Pediatric and Teen CL Care

Being Stern is Not Mean…

BY CHRISTINE W. SINDT, OD, FAAO

It’s responsible, loving, and mandatory.
Two-year-old Little Missy is running around the exam room, touching things. As I walk in, she’s picked up the retinoscope and is about to use it as a hammer. “Oh, no, no, no!” I exclaim. “That’s very expensive, and Mommy and Daddy don’t want to pay for it.”

I glance over at Mommy and Daddy, who both have their heads down, staring at their phones, oblivious to what’s going on around them. It probably explains why Little Missy had her eye injury in the first place. However, that’s in the past, and I’m here to treat her eye and to give her the best future vision possible.

I pull Little Missy onto my lap to firmly secure her and to prevent further exam room damage. I begin by questioning the parents about Little Missy’s contact lens wear since her dispensing visit. As it turns out, they haven’t bothered to apply the contact lens… ever! Why? Well, they just had other things to do, and never got around to it.

Little Missy was poked in the eye with a stick by an older sibling. She has irregular astigmatism and is aphakic in that eye, but miraculously her retina is intact. A contact lens is just the ticket to excellent vision development. Without one, however, there will be permanent vision loss and probably a sensory deprivation exotropia. The parents have to understand this.

My job is not to be friends with the parents, but to do everything possible for Little Missy’s vision. First, I will be empathetic, but stern. I will offer them resources for help, attempt to understand their situation, address all barriers to success, and discuss alternative options. I document everything clearly in the medical record because ultimately, failure to apply the contact lens is neglect, and I am a mandatory reporter.

Mandatory Reporting

Most states have mandatory reporting to the department of human services for suspected abuse or neglect of a child. As healthcare professionals, we are mandatory reporters and can be held liable in both civil and criminal courts for intentional failure to file a report.

Neglect—as in this case—is denial of proper care. It also pertains to parents’ repeated failure to make appointments, thereby causing harm to the child.

It is not necessary to inform the parents that you are making a report. However, when I feel that the situation is beyond remediation with in-person contact, I typically send the parents a certified letter outlining the circumstances, the requirements for care, and the next steps that will be taken if they don’t do what is necessary for their child’s vision.

A mandatory report must include a full description of the situation, including why the care is necessary, what will happen if care is not rendered, and dates/times at which the situation was discussed with the caregiver(s). An investigation will be launched if you make a report, so make sure that your chart notes are thorough. Mandatory reporting supersedes protected healthcare information laws.

Be Stern When You Need to Be

No one wants to be put in the position of being a mandatory reporter. That’s why taking a no-nonsense stance at the outset is the most loving and responsible thing that you can do for the child—and for the parents. CLS

Dr. Sindt is a clinical associate professor of ophthalmology and director of the contact lens service at the University of Iowa Department of Ophthalmology and Visual Sciences. She is the past chair of the AOA Cornea and Contact Lens Council. She is a consultant or advisor to Alcon Vision Care and Vistakon and has received research funds from Alcon. You can reach her at christine-sindt@uiowa.edu.