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January 25, 2006


Question from San Diego, California, USA:

My sister and her ex-fiance are going through a child custody battle right now, right after their child was diagnosed with type 1 diabetes. They cannot agree on the physical custody of my nephew, so they have gone through the courts.

Just yesterday, the assessor said that she is going to recommend to the court that due to his health condition (type 1 diabetes), it is not good for him to be moved around between both parents’ houses. She said that just one parent should have sole physical custody. It doesn’t seem as though she has spoken to any health experts before making this recommendation, just talked with the parents themselves and a few others. Doesn’t this seem completely unjust and unfair? I can’t imagine that ANY health expert/doctor would ever say that a child should be taken away from one parent and the child should only live with one parent, not share the time equally.

Since going to court, the judge initially awarded a 60/40 split between parents which has been working well and my nephew seems to be fine. Is there any reason why this recommendation is a good one or can this be fought with medical experts saying otherwise?

I am very concerned for my nephew because I think, especially with a medical condition, the more love and support from ALL of his family is absolutely crucial to him living a happy and healthy live.


From: DTeam Staff

I have cared for many children who spend time at different homes with different parents. What is extremely important is that the parents cooperate regarding the plan for diabetes management. Sometimes different plans have to be worked out if the schedule is different at the different homes.

I usually recommend that the parents initially try to come in together to discuss the management, and then alternate visits. It is important that blood sugar/insulin/food records be shared. This can be done easily by maintaining a log on the computer that is e-mailed back and forth when the child changes where he is living, so there is just one log for both parents to use and to share with the child’s doctor/nurse/dietician. Each parent must fill in the log when the child is with them.

If the parents can’t agree on diabetes management, then it may be better for the child to live with one parent and arrange visiting with the other parent. Ask a lawyer how to get joint custody (I am assuming there are no other issues not related to the diabetes). You will probably need a letter from the child’s physician that he or she feels it would be medically safe for the parents to have joint custody.

Additional comments from David S. Holtzman, Esq.:

Custody determinations are complicated legal proceedings that have long term consequences for the entire family. Every state has a different procedure and standards for determining how custody is determined. Each parent should seek assistance from an attorney who has expertise in family law.

Additional comments from Debbie Butler, MSW, LICSW, Licensed Clinical Social Worker:

It is difficult to comment on this situation without knowing more details, but I definitely agree with the last statement that you wrote that love and support from a child’s family is extremely critical in a child’s life. I have recommended that some families call the American Diabetes Association (ADA) Advocacy office when they are worried that their child is being discriminated against because of diabetes. If you are interested in contacting the ADA about this situation, the number for the ADA is 1-800-DIABETES (1-800-342-2383) and you can ask to speak to the advocacy department.

Additional comments from Dr. David Schwartz:

There are so many factors that have to be weighed.

In broad terms, I agree with the writer that the child should not be denied the love and support of both parents.

But, everyone must be realistic. You indicate that this child is young.”SOMEONE” will be required to check glucose levels several times daily, draw up and give insulin, check for ketones when glucose is high and on sick days, take the child to the doctor, pick the child up from daycare or school when sick, have the Glucagon Emergency Kit, etc.

Of course, ideally, both parents should be trained and know what to do, even for sporadic visits. Does one parent travel out of town? Is a parent unemployed? Do the separating parents have new commitments to new partners and families? How will those step-parental figures do? Divorced parents should be allowed to move on with their lives. But, the child’s pediatrician and the courts must be the child’s advocate.

Is this child and child custody being used as a lever in this ending relationship? That is clearly NOT in the child’s best interest.

I would think that the assessor would want to talk to the child’s diabetes team, but I don’t know that she is required to. Can’t the parents ask for that input?

Additional comments from Dr. Larry Deeb:

Regrettably, we have to share this scene more than we would like. I have never seen a parent refused custody because of diabetes. I agree that it is just wrong. I don’t know the parent in question. If the child’s diabetes is terribly controlled, multiple admissions for DKA or seizures in the night, maybe only one parent should get custody. This might be an interesting question for the legal advocacy department of the ADA.