Need advice - is this abuse?

What you describe is more a case of medical neglect (for not starting the special diet) since it sounds like the child may actually have a metabolic disorder.

Have you considered the possibility that the problem is the Aunt and not the cousin? To be very honest, in years of working with medically fragile children I encountered many families where a grandparent had issues with the medical care and decision making by the childs parents. Often the grandparent had no real clue about the childs illness or needs because the childs parent limited the contact & information given due to the level of dysfunction and to avoid conflict.

As it appears the information you are getting is second or third hand it probably does not fall with your states mandatory reporting guidlines as you have no direct knowledge of abuse or neglect. You will need to let your conscience be your guide in this.

What you describe is more a case of medical neglect (for not starting the special diet) since it sounds like the child may actually have a metabolic disorder.

Have you considered the possibility that the problem is the Aunt and not the cousin? To be very honest, in years of working with medically fragile children I encountered many families where a grandparent had issues with the medical care and decision making by the childs parents. Often the grandparent had no real clue about the childs illness or needs because the childs parent limited the contact & information given due to the level of dysfunction and to avoid conflict.

As it appears the information you are getting is second or third hand it probably does not fall with your states mandatory reporting guidlines as you have no direct knowledge of abuse or neglect. You will need to let your conscience be your guide in this.

It is not required that mandated reporters have "direct knowledge" of abuse or neglect -- just that you have reasonable cause to suspect abuse or neglect. It is the job of the state's Child Protective Services personnel to make a determination about whether abuse or neglect is occurring, not the reporter.

Also, you certainly don't have to be a "mandated reporter" to report a situation that you are concerned about. As a long-time child psych CS, I would say, based on the information that you've reported (assuming for the moment that it is true/accurate), what you're describing is at least neglect and possibly abuse.

Of course, it is your choice whether to report or not. But which would feel worse -- to report and possibly create some family conflict (remember that your report is confidential), or find out later that something awful ended up happening to this little girl and you had done nothing to prevent it?

It is not required that mandated reporters have "direct knowledge" of abuse or neglect -- just that you have reasonable cause to suspect abuse or neglect. It is the job of the state's Child Protective Services personnel to make a determination about whether abuse or neglect is occurring, not the reporter.

Also, you certainly don't have to be a "mandated reporter" to report a situation that you are concerned about. As a long-time child psych CS, I would say, based on the information that you've reported (assuming for the moment that it is true/accurate), what you're describing is at least neglect and possibly abuse.

Of course, it is your choice whether to report or not. But which would feel worse -- to report and possibly create some family conflict (remember that your report is confidential), or find out later that something awful ended up happening to this little girl and you had done nothing to prevent it?

This sounds somewhat like Munnchausen's Syndrome by Proxy, where a caregiver continually seeks medical attention for a child or dependent adult with nonspecific complaints (often vomiting, diarrhea, failure to thrive, unresponsive episodes and such), insists on invasive testing, and actually may be harming the person in order to "prove" there's something wrong with them. Often times the symptoms are not reproducible once medical attention has been obtained. Children have had major surgeries that have turned up no sign of the suspected diagnosis, there've been cases of feeding tubes and trachs being placed in perfectly normal children, and many other incidents. A quick Google search will help make it all real to you. If you suspect that is a possibility, then social services needs to assess the situation. As the previous poster suggested, the social work department of the children's hospital would be the place to start. I would believe that your cousin's child is in danger, whether you aunt is exaggerating or not.