An 11-month-old baby was admitted to "Dr. Pedro de Elizalde" Children's Hospital on 10/2/02 for an episode of ALTE (an apparent life-threatening event).
The mother reports that, when she is at home, she presents an episode of hypotonia, cramping and respiratory distress, which is why she is hospitalized for a child.
She suffered a similar episode one month ago, and was admitted to another hospital, where she underwent neurological examination (without EEG) and cardiological examination (ECG) with normal results.
During hospitalization, she presented episodes of similar characteristics to what motivated her admission (hypotony, vomiting, sweating and coldness of extremities), and a convulsive episode medicated with diphenylketony (7 mg/kg).
Family history: 19-year-old mother with psychiatric disorders, treated at Tobar García hospital for anorexia nervosa.
She had a history of drug addiction and suicide attempts, two hospitalizations for depressive episodes and another for drug intake at 2 months of pregnancy.
Patient studies: • Cardiac: clinical examination, ECG, TILT Normal test • Neurological: clinical examination, EEG, polysomnography, brain ultrasound.
All with normal results. • Gastroenterological: clinical examination, antigliadin antibodies, arthritis and pH monitoring, abdominal ultrasound.
All normal. • Endocrinological: suggest ruling out familial dysautonomia EEG and diagnostic confirmation.
The following laboratory tests were performed: complete blood count, urine, blood glucose, hepatogram, muscle enzymes, calcium, phosphorus and magnesium in blood, coagulation profile, thyroid hormone, two-titration bladder and urine collection.
All results showed normal values.
The mother was given a dosage of drugs of abuse: non-dose.
In the girl: positive result for benzodiazepines, which was interpreted as secondary to seizure medication.
Because all the evaluations and laboratory values were normal, the episodes of apnea occurred exclusively in the presence of the mother and when the episodes were suspected, family violence was requested.
This care unit, consisting of medical professionals, psychologists, social worker abuse, is devoted to diagnosis and comprehensive approach with an interdisciplinary character of the different manifestations of children and adolescents.
Within this framework we proceeded to: Interview on admission with the maternal grandmother, interviews with the mother, interviews with the father, interviews with the maternal grandmother, interview with the paternal grandmother and pediatric evaluation.
During hospitalization, the parents played a leading role in episodes of cross-conjugal violence, which led to the suspension and resumption of coexistence repeatedly, as had happened before.
The mother showed a challenging, not very collaborative attitude, without being able to approach the clear description of the events that resulted in the referred symptomatology; besides, she was involved in the episodes experienced by her daughter.
However, it was possible to infer that her daughter did not continue her care.
In the interviews with the maternal grandmother, there was an evident concern about labor issues, as the whole family group depended on her.
Nor did he show an empathic commitment to the niet and rejected the possibility of taking care of the child.
The father expressed difficulties to speak spontaneously and was resistant to provide information.
She knew all the possibility that the mother had participated, causing her daughter's suffering.
The father-in-law considered that neither his son nor his mother could remain in charge of the creature.
However, her own personal and family situation made it impossible to provide the protection that the child deserved.
The possibility that the episodes were caused by the mother and in the absence of reliable relatives, the services of a hospital caregiver were required 24 hours a day.
It was intended to continually supervise any procedure performed by the mother that could put her child's health at risk.
After incorporation, the patient did not repeat the described clinical picture.
It should be noted that, in developed countries, there are video cameras in the inpatient wards that allow the observation and filming of procedures that could lead to the discarding of people who remain in the care of the patient, which allows Munch or
Given the delicate situation of the patient, it was necessary to protect her integrity as a subject of rights to the Defensor of Minors and then suggest the child Judge who intervened knows the psychological resource supervision.
