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.
2

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. 
3

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.
4

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 wellbeing 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.”). 
5

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). 
6

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.