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Review
. 2022 Jun:128:105605.
doi: 10.1016/j.chiabu.2022.105605. Epub 2022 Mar 31.

A Venn diagram of vulnerability: The convergence of pediatric palliative care and child maltreatment a narrative review, and a focus on communication

Charles B Rothschild  1 , Barbara H Chaiyachati  2 , Kara R Finck  3 , Melissa A Atwood  4 , Steven R Leuthner  4 , Cindy W Christian  2
Affiliations
Review

A Venn diagram of vulnerability: The convergence of pediatric palliative care and child maltreatment a narrative review, and a focus on communication

Charles B Rothschild et al. Child Abuse Negl. 2022 Jun.

Abstract

Child maltreatment and end-of-life care independently represent two of the most emotion-laden and uncomfortable aspects of pediatric patient care. Their overlap can be uniquely distressing. This review explores ethical and legal principles in such cases and provides practical advice for clinicians. The review focuses on three archetypal scenarios of overlap: life-limiting illness in a child for whom parental rights have been terminated; life-threatening injury under CPS investigation; and complex end-of-life care which may warrant CPS involvement. While each scenario presents unique challenges, one consistent theme is the centrality of effective communication. This includes empathic communication with families and thoughtful communication with providers and community stakeholders. In almost all cases, everyone genuinely wants to do what is in the best interest of the child in these unthinkable circumstances. Transparent and collaborative communication can ensure that broad perspectives are considered to ensure that each child gets the best possible care in a manner adherent with ethical and legal standards, as they apply to each case.

Keywords: Child maltreatment; Child protective services; Communication; End-of-life; Palliative care.

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