A Case of Paediatric Obesity

Case history

AA was the youngest of six children. Both parents had a history of drug abuse and his mother had borderline personality disorder. The family had previous involvement with Community Services (CS).

When aged seven years, AA was admitted to ICU with respiratory distress. He was diagnosed with morbid obesity and obstructive sleep apnoea. His weight was 50kg and BMI 30. Upon discharge, his parents were informed that his obesity was serious and advised to adjust his diet and activity levels, attend a dietician and the ENT clinic, and have a glucose tolerance test.

However, AA continued to gain weight, missed the follow-up appointments arranged at the hospital, and was largely absent from school. A year later his weight had increased to 68kg and he was again admitted to ICU with a respiratory infection. His parents were advised that his condition was at a medical emergency level, but he still continued to miss medical appointments. This period of time coincided with escalating drug use by his parents. AA did not attend hospital again until a year later when he weighed 80kg. He lost consciousness at home, had a cardiac arrest on the way to hospital, never regained consciousness and died.

Medico-legal issues

The Coroner noted that despite the doctors having impressed upon the parents that AA was in a life and death situation, the parents were unable to make the necessary changes.

During AA’s contact with the health services, two reports were made to CS. The Coronial inquest highlighted that there was poor communication between CS and medical staff. AA had not been allocated a case worker, and his case had been closed by CS due to “competing priorities”, meaning that no case worker was available to take the case.

A review of this decision found that CS staff had not adequately recognised the risk to AA, and the intersection of medical needs with neglect had not been understood. Effective management would have required a joint child protection and health service intervention – but high workloads, competing priorities, poor interagency collaboration and inexperienced staff meant that CS did not become involved.

Discussion

Twenty-six per cent of Australian children aged 5-14 years are overweight or obese.² This case is extreme, in that AA was very obese and his parents were unable to adequately address his medical needs. However, it is likely that there will be further cases where extremely obese children may need to have the involvement of child protection services to adequately address their health issues.

This is a very complex area. Good communication between medical services and child protection services is essential to adequately monitor such children and to determine what action should be undertaken, and when it should happen.

Dr Jane Deacon
Medico-legal Adviser, MDA National

References

1. NSW Coroner’s Court. Inquest into the Death of AA. 26 September 2014.
2. Australian Bureau of Statistics. Australian Health Survey: Updated Results, 2011-2012. Available at: abs.gov.au/ausstats/abs@.nsf/Lookup/33C64022ABB5ECD5CA257B8200179437