UPDATE: A day after a Florida judge ruled that the parents of a 4-year-old boy with leukemia won't regain custody of him, the boy's mother posted an emotional message on Instagram.

The boy, Noah McAdams, was removed from his parents' custody in April when they skipped a chemotherapy session and left the state in pursuit of alternative treatments.

On Monday, Hillsborough County Unified Family Court Judge Thomas Palermo denied a bid by Noah's parents, Taylor Bland and Joshua McAdams, to regain custody of him.

Bland, in a message posted Tuesday to the social media platform, asks Palermo a series of questions.

"Are you going to be there rubbing his back at 2 a.m. when he's up crying his belly hurts and puking?" she wrote. "Are you going to explain to him why his beautiful long hair is coming out in chunks? Are you going to hold him and make him smoothies and juices when his mouth hurts so bad from methotrexate sores, he can barely eat?"

She also asked the judge if he would lie with Noah when the boy is too tired to get out of bed, would he rub Noah's feet when he's experiencing neuropathy or if he would take "the bites, punches, kicks (and) screams" when Noah suffers a mental breakdown.

In a photo that accompanies the Instagram post, Bland's eyes are closed and she's holding her closed left fist against her mouth. The number "133" is written in red ink on her fist, which apparently is a reference to the number of nights Noah's parents have been without him.

"I hope this sits with you in the darkest hours on the latest nights like the many dark and lonely nights I have sat through without my child for 133 lonely nights, while you have yours," she wrote.

Bland ends her message with a dig at the judge and a hashtag.

"I hope you remember the face of a mother that loves her baby, since you wouldn't even look at me yesterday. #BringNoahHome."

Palermo won't make any comment on Bland's message, a court spokesman said.

"The judges are precluded from commenting by their canon of ethics," spokesman Mike Moore told CNN. "He issues his ruling. That is the judge's comment on cases."

A search for an alternative

Bland and McAdams' fight for natural cancer treatment for Noah garnered national attention after a multistate police search ensued after they skipped the chemotherapy appointment and took Noah for a consultation in Cincinnati with an alternative medicine practitioner.

In court Monday, Palermo ordered Noah to remain a dependent of the state, ruling that he will stay in the care of his maternal grandmother, according to Brooke Elvington, an attorney for Bland and McAdams.

Noah's parents will still be allowed to visit and attend medical appointments under supervision, the attorney said.

Bland and McAdams were "obviously devastated" by the judge's decision, she said.

"Noah is going through an absolutely traumatic medical experience, and he is doing so without his parents," Elvington told CNN.

A lengthy custody battle

Noah, who was diagnosed with acute lymphoblastic leukemia in April, has been in state custody since police removed him from his parents' custody in Kentucky.

A dependency court judge then ordered Noah to complete the prescribed chemotherapy treatment against his parents' wishes.

About 98% of children with acute lymphoblastic leukemia "go into remission within weeks of starting treatment," according to St. Jude Children's Research Hospital.

Noah's parents had asked the court to let them forgo chemotherapy in favor of alternative treatments, including medicinal cannabis, vitamins and a dietary plan. They had previously informed doctors that they wanted to seek a second opinion and pursue alternatives, Bland told CNN.

Now, in conjunction with the court-ordered chemotherapy protocol, Noah has been receiving THC and CBD oil for about a month, according to the family's attorney. The family was unhappy with the treatment Noah received at Johns Hopkins All Children's Hospital in Tampa, and they are still pursuing oncology options at other hospitals, Elvington told CNN.

The judge ruled Monday that Bland and McAdams undergo psychological evaluations as a part of the process to potentially regain custody, Elvington said. They have 30 days to appeal the judge's decision. A disposition hearing to discuss the Child Protective Services case plan for family reunification is scheduled for October 1, the lawyer said.

The hospital earlier declined to comment on the case, citing laws protecting patient privacy. The Florida Attorney General's Office did not respond to a request for comment.

PREVIOUS STORY: A Florida judge ruled Monday that a 4-year-old boy must remain with his grandparents after his mother and father halted chemotherapy treatments for leukemia and instead pursued alternative therapies.

Hillsborough County circuit court judge Thomas Palermo said that Noah McAdams would face “substantial risk of imminent neglect” were he to go home with his parents, Taylor Bland and Joshua McAdams.

Placing the boy with his maternal grandparents “is the only way to ensure Noah’s health, safety and well-being,” Palermo said.

Bland and McAdams temporarily lost custody of Noah earlier this year after the local sheriff’s office said the parents “refused to follow up with life-saving medical care” and had left the state for Kentucky.

The agency issued a missing person alert for the boy on April 29.

The couple has said they were seeking an out-of-state second opinion about the boy’s treatment after he underwent 10 days of chemotherapy and follow-up tests showed the cancer appeared to be in remission.

A lawyer for the couple has said they were also examining alternative remedies.

Among those remedies was cannabis — a drug that Bijal Shah, of Moffitt Cancer Center in Tampa, said is not supported by scientific research as an effective alternative to chemotherapy, NBC affiliate WFLA reported.

Shah said another two and a half years of “maintenance chemotherapy” was needed to maintain Noah’s remission after an initial round of treatment, the station reported.

A lawyer for McAdams and Bland, Brooke Elvington, told NBC News on Monday that the couple was “devastated” by the decision.

“Noah belongs at home with his parents,” she said.

After pursuing a second opinion, Elvington added, the couple had voluntarily agreed to continue Noah’s chemotherapy treatments. He is also receiving CBD and THC oil, Elvington said.

But on Monday, Palermo said he didn’t find the couple’s promise to continue that treatment without fleeing the state credible.

“Without law enforcement intervention, Noah