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Clinical Pediatrics
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The Death of a Child With Diabetes from Neglect

A Case Study

Gary Geffken, Ph.D.

University of Florida, P.O. Box 100234, Gainesville, FL 32610-0234

Suzanne Bennett Johnson, Ph.D.

Department of Psychiatry, University of Florida Gainesville

Janet Silverstein, M.D.

Department of Pediatrics, University of Florida Gainesville, Florida

Arlan Rosenbloom, M.D.

Department of Pediatrics, University of Florida Gainesville, Florida

This case report of a child with insulin-dependent diabetes mellitus (IDDM) describes a naturally occurring ABABCA design. The A condition represents poor diabetes management provided in the home setting, and the B and C conditions represent improved diabetes management in residential treatment (condition B) or foster care (condition C). The A condition was consistently associated with episodes of diabetic ketoacidosis, high glycosylated hemoglobin percentage, and school failure. In contrast, the B/C conditions were consistently associated with improved health status and school performance. On two occasions, the child was returned to condition A by the state's protective service agency (HRS) in direct conflict with the recommendations of the child's psychological and medical treatment staff. During her last condition A placement, the youngster died. Chronically ill children who are neglected may not receive the protection they need because of lack of awareness about the psychosomatic aspects of their problem.

Clinical Pediatrics, Vol. 31, No. 6, 325-330 (1992)
DOI: 10.1177/000992289203100602
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