in a difficult situation with "natural med" friend

[anon456, BSN, RN]

I have a dear friend who I have known for 10 years. I attended and supported her through her two natural childbirths including one at home (just as the friend, not the midwife!- she had one of those). I have answered her called in the the middle of the night when she was a new mom and baby was crying or she was having trouble nursing. I was not a nurse then-- I am just now a new RN. We differ on a lot of things including the fact that I have put my trust in conventional medicine, esp after one of my children was born with a complex medical issue and needed lots of medical intervention that homeopathy would not have touched and may have even caused more harm.

So last year she called me saying her child was having some breathing trouble, fast respirations, retractions. I told her to immediately take her to the ER. She didn't listen. Finally a couple of days later she took her to the naturalpathic doctor, who called an ambulance from the office and the girl was admitted for several days with asthma. She was given instructions to give the child medicine and breathing tx, but has not done either. And yet she calls me all the time asking what she should do, and I always tell her to take the child in and she doesn't.

Last week she called again in the middle of the night. Her child had a high (103) fever for a few days which did not respond to Tylenol. She called only when the child was complaining of a stiff neck and was not lucid, seemed to be having hallucinations and was sleeping a lot in between these fitful waking periods. Once again I told her take the child to ER but she didn't. Instead she gave the child phosphorus which was something she had read about in a book. She also started to wake the child more often to offer fluids. The next AM she called to say the fever was gone and the child was better and she was glad she didn't bring the child in, they would have just done the spinal tap and put the child through needless suffering. I say she had a very close call with this child! It could have been serious. And to add insult, she changed to the subject of asthma since I have a cough right now, and suggested that the chiropractor could cure my asthma with a few adjustments! I have been suffering my whole life and know how to manage it with meds and doctor visits.

She's planning to go to a third world country with the children in a few months. I educated her once again about vaccines and encouraged at least the Dtap and polio. She did finally relent on those after me telling her horror stories of children I had seen in this same country when I traveled there several years ago. Polio is alive and well.

ow

I don't know why this friend keeps calling me. I don't know if I'm obligated, now that I'm an RN, to report her lack of action with a child who's ill, esp. the last time when it could have been very serious. I love her and I know she loves her children but it's just hard to watch. I know I have to report abuse but does this count as abuse?

Thanks for listening.

[Purple_Scrubs, BSN, RN]

This is a very difficult situation. Medical neglect is considered abuse. If your state's regulations are like mine, then nurses are required by law to report even the suspicion of abuse. So, if I put myself in your shoes, I would definitely suspect medical neglect/abuse in the situation you described, and I would feel obligated to report to CPS.

I would also feel obligated to tell my friend that because of our differing opinions on medical issues, she should not call me with medical questions or for medical advice of any kind. If she continues to do so, I would simply say, "take the child to the doctor" and end the conversation.

I am all for natural options and seek them often myself, but conventional medicine is absolutely needed in many cases. I am afraid that it might take a trajedy for this person to see the light. I would remove myself from the situation is quickly as possible, sorry to say.

[BluegrassRN]

First of all, no, I don't think you are obligated to report someone in this situation. Parents actually can refuse treatment for children. Do you think her children are actually in danger? You think they should be removed from her care, that the children should go to foster care? I suppose if that's true, then yes, report her. But from what you've told us in your post, no, I don't think so.

When I read your post, to me it seems that this woman isn't exactly secure in her beliefs on natural medicine and homeopathy, and is bouncing these ideas off of you. You are a "safe" allopathic practitioner in her eyes. Allopathic medicine is not the end all, and many of us know that. How many of us allopathic practitioners take vitamins or supplements, use massage, see chiros and acupuncturist? All of which is naturopathic medicine. She sounds like she takes it to the extreme (much like those of us who want a pill for everything, when diet and exercise and healthy living would suffice).

I think if you don't want to remain friends with her any longer, that her views of natural healing and her rather unfriendly manner of throwing it back at you "thank goodness I didn't actually listen to you and take him to the ed" are stressful and rather toxic, then distance yourself from her. If you tend to enjoy her company most of the time, then I would let this little bit go. It's obvious that, in times of crisis, despite all her protestations, she *still* calls you for advice. In some manner, your advice must be comforting or informative for her. Keep telling her your opinion, why you believe what you believe, how you would handle it if it were your child, and then back off and let her make her own decisions.

