The abandoned children

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    I work on a unit with lots of chronically ill kids who end up being too much for their families to care for. We have several ped LTC facilities in our area and many of the kids live there. I understand that some families cannot care for the kids at home but they still visit them and love them and make them part of their lives. I am talking about the kids whose families have detached and moved on, who never visit or call. And yet they are able to still make medical decisions for their children, including DNR or hospice or palliative care.

    We have kids who do live at home but are regularly dropped off on the unit, just admitted and then the families leave and never call or show up to visit until discharge time. Or, we are considered babysitters, especially on weekends and holidays. Since they are complex we can't discharge right away even if they are not far from their baseline. We have to admit them and make sure they are stable and that can take a few days.

    If families of non-medically needy kids did this, it would be considered child abandonment and the parents would lose their legal rights after a time. But time and time again I see these no-family kids in and out of the hospital. The saddest ones are the neuro-intact kids who would thrive in a family home, even a foster home would be so much better than LTC. They are so hungry for social interaction, and we cannot spend our entire shift with them, and the staff are not there long enough for these kids to form a bond with anyone. They spend their whole lives in climber cribs and learning to soothe themselves to sleep and dealing with boredom. I so wish we had more medical foster care families that could take such children.

    Then there are the neuro-devastated kids, the ones who really and truly are so far gone they are just a body with reflexes, and they react to pain and not much else. Their parents sign papers to do everything possible to save them from their multiple medical crisis that come up due to their being bedbound and total care, and yet they never show up for surgeries or recovery or anything else. They just give instructions to keep saving the patient. At Christmas or the child's birthday there are no visitors at all much less any other time. We have children that come and go often, and I have never ever met any family for them.

    It is not my place to make decisions other than how to best comfort and care for them during my 12 hour shift. But I feel like no one is really wanting to get their hands dirty and make some decisions for these patients at all, so they just linger in their vegetative states for decades. I can't even imagine the cost financially, but I see the physical costs.

    When is someone going to pass some laws or *something* to keep these kids from falling through the cracks? Because that's what seems to be happening to so many of them, and with better medical science the numbers are increasing all the time.
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  3. 13 Comments so far...

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    I've seen lots of situations in psych over the years, in a few different states, in which parents who had kids who were ready for discharge but weren't "holding up their end" in terms of coming in for appointments for family sessions or didn't show up when we were trying to discharge the kids, were reported to CPS for abandonment/neglect. Often just the threat of reporting them would get them to show up and cooperate. I agree with you that the larger question is what is going to happen to the kids you describe when they are remaining in families that have so little attachment to and interest in them.
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    I have seen a lot in my career, too. In many cases, I don't blame the parents -- who may have simply given all they have to give and/or have other children whose needs must also be considered. I blame society for not offering families who face tragic stituations more and better choices.
    JeanettePNP and hiddencatRN like this.
  6. 0
    Quote from llg
    I have seen a lot in my career, too. In many cases, I don't blame the parents -- who may have simply given all they have to give and/or have other children whose needs must also be considered. I blame society for not offering families who face tragic stituations more and better choices.
    I agree with you about this -- at the same time, though, children aren't like puppies or kittens who can be dropped off at the shelter because things haven't worked out at home.

    I've been involved a few cases where parents did actually voluntarily surrender their parental rights, and basically gave their kids to the state (or "returned" adopted children). Boy, there's nothing I've seen in my career more brutal (emotionally) for a child.
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    I saw a lot of this when I worked peds. I think the situations you are describing is one of the reasons I could not working on units with a large chronic peds population. I wish there were other options for these kids. All you can really do is document. The only time I have ever been able to get CPS involve is when we were able to prove the parents who were detached but still had these medically complex kids at home were actually neglecting them, but often that isn't easy to prove.
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    Quote from elkpark
    I agree with you about this -- at the same time, though, children aren't like puppies or kittens who can be dropped off at the shelter because things haven't worked out at home.

