 3 elementary age kids of both genders?)
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  2. 10 Comments

  3. by   PeakRN
    If the parent is truly unable to care for the child due to their medical condition then we will start to work with them to get a family member to watch them, when this is not possible our social worker will start their magic and either try to find a responsible party that can take care of the child or ultimately work with CPS to find temporary placement.

    As far as who is going to watch over the infant while they are in the hospital? Typically we have enough ED staff that someone can take care of them, but we can also call our house supervisor and we will find a staff member to come hang out with them. If the MOC was not under arrest its not really a PD issue, although here they would typically want to stay and take care of the baby. Same goes for EMS and Fire, generally someone likes kids and word spreads quick.

    If the parent is on a medical or psych hold they do not have an inalienable right to have their child with them, and if it is not safe for the patient or the child (same as any other visitor) we will not allow them to be together.

    Parents do not get to take their children up with them and be the sole care provider while an inpatient in our facility. We will have our social worker talk to them if they are insistent that no one can come and care for them. With the exception of neonates on postpartum (and they must have a family member present to take care of the baby) this is a hard stop, children are not allowed to spend the night if they are under 14 and I have yet to see a teen that wouldn't rather just stay at home and take care of themselves.
  4. by   NutmeggeRN
    Quote from jdub6
    What do you guys do with kids brought by EMS because the parent is the patient and the child can't be left alone? What if the parent is unable to speak/arrange care? if the parent is intoxicated or psych (psychotic or a suicide attempt)?

    I recently ran across a baby brought in with a mom who had attempted suicide. She was unresponsive. She had sole custody. Baby was 5 weeks. We don't have the security systems/bands to keep a baby, our staff has minimal experience with infants and that kid is vulnerable to infection and shouldn't be cared for in the middle of an adult ED by staff caring for adults sick with whatever. We tried sending the babe to well baby but they wouldn't take a kid who had been home (infection control.) CPS took hours to come. The police had been on scene. There was no concern of abuse (and if there had been a neighboring hospital has a forensic child abuse team that would have been more appropriate). We were wondering if the police should have kept the baby until CPS could take custody.

    Also what if the patient is psych and aggressive or intoxicated, or there is an allegation of abuse/neglect but CPS hasn't made a decision yet-and the patient demands to see the child or breastfeed. Staff feels this is dangerous but the parent still has custody. What are our responsibilities?

    Finally what do you do with conscious/oriented patient-parents being admitted whose kids are there and parent insists no one can pick up the kids? I would think its illegal to require parent to setup child care before admission but what do you do with the kids? (A baby could maybe stay with mom, but what about 3 elementary age kids of both genders?)
    How sad all of those situations are. How frustrating.
  5. by   Munch
    My sister is a hospital social worker and used to deal with this quite frequently actually when she was working at a busy teaching hospital in the heart of Chicago. She had a frequent flyer that was non-compliant with dialysis and eventually when this patient would bottom out(which was all the time) and come to the ED and be admitted for her tuneup she always had her daughter with her. Many times the patient would threaten to leave AMA if her daughter couldn't stay with her(she was around 8-9 years old). When my sister was floating and working in the ED it was her job to find a solution. Luckily this patient was alert and oriented so my sister would make it clear if the patient didn't find someone to pick her daughter up she would be calling children's services to handle the case. She had to lay down the law with this patient a lot it was clear she didn't know what was for her own good(habitually missed her dialysis appointments). But every time she came to the hospital she insisted her elementary age daughter come and stay with her. I don't know 8 years old is a little young if you ask me to have to deal with adult issues like that. My sister did go out of her way to make sure the daughter was fed and often had childlife come down with games for her while she was waiting for family to come. My sister felt that she was neglected but their were no outward signs of abuse(bruises, so signs of malnourishment or other signs of injury). My sister also even went to ask her as much and she said everything was fine at home so my sisters hands were tied...CPS doesn't work on hunches unfortunately because hunches at times turn out to be something.

    In other cases when the patient wasn't able to make decisions about care(acute psych, intox or unconscious) my sister would do her best to play detective and find a family member to come pick the child up. If she wasn't able to find family then she would have to call children's services as a last resort. Most of the time it didn't have to come to that she was usually able to find family to pick the child up.
  6. by   canoehead
    We have a patient that comes to the ER monthly (or close to it) and brings his dog. EHS loads them up and drives them in because the patient has fits about having no one to care for the dog. He also claims its a service dog, but the dog is not trained to a leash, rarely obeys commands, and has performed no visible service in hospital, so I call dog turds on that. Someone on staff always cares for the dog, because what else can you do once he's here- make him pee on the floor?
  7. by   Pixie.RN
    Quote from canoehead
    We have a patient that comes to the ER monthly (or close to it) and brings his dog. EHS loads them up and drives them in because the patient has fits about having no one to care for the dog. He also claims its a service dog, but the dog is not trained to a leash, rarely obeys commands, and has performed no visible service in hospital, so I call dog turds on that. Someone on staff always cares for the dog, because what else can you do once he's here- make him pee on the floor?
    You are allowed to ask what task the dog performs, and an emotional support animal does not equate to service animal. Has anyone asked?

