IN THE COURT OF APPEALS OF IOWA
No. 17-0818
Filed July 19,2017
IN THE INTEREST OF L.F.,
Minor Child,
S.F., Mother,
Appellant.
________________________________________________________________
Appeal from the Iowa District Court for Linn County, Barbara H. Liesveld,
District Associate Judge.
A mother appeals the adjudication of her child as a child in need of
assistance following a dispositional hearing. AFFIRMED.
Ellen R. Ramsey-Kacena, Cedar Rapids, for appellant mother.
Thomas J. Miller, Attorney General, and Mary A. Triick, Assistant Attorney
General, for appellee State.
Julie Gunderson Trachta of Linn County Advocate, Cedar Rapids,
guardian ad litem for minor child.
Considered by Vogel, P.J., and Doyle and McDonald, JJ.
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VOGEL, Presiding Judge.
A mother appeals the adjudication of her child as a child in need of
assistance.1
I. Background Facts and Proceedings
L.F., born June 2015, came to the attention of the Iowa Department of
Human Services (DHS) in August 2016, upon allegations of child abuse and
denial of critical care by the mother. Specifically, the DHS, alerted by medical
providers, was concerned the mother was fabricating medical symptoms and
insisting L.F. undergo extensive and unnecessary medical evaluations and
treatment. The mother began bringing L.F. to the emergency room shortly after
L.F. was born, reporting the baby would vomit after eating. Between June 27
and August 4, 2016, the mother brought L.F. to the hospital at least nineteen
times, asserting L.F. was allergic to several varieties of food, which she believed
caused both vomiting and diarrhea. However, despite the mother’s reports,
multiple physicians informed the DHS that L.F. had not shown any remarkable
symptoms during her hospitalizations. The physicians had doubts about the
veracity of the information they received from the mother and concerns the
mother was feeding L.F. an inappropriate diet, potentially causing some of the
symptoms. Several rounds of food-allergy testing ultimately revealed that L.F.
did not have any food allergies.
Following an unrelated procedure, the physicians told the mother that L.F.
needed to be on a normal, regular food diet. Despite that recommendation, the
mother refused to give L.F. regular food and insisted on a diet consisting only of
1
The child’s father supported the adjudication and does not appeal.
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donated breast milk. Nurses also reported concerns about the mother’s behavior
towards L.F., including forcibly changing L.F.’s diaper, shaking L.F.’s crib while
telling her to “shut up,” and physically striking L.F. on one occasion. The child
abuse specialist at the University of Iowa Hospitals and Clinics was concerned
the mother’s behavior was rooted in a mental-health disorder, such as pediatric
condition falsification (also known as Munchausen by proxy). Ultimately, a child
abuse assessment performed by the DHS found the allegation of denial of critical
care was founded.
On August 24, the State filed a petition to adjudicate L.F. a child in need of
assistance. Following a contested adjudication hearing, the juvenile court
adjudicated L.F. a child in need of assistance under Iowa Code section
232.2(6)(b) and 232.2(6)(c)(2) (2016). The dispositional order of May 9, 2017,
ordered L.F. “remain with her parents while under the protective supervision of
the Department of Human Services.”
The mother appeals.
II. Scope and Standard of Review
We review a juvenile court’s adjudication of a child as a child in need of
assistance de novo. In re J.S., 846 N.W.2d 36, 40 (Iowa 2014). Though we give
weight to the juvenile court’s findings of fact, we are not bound by them. Id. “Our
primary concern is the children’s best interests.” Id.
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III. Statutory Grounds2
Iowa Code section 232.2(6)(b) provides:
6. “Child in need of assistance” means an unmarried child:
....
b. Whose parent, guardian, other custodian, or other
member of the household in which the child resides has physically
abused or neglected the child, or is imminently likely to abuse or
neglect the child.
Iowa Code section 232.2(6)(c)(2) provides:
6. “Child in need of assistance” means an unmarried child:
....
c. Who has suffered or is imminently likely to suffer harmful
effects as a result of any of the following:
....
(2) The failure of the child’s parent, guardian, custodian, or
other member of the household in which the child resides to
exercise a reasonable degree of care in supervising the child.
“Within chapter 232, ‘physical abuse or neglect’ and ‘abuse or neglect’ mean ‘any
nonaccidental physical injury suffered by a child as the result of the acts or
omissions of the child’s parent, guardian, or custodian or other person legally
responsible for the child.’” J.S., 846 N.W.2d at 41 (citation omitted). Our
supreme court has defined harmful effects under section 232.2(6)(c)(2) as
“established when there was harm to a child’s physical, mental, or social well-
being or such harm was imminently likely to occur.” Id. at 41–42.
The mother argues the State failed to prove by clear and convincing
evidence L.F. had suffered or was imminently likely to suffer abuse or neglect or
2
On appeal, the mother also raises constitutional claims in regards to exhibits introduced by the
State at the adjudicatory hearing. However, those arguments were not made below and were
therefore not ruled on by the juvenile court. See Meier v. Senecaut, 641 N.W.2d 532, 537 (Iowa
2002) (“It is a fundamental doctrine of appellate review that issues must ordinarily be both raised
and decided by the district court before we will decide them on appeal.”).
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had suffered or was imminently likely to suffer harmful effects as a result of the
mother’s failure to exercise a reasonable degree of care in supervising L.F.
Based on the record, we agree with the juvenile court the State proved by
clear and convincing evidence L.F. was a child in need of assistance. In the child
abuse assessment performed by the DHS, the social worker stated:
The concern with regard to getting the medical care is the
caretaker’s action (or “acts”) of “fabrication, exaggeration, etc.” fail
to provide adequate health care because it not only places the child
“in danger of suffering injury or death” but also may mask . . . other
health care needs.
In its adjudication order, the juvenile court concluded:
The Court finds that the State has proven by clear and convincing
evidence that the child is a child in need of assistance pursuant to
Iowa Code [section] 232.2(6)(b) and (6)(c)(2). The evidence shows
[L.F.] has been seen and treated by multiple medical professionals
for vomiting, diarrhea, and perceived food allergies observed
primarily by the mother. [The mother] has not followed medical
advice on at least one occasion which, thankfully, was not life
threatening for [L.F.] but could have been. There is a founded child
abuse assessment for denial of critical care, lack of adequate
medical care. There are documented concerns from multiple
doctors that [L.F] was/is a victim of medical child abuse. The court
concludes there is insufficient evidence to support a diagnosis of
Fabricated Childhood Illness (also referred to as Munchausen
Disorder by Proxy, Pediatric Condition Fabrication by Proxy, and
Factitious Disorder), but such a diagnosis has not been completely
ruled out. Voluntary services are not sufficient to resolve the safety
concerns.
We agree with the juvenile court the facts of this case clearly demonstrate the
mother was imminently likely to abuse or neglect L.F. under section 232.2(6)(b)
and L.F. was imminently likely to suffer harmful effects as a result of the mother’s
failure to exercise a reasonable degree of care in supervision under section
232.2(6)(c)(2).
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IV. Conclusion
Because we agree with the juvenile court’s conclusion the State proved
the statutory grounds for adjudicating L.F. a child in need of assistance, we
affirm.
AFFIRMED.
In the Interest of L.F., Minor Child, S.F., Mother
Combined Opinion