What happened to the follow-up on this child?

oramar · Jan 7, 2011

Here is my take on the matter, it is a total GUESS based on a life of experiences as a working class family member and taking care of blue collar people. You may say I am out of line making an educated guess like this but wait till the facts come out and I bet I will be closer than you would think. I DO NOT KNOW THESE PEOPLE! I think the father is a controlling, paranoid goof ball. He probably didn't much care for medical care and interference by outsiders. The mother was completely under his control, not even permitted to practice birth control.(no excuse) Totally overwhelmed by the care of this large family and a medically frail child she imploded. She just stopped taking care of the family which included doing the medical care she was taught to do while the medically frail child was in the hospital. Why wasn't there follow-up? The father probably chased the visiting nurses away assuring everyone that the family would take care of it's own. Let us see how close I am to the truth when the facts come out. Forgive me for jumping to so many conclusion but I have personally witnessed similar situations just like this. I am currently tearing my hair out in frustration over this childs death.

umcRN, BSN, RN · Jan 9, 2011

It's so frustrating when children we care for end up like this. There was a similar incident in my area, we had a baby in our unit for quite a few months, went home on oxygen and a monitor. The mother was difficult to get in for teaching but eventually it was all done and he went home with her. He missed his first three follow up appointments and our case managers tried vigilantly to follow up with them. When they finally did they got word that the infant had died, found in his car seat, attached to an empty oxygen tank and no monitor. I'm not sure if anyone ever found out what happened to the mother but thoughts among us were that she would not be charged and that his death would be blamed on underlying conditions despite the empty oxygen tank and lack of monitor. :mad:

JeanettePNP, MSN, RN, NP · Jan 9, 2011

I don't understand how a child like this gets discharged home.

Pediatric Critical Care Columnist · Jan 9, 2011

Many years ago I was primary nursing a baby in the intermediate care nursery. He was a former 32 weeker with an unidentified neuromuscular disorder that caused him to occasionally just not breathe; he also had reflux and mild chronic lung disease. Beautiful little boy. His family lived in a small, remote community several hundred miles from our referral centre and didn't visit at all until just before he was ready for discharge. I spent several days trying to teach his mother his care so that she could take him home, but she was more interested in shopping and visiting the other women at the boarding home. She repeatedly missed appointments with the NP and the physician, showed up late for feeds and wasn't interested in hearing about positioning or feeding precautions. I reported and documented my concerns six ways to Sunday but ultimately the baby was discharged to her care. The plan was for them to stay at the boarding home for several days so she could get used to caring for him before returning to their very remote hometown. He was discharged on a Friday morning. On Saturday afternoon I got a call from a friend who was working in the ED... he had been brought in that morning in full arrest. Mom said he hadn't woken her up for a feed during the night so when she woke up she went outside for a smoke without checking on him more than a glance in his direction. When she came back she noticed he wasn't breathing. Duh. Who knows how long he was dead? I was just sick... I did everything I could short of kidnapping him. I wish I would have.

Years later there was another child with SCIWORA who was in hospital forever because his parents wanted to have a house built for his needs, fundraised from charitable organizations to do it and then built out in the country, kept putting off learning CPR, trach care and so on then finally took him home only to let his baclofen run out about 6 months later. He died of malignant hyperthermia.

There are too many people who shouldn't have kids.

littlemammanurse, BSN, RN · Jan 9, 2011

This is so sad Children represent innocence, and it saddens me when they are exposed to such harsh and horrible conditions such as this

I remember when I did my pregrad placement on a postpartum floor.One girl who was only 19 was on her second child.She was a drug addict and did drugs throughout her pregnancy with both children.The father of both kids had just gone to prison because he was caught dealing drugs, and in a drug raid found thousands of dollars in drugs in their home.She was getting upset at the social worker because she couldn't understand why she was being sent home without her child.Her other child she lost custody of because she was neglecting the child so she could do drugs.Her mother had full custody of the child, and the saddest thing was the baby called this girl's mother "Mommy".She didn't even know that her real mother is a drug addict and her father was a drug dealer.It was the saddest thing of my life to watch this girl try to claim that she didn't do drugs during her pregnancy when every test, and her newborn claimed she did I was thanking God that the child didn't go home with her as sad as that sounds.

umcRN, BSN, RN · Jan 9, 2011

I don't understand how a child like this gets discharged home.

In regards to the baby I wrote about, he also had a primary nurse who tried again and again to get another plan on the way. CPS was involved, social work and case management all involved but without CPS saying the baby cant go home with the mother then the baby will go home with the mother, no matter how much documentation done, reports filed etc. There is only so much we can do sometimes :mad:

JeanettePNP, MSN, RN, NP · Jan 9, 2011

I work in pediatric LTC as well as in pediatric home care. The kids in LTC are not necessarily sicker or less stable than the kids in home care; a lot depends on the home environment and what the parents can provide. If the parents are not able to provide the level of care the child needs (even with nursing support), the child goes to LTC. This isn't a judgment on anyone, just a realistic assessment of the resources available in each case. I understand that sometimes kids fall through the cracks.