Obese kids face CYF referral

Doctors are developing protocols to refer obese children to child protection services if their parents ignore medical advice to help their children lose weight.

Australian paediatrician Dr Alice Johnson told a child abuse conference in Auckland yesterday that her unit at Perth's Princess Margaret Children's Hospital had referred 13 children and teenagers to child protection services since 2008 after parents failed to address children's obesity or when there were other child protection issues such as drugs or domestic violence.

In four cases the child protection agency removed children from their parents to ensure that they kept appointments with dietitians and tried to lose weight.

In New Zealand, Starship hospital paediatrician Dr Patrick Kelly said he was working with police and Child, Youth and Family (CYF) to develop a "traffic light" system to guide referrals to CYF for "medical neglect".

"Green means we are working with the family to make sure they have all the cultural support they need and all the access issues in Obese kids to be sent to CYF if parents fail to place, such as transport," he said.

"Orange is where you are starting to think we are still not making progress and this is putting a child at risk. Red is where you are starting to involve the statutory authorities. It's not specific to obesity, but I can imagine there might be some obesity cases."

Dr Johnson, who sees children referred to her Perth clinic from all over Western Australia, said some parents failed to make sure their children took medication for other conditions such as diabetes and cystic fibrosis. But the obesity cases had increased over the past five years.

"With the vast majority of children with obesity there are no child protection concerns," she said. "It's a very tiny minority of children with severe obesity who have medical complications or comorbidities and whose parents are not addressing their needs."

Many of the children have obstructive sleep apnoea, high blood pressure, insulin resistance and diabetes, fatty liver disease or mental health issues such as poor self-esteem or depression.

Dr Johnson said her hospital had developed a suite of interventions to help the families, including hospital treatment, intensive in-home support from social services, parenting programmes, financial support and "as a last resort" removing children from their parents.

Interventions had been put in place for 15 children so far. In two cases the parents responded as soon as they realised the serious risk to their children, but the other 13 were referred to the state's child protection service. Nine were left at home and four were moved to other carers.

Dr Johnson said all the children lost weight in an initial three- or four-week stay in hospital simply by eating a normal hospital diet and getting some exercise and physiotherapy. One 11-year-old boy who weighed 155kg lost 9kg in three weeks. "He loved doing the exercises and was feeling really good about himself."

However, the results after they left hospital were disappointing. Only one of the nine children who stayed at home lost significant weight. The four who were moved to other carers all lost weight initially, but three of them put it on again when they help them lose weight moved to other carers or back home.

A third to half of the children were Aboriginal, often in remote areas. Many had other issues in their families such as parental drug use, violence and mental health issues.

Otago University paediatrician Professor Dawn Elder said children's eating might be influenced by the stress of those other issues.

But Dr Johnson found no answers when she asked other experts at the conference if anyone had found a way to overcome the problem.

"There has been improved attendance at appointments, but no change in weight for the vast majority," she said. "The outcome is it doesn't seem to make a difference. What do we do?"

Medical Association chairman Dr Mark Peterson said later that New Zealand doctors would always try to help a family to change their diet and exercise more rather than reporting them to CYF. "I'm not saying there would never be a case for it, but it would be very rare," he said.

Otahuhu Recreation and Youth Centre nutritionist David Hill said most parents tried to help their teenage children to lose weight, but that the teens often resisted the pressure.

- Simon Collins of the NZ Herald

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