Neonate with abdominal distention:

While working as the attending pediatrician in the neonatal ICU, you are called by nursing to examine a two day old male child who has recently begun vomiting. The nurse also notifies you that the child has failed to pass meconium since his birth. Physical examination demonstrates significant abdominal distention. A rectal examination shows no stool. You strongly suspect Hirschsprung disease and inform the mother of the child that an abdominal radiograph and barium enema are necessary. The mother forbids you from continuing with any further testing or procedures because she does not believe “there is anything wrong.” What is the most appropriate next step?

A) Wait until mother provides consent
B) Call grandparents of child to obtain consent
C) Contact the hospital’s ethics committee for guidance
D) Proceed with tests
E) Agree not to perform the tests
F) Obtain a court order to authorize testing

[expand title=”CLICK HERE VIEW CORRECT ANSWER:”][sociallocker]Correct answer is D. Because the child in this case has suspected Hirschsprung disease, failing to confirm the diagnosis could result in potentially life threatening complications (e.g. perforation). The physician should therefore first try to explain to the resistant parent the consequences of withholding diagnostic test and treatment. If the parent continues to refuse permission in cases (such as this one) where a delay could have disastrous consequences, a physician is legally authorized to provide the emergency treatment for the child.[/sociallocker][/expand]