Tuesday, February 27, 2007

What to do when a child doesn't fit in

Another entry from the annals of government parenting by proxy. A mother in England is facing the possibility of losing custody of her son if he doesn't lose weight.

The boy is 8 years old and 218 pounds, making him three times the average weight for a child his age. His weight makes him prone to a number of health problems, and already he is unable to take part in certain school activities and stays home from school frequently due to weight-related illness. His mother seems to feel helpless to stop the boy's eating. She says he eats three times what is normal for his age, complains if he doesn't get as much to eat as he wants, and will steal and sneak food.

Health services says taking custody of the child would be the worst-case, last resort scenario, but that it is a possibility. They cite evidence that the boy's weight is a health risk. They say they have tried to intervene, but that the boy and his family have missed appointments. They say allowing the boy to continue to eat and grow the way he has would amount to child abuse and neglect.

Since becoming a parent myself, I often bristle at the thought of government authorities reigning over my parenting practices. All too often, it seems the authorities meddle in parenting choices they simply disagree with. In Texas, a one-year-old child and his older brother were taken from their mother in 2002 and kept in foster care for several months after their parents tried to develop photos of the younger child nursing. Authorities called nursing an 18-month-old "performance of a sexual act", demonstrating a tragic misunderstanding of shifting societal norms. Although the norm in the United States may now be to nurse for mere weeks or months, until formula became an accepted and a relatively acceptable substitute for breast milk, nursing for several years was as normal in the United States as a whole as it still is among a subculture of mothers in this country and in many other parts of the world. Health practitioners widely endorse nursing into the preschool years. Researchers are now even urging HIV-positive mothers in Botswana to nurse, considering the risk of transmission to children less than their risk of contracting a deadly gastrointestinal illness from the water in formula. The standard WHO recommendation is for a minimum of two years of nursing for all mothers. The idea that a young, nursing child could be taken from his mother because authorities do not understand a relatively normal parenting practice is deeply disturbing.

Of course, lines may be reasonably drawn in different places in different societies. In the United States, we agree that a certain level of physical punishment is unacceptable and that parents who cross the line can lose custody of their children. We agree that children under a certain age are unable to consent to be married or to have sex. Though children of the same age in other times and places might already have families of their own, and though these children might be perfectly fine and happy within their time and place, it is basically good that we set socially agreed-upon standards. We do this out of concern for the mental and physical health and well-being of the child, and out of an understanding for what is acceptable for the majority of people who live here and now. We must also, however, remember that current standards are relative and fluid, and that there is a large grey area at their boundaries.

In the case of the overweight child, concern for the child seems to stem from a growing obsession with healthy eating practices, and frustration with a child and parent who haven't jumped on the bandwagon. This particular child's weight problem is extreme, and there are valid concerns at the heart of health service intervention. But though I think the case of the 218 pound 8-year-old is tragically close to the line, I don't think it has crossed into custody-rights territory, and hope extreme government interference does not become typical in such cases.

The main concern in this case is that the boy's lifestyle choices are dangerous to his current and long term health, and that his mother is enabling unhealthy choices. I agree. Let me be clear that I feel sad for this boy, and hope he and his mother will make some changes. The boy seems unhappy and unhealthy, and my heart goes out to him. I feel frustrated by the parenting choices his mother is making, and feel she has a responsibility to help him maintain his health.

But I don't see the risks here as objectively much worse than those taken, for example, by children whose parents allow them to be involved in extreme or Olympic-level sports. Young figure-skaters, for example, are at risk for incuring severe injuries during practice and for severe chronic pain in later life, as well as for crippling conditions such as early onset osteoporosis, not to mention the effects of emotional stress during competition. Yes, the young boy in this case is unhealthy now, and may develop serious conditions such as diabetes and heart problems if he doesn't lose weight. But our willingness to accept certain health risks while deploring others stems from the value we place on athleticism, strength, and being thin at all costs, and the apathy and even disgust we feel towards people who lack those qualities.

Does the possibility of fame, fortune, and a crowd full of fawning fans really make calculated health risks acceptable for child athletes, while our recent societal obsession with "healthful" eating means a boy whose health is at risk because he is eats too much could be taken away from his home, mother and sister? Beyond expressing their disapproval and encouraging changes in behavior, how far should the government go to intervene here?

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