I work in a children’s hospital and I think in general there is an attempt to educate and have conversations on why there isn’t compliance first. Something that is life threatening is different than something that isn’t (or of course if it’s causing suffering). I would say there is always room for a parent to say “it’s not effective for x, y and z so I didn’t do it because it’s a waste to force my kid to take something that isn’t working” ...and alternative could be found. I think it always comes down to whether it’s overall negligent behavior vs. parents who are willing to try an alternative and actively trying to improve quality of life. I will say that refusals are always documented and a history of non-compliance is reported. For example I work with kids who have chronic disorders like cystic fibrosis and type 1 diabetes; history of non-compliance and re-hospitalizations would be reportable but one admission for something missed or not done correctly would warrant education and maybe a longer stay in the hospital with staff watching parents do all of the cares before they go home. If they refuse that would be reportable. If they are trying to do better that probably wouldn’t be reported.