[elkpark]

I agree that medical neglect is considered child abuse, nurses are mandated reporters (and not just at work), and there are legal restrictions on parents' ability to refuse treatment for their children. It sounds like you are being informed about situations with her child that could be life-threatening. How are you going to feel if, the next time you advise this friend to take her kid to the ED and the friend doesn't do it, the child ends up dead? That's something you would have to live with the rest of your life.

In all seriousness, I would be inclined to either go ahead and report this to CPS (and the child would probably not be taken away from the mother and put into foster care -- DSS doesn't have enough places to put all the kids they get reports on; in my experience, they bend over backwards to avoid taking kids out of homes), or, at least, inform my "friend" that, the next time she contacts me about a situation like this, I will report it. In that case, she would probably quit calling you about this stuff, and, at least, you would be out of the situation.

[mazy]

Your friend wants to do what's best for her children but she is making poor decisions. I think there is a lot of merit in a natural/homeophathic lifesyle options, but not when someone is not well-educated about how those translate into good parenting. Here are two recent stories in the news about similar situations with tragic outcomes;

http://www.cbsnews.com/stories/2007/05/09/national/main2778653.shtml

http://www.msnbc.msn.com/id/42608212

In addition, she is also planning to take her children to an area of the world where medical and nutritional resources are extremely limited. I know a lot of people look to less developed countries for information about more natural child-rearing resources, but I'm willing to bet that there are very few parents there who wouldn't jump at the chance to offer their children access to the resources we have in this country. How many people do we see immigrating to this country so that their children can have better lives?

One way or another you are going to lose a friend. Either by stepping away from this or by watching her make a catastrophically bad decision. It sounds like you are concerned and want to help. Does she have any family members that you can bring into this?

I agree with elkpark. It is very unlikely that CPS would take her children away if you reported this, but they willl light a fire under her to do what's best for her kids -- and not what's best for her.

[Whispera, MSN, RN]

I think you should tell her that heathcare is not something you will discuss with her, because it's clear you have different ideas about it. Also, if she negates your beliefs with an "I'm glad I didn't...." remark, I'd be saying something about it, if I felt devalued.

Is she a good friend? Other than medical issues does she make deposits in your emotional bank account? If not...welllll... ahem.... If so, then you might have to stick up for yourself and her child's health.

CPS doesn't yank kids out of their homes without big reason. Like someone said, they don't have places for them. Plus, their focus is keeping families together and making families non-neglectful and non-abusive. They might start an investigation if you report your friend, but maybe that's necessary.

Nurse are obligated to report possible neglect or abuse. Only you can decide if you really want to do it.

[traumaRUs, MSN, APRN]

I think you need to sever ties with this "friend" if she won't take your advice anyway.

Also, as an RN, I'm like you - the only advice folks get is "see your provider."

Don't know about reporting her - I doubt they would do anything. Sounds like she cares for the children, just not according to our standards of medical care.

[SummitRN, BSN, RN]

Hope you don't hear on the news that her kid died of an asthma attack because she rushed the kid to the chiropractor instead of giving the rescue inhaler.

[MouseMichelle]

You are a mandated reporter so report her, yes home remedies work but geez with what you're saying she's putting her child in EXTREME jeopardy.

[enchantmentdis, BSN, RN]

If you remain this person's friend eventually you will be going to her child's funeral. Report her first to the authorities and then never speak to her again. She deserves it for being so stupid and putting her child's life in danger. Being her friend will only cause you continuing stress and heartache. You deserve better than that. Let her own family members handle her. So tragic that the poor kid has to suffer.

[CrunchRN, ADN, RN]

I would tell her not to call and ask me for advice any longer if she is not going to take it. And not to call and report symptoms either unless she would then take my advice.

If she did anyway and I felt the child was in danger then I would call and report her.

[usalsfyre]

I personally could not remain friends with this person. "Naturopathy" to the neglect of other, accepted medical treatment has another name. It's called quackery. Your friend is setting her child up to die. Her child had an asthma exacerbation that needed to be admitted for several days and instead being willing to use accepted medical treatments for a life-threatening condition she wished to use fantasy and hocus-pocus. If you can continue to be involved more power to you. I couldn't simply sit by and watch someone place their children in danger daily.