How to Support Children of Impaired Carers

How to Support Children of Impaired Carers

The American Academy of Pediatrics (AAP) Committee on Medical Liability and Risk Management has published a new guideline for paediatricians on how to support children of impaired carers.

The guideline provides ethical, professional, and legal obligations of a paediatrician when dealing with a caretaker whose ability is impaired from alcohol or other drug use.

This guidance is especially important as 8·7 million children in the USA live with a parent or guardian with a substance use disorder.

The guidance discusses how impairment (a diminished or damaged state of physical or mental health) affects doctors’ decisions around safety, privacy, and confidentiality; mandated reporting; and consent. Some of the key points in the guideline are as follows:

  • Paediatrician’s first duty of care is to the child, but there are also instances to help safeguard the health and welfare of the caretaker.
  • Conversations should be non-threatening and discreet.
  • Physicians should be trained to recognise their inherent biases when determining impairment and reporting to authorities- e.g., discrimination against those who are socially disadvantaged or from ethnic minorities.
  • Safety of patients, visitors, and staff is highly important, therefore, effective workplace policies, staff training, and safety audits are recommended.
  • Dialogue about the caretaker’s substance use and the risks their behaviour poses to the child is highlighted, however this needs to be sensitive and confidential.
  • Paediatricians must know the state’s confidentiality laws and report suspected child abuse or neglect to law enforcement and child protection services. Failing to do so can have legal and professional consequences.
  • AAP advises postponing non-urgent care, with consent, if the caretaker’s impairment prevents them from authorising their child’s treatment.

With the rise in substance use in the United States, the guideline is important for paediatricians to understand their responsibilities towards the child and the caretaker.

Source Website: The Lancet