American Academy of Pediatrics Provides Guidance on Dealing With a Caretaker Who Is Impaired

​The U.S. Department of Health and Human Services estimates that 8.7 million children live in a household with a parent with a substance use disorder. In a clinical report published in the December 2019 Pediatrics, the American Academy of Pediatrics outlines the professional, ethical and legal obligations for medical professionals who, during a medical encounter, suspect a caretaker is lacking judgment due to impairment. The report, "Dealing With the Caretaker Whose Judgment is Impaired by Alcohol or Drugs: Legal and Ethical Considerations," published online Nov. 25, focuses on handling immediate risks and offers guidance on how to respond to potentially volatile and risk-laden scenarios. While focusing on impairment due to alcohol or substance use, the recommendations may also be applied to scenarios in which impairment stems from behavioral health issues, dementia or an unstable medical condition. Recommendations include: conduct a safety audit of the medical facility; establish procedures, office policy and training for managing judgment-impaired visitors; verify state confidentiality and child abuse laws; and postpone nonurgent pediatric care if there is any question about whether an impaired caretaker is able to give permission for medical treatment for a child. The report also discusses mandated reporting laws and how to conduct conversations to lessen tension and provide a safe environment.

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.