    Great resource: Welcome to Service Dog Central | Service Dog Central
  8. by   NurseCard
    Quote from Pixie.RN
    You are allowed to ask what task the dog performs, and an emotional support animal does not equate to service animal. Has anyone asked?

    Great resource: Welcome to Service Dog Central | Service Dog Central
    Sounds like it is pretty safe to assume that the dog is NOT a service
    animal, but everyone involved is giving in to this patient's demands
    to have the dog with him when he goes to the hospital.

    And like canoehead said, once the dog is there, what can you do?
  9. by   JKL33
    Quote from NurseCard
    And like canoehead said, once the dog is there, what can you do?
    IF there is no legitimate reason for the dog to be there, I guess I would call animal control. A hospital representative should handle this with him and let him know that is the plan going forward. I'm surprised they don't recognize that having a random dog in the ED is just a bit of a liability. Not to mention the nursing hours that are not being used for the care of emergency patients and are instead being used for dog-sitting.
  10. by   Pixie.RN
    Quote from JKL33
    IF there is no legitimate reason for the dog to be there, I guess I would call animal control. A hospital representative should handle this with him and let him know that is the plan going forward. I'm surprised they don't recognize that having a random dog in the ED is just a bit of a liability. Not to mention the nursing hours that are not being used for the care of emergency patients and are instead being used for dog-sitting.
    Good call. We had a patient who used to come in with a flea-infested dog that was super sweet to females but would become aggressive with male staff members. I had to hold the dog's leash while our ED doc did the MSE (and found nothing emergent) and I was NOT COMFORTABLE because the dog was growling the whole time (and I sat there and contemplated if I really liked this doc or not, haha ... j/k, he was one of my favorites). This was not a small dog, either. I worked in an Army hospital and the patient was not eligible for care, so we sent her out after the MSE. I felt bad for the dog!!!
  11. by   jdub6
    Quote from JKL33
    IF there is no legitimate reason for the dog to be there, I guess I would call animal control. A hospital representative should handle this with him and let him know that is the plan going forward. I'm surprised they don't recognize that having a random dog in the ED is just a bit of a liability. Not to mention the nursing hours that are not being used for the care of emergency patients and are instead being used for dog-sitting.
    First off thanks to all who replied. I know the med surg floor had a problem like this one-elderly patients spouse brought the dog to spend the night. The patient was being made comfort measures and they do allow pet visits for dying patients but this wife and dog settled in for multiple nights. They had been dropped off by a daughter who disappeared and wife claimed she had no way to get herself or the dog home.

    The biggest problem (besides the obvious issues with a pet in the hospital) was the wife was old and had mobility issues. This was the 7th floor. She claimed she was physically unable to take the dog out and just let it pee on the floor if staff didn't take it. Poor dog would cry and bark-because it needed to go out-so staff often took it just to stop the disruption. Also she went to sleep in the recliner holding the dog-had a crate but never put/left dog in despite multiple requests-and when staff entered to provide care the dog would get territorial/protective. It barked loudly which was disruptive and sometimes frightening to other patients and nearly bit a tech.

    Wife became very manipulative/passive aggressive when the issue was raised and when all else failed played the dying husband card. Admin didn't have the guts to make her angry so never took real action to remove the dog. Very frustrating to staff who felt unsupported while this woman walked all over them.

    Basically I started this thread to see if other places actually draw and hold a bottom line and take action like calling animal control etc...so frustrating that it seems my job isn't the only place where this stuff is allowed to continue and nursing is expected to just deal with it.
    Last edit by jdub6 on Nov 8 : Reason: addition
  12. by   jdub6
    Quote from NutmeggeRN
    How sad all of those situations are. How frustrating.
    Thats what it is-frustrating. Recently had a parent come in with dizziness and feeling confused (normal Neuro exam) freely admitted having been on a 3 day crack and MDMA binge. 4yo daughter in tow. Parent couldn't/wouldn't find child care, we provided snacks and DVDs for the kid while they waited. Kid was understandably bored/restless and got whiney, and at one point parent slapped child across the face in front of an xray tech.

    CPS was already being called as the patient admitted doing crack while alone with the daughter. There were no signs of abuse/neglect-kid appeared healthy, appropriately dressed, no visible bruising etc-and CPS elected to take no immediate action. They said they would follow-up. Parent discharged home with child after 8 hour eval. Frustrating and also time consuming for staff trying to make sure kid was okay, and figure out and do what was required. Which didn't feel like a good option.definitely felt bad sending kid with patent but had no choice. (I don't believe one slap warrants removing a kid from a parent, but scary that parent has no issue using hard drugs in the presence of a young child they are supervising, with no other adults present, when the parent knows they become confused and hallucinate with said drugs.)

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