Wolf et al1 presented an interesting approach to situations in which parents reject interventions to reduce postnatal transmission of the human immunodeficiency virus (HIV). We wish to offer an alternative perspective. Wolf and colleagues provide a framework focused on parental behavior or omissions in care. The multiple and interacting factors that contribute to children's needs not being met have been underscored by recent reports exploring issues of noncompliance2 and neglect.3 These factors include aspects of the disease, the treatment, the child, family functioning, community and societal factors, and parental behaviors. There are clear advantages to view neglect from a child's perspective—occurring when a child's basic needs are not met—and to acknowledging the many risk factors that may be responsible.4 After all, our goal is to ensure children's well-being, not to blame parents.
Dubowitz H, Watson D, Farley J. Medical Neglect: A Child-Focused View. Arch Pediatr Adolesc Med. 2002;156(3):297–298. doi:
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