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B. Yuksel, K. Withana.

Barnet and Chase Farm Hospitals NHS Trust, Department of Paediatrics, The Ridgeway, Enfield, London EN2 8JL

During the past decade, an increased number of children and families have applied for political asylum in UK. We wish to present four children who faced major medical emotional problems and required hospital admissions provoking ethical/legal discussions.

Objective: To highlight the problems these children faced and assess the possible ways of helping them.

Methods: Four children/young persons appealing for asylum in UK were admitted to the General Paediatric ward recently with major medical problems.

Patients: First two children were siblings from Pakistan, 2 and 3 years of age with severe undiagnosed neuro-developmental disorders, learning and feeding difficulties and Epilepsy. Parents applied for political asylum in UK. Possibly after their application was refused, they have disappeared from the ward following 2.5 months of admission, and hence cannot be followed-up despite serious medical implications. Third case was a teenage female from Uganda with post-traumatic stress disorder, suffering from severe depression, nightmares and flashbacks. Her asylum application was refused by the Asylum Appeals Panel. Fourth case was a teenage Albanian male who cannot even communicate with his foster parents because of the language barrier. On arrival in the UK, he suffered a head injury in an accident. Latter two children witnessed the murder of their families in their home countries.

Result: First two children were taken away from hospital with serious concerns about their survival. The other two have serious social/emotional problems and face the possibility of being forcibly returned to an environment that was, in their view, extremely hostile.

Conclusion: We have to elucidate avenues of helping such children who have already been severely traumatised and have long-term medical needs. There are major concerns from ethical and legal standpoints. The responsibility of helping these children during and following discharge from hospital needs to be clarified.


S.A. McKenzie.

Barts and the London NHS Trust, London E1 1BB

Background: Parents do not always appreciate that their child is overweight and find it difficult to follow advice. Obesity programmes in the USA for children have been largely unsuccessful. Childhood obesity has become one of the most challenging public health issues. Parental behaviour that produces significant harm by impairing a child’s growth and development is subject to child protection investigations. Should over-feeding be seen as harmful behaviour?

Aim: To consider whether over-feeding children who are obese should be a child protection issue.

Methods: The histories of three grossly obese children will be presented. One, aged 4y, died of right heart failure due to obesity. Another aged 4y was considered ‘at risk’ because social services believed he was being given excessive corticosteroids for asthma. A third, aged 11y, also under the supervision of social services, continued to gain weight despite all efforts. Medline was reviewed for information about obesity, over-feeding and child protection.

Results: Body Mass Indices were 7.2, 4 and 5.1 z scores. All children had significant obstructive sleep apnoea. All had extensive medical investigations. All families had child psychiatry input. Some members of each household had mental health problems. Only the child on the child protection register - where there was substantial home supervision of diet and activity - has not gained weight. Although there was no proof of excessive steroid intake, there was ample evidence of over-feeding. There were no reports on Medline about obesity, overfeeding and child protection.

Conclusion: Over-feeding of children by adults can be regarded as producing significant harm and could trigger statutory intervention, which could include access to the home to allow supervision of eating and activity.