    I've been involved a few cases where parents did actually voluntarily surrender their parental rights, and basically gave their kids to the state (or "returned" adopted children). Boy, there's nothing I've seen in my career more brutal (emotionally) for a child.
    I agree with you about the commitment that must be there when parents bring children into the world. There's no guarantee that they will be healthy, and just because they are not, you can't just wash your hands of them. Either give them to the state so they can qualify for foster care or adoption (and I have seen several chronic kids adopted), or remember that they are part of the family, too. These kids sit in limbo because no one is advocating for them or owning their situation.

    The saddest case is a child who was developmentally normal, just requiring some long-term PICC line meds. The family just basically gave up on the child and they stayed inpatient for almost a year. The last I heard the child was going to a long term home because family did not want to take the training or agree to a nurse to come and manage the home care needs.

    I did see one case where the MDs got together and agreed that it was unethical to provide any more medical interventions for a child who was suffering terribly every minute with poor prognosis. The child was being kept alive due to a social/legal situation within the family. They brought the case before a judge, who decided in the favor of the MD's. The child was put on hospice and passed very shortly afterwards. I was glad that at least in that case, the child did have advocates come forward. But that was probably one in a million.
  9. 1
    This is a topic that hits home with me because we do have children that will frequent our floors that fit this description. These are the children that I cry for on the way home from work in the morning... the ones that I carry around in my heart. I have often tried to explain to people why these kids affect me the most, because after all - they are not always the sickest that we see. I just almost feel like the sickest kid who is surrounded by people who love them have it better than the abandoned child who is just dropped off to fight their battles alone.
    RunnerRN2b2014 likes this.
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    I am so thankful I found this thread! I am new to pediatrics...its been four months now and I absolutely love it! The kids are great, but the parents give me an awful gut wrenching feeling when I see the ones who sleep through any and everything, prop bottles, and have no attachment what so ever...My first emergent experience was horrible..mom had a smirk through the entire thing...I was mortified and pretty sure my nurses face was erased..This is the first time I've cried for this kid everyday since I clocked out! I know they say "leave work at work." However irregardless of the age of this pt they could of been an oldie and I'd still be hurting for them.. Anyhow I needed to read this because now I 100% certain I'm not alone....
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    What I've learned is not everyone has the compassion, or the access to set up their homes (the more children people have=increased risk of poverty) or some have the dynamics of seeing a child as dollar signs (unfortunately). I worked agency in a group home, where the social workers would not order children adequate clothing and nurses would keep pressing for better conditions. One child that sticks out for me is the child who was severely beaten by her mother's boyfriend and has a piece of her skull removed. The boyfriend hit no parole and her rights were taken away...nurses would have to "supervise" the rest of the family...unfortunately (or fortunately) the group home was shut down due to the issues that the nurses raised.
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    I think that in at least some cases the parents care, but the burden of caring for a medically complex, chronically ill child just grinds down at them and depletes all their resources. t's one thing to marshall the troops for a one-time crisis, and people will come forward with offers to cook meals, babysit the other kids, etc. but not as easy to do on a regular basis if the child is being hospitalized every 6 weeks or so. when a child has long term needs requiring frequent hospitalizations, everyone else goes back tot heir lives and the parents are left to cope on their ow problem is exacerbated if the parents live far from the hospital. not everyone can just drop their lives, their jobs, their other kids, to sit with the one child who is hospitalized, especially if it happens at an inopportune time like a holiday, etc. I would not judge the parents in such a case if they just cannot manage to be with the child in the hospital 24/7.

    Regarding the LTC kids: at one point i was volunteering in a LTC and the nurses asked me NOT to hold the babies because then they'd get used to it and cry to be held. And some of these kids, esp the cardiac or trached kids, can turn blue/stop breathing if they cry too much. I do understand their rationale but how sad is it that even with a willing volunteer (okay, so I could only be there a few hours a week) the babies still could not get holding and cuddling.
    Halcyonn likes this.


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