Separation of children from their parents is one possible traumatizing consequence of a mandated report, which is not to be taken lightly. This commentary on a case considers how racism and poverty should influence clinicians' construal of their duties as mandatory reporters of abuse and offers recommendations about how to respond in similarly difficult cases.Case AB, age 1 year, is accompanied to a visit with pediatrician, Dr K. AB's grandmother apologizes for missing prior scheduled appointments and explains that she and her daughter both work many hours beyond full-time. Dr K asks about AB's caregiver when they're at work. AB's grandmother pauses and explains that neighbors "check in on" AB during the day. Dr K, recording AB's below-normal weight, certainly feels there's enough evidence to suspect that AB is neglected, although AB's lack of regular adult supervision and insufficient caloric intake are due to poverty, not to insufficient parental impulse or love.Dr K hesitates, therefore, to "suspect" neglect. Dr K learned that one result of a recent mandatory report to the state's child welfare agency led to a 3-year-old patient's removal from a home in which the parents live in poverty. When that child returned to Dr K for an annual visit, the child was in a third foster care home, could not sustain eye contact with Dr K, would not engage in any kind of play Dr K tried to initiate, and was still underweight.Dr K worries, "Neglect is obvious, so, yes, I suspect it. This means I'm mandated by federal law to report this to the state. But, ethically, that hasn't helped some of my patients before and might do more harm than good for AB." Dr K doesn't speak with anyone else and wonders what to do.
CommentaryFederal law requires that all 50 states have procedures for mandatory reporting by certain individuals when they suspect child abuse and neglect. 1 This case illustrates a common dilemma in child welfare for mandatory reporters and caregivers who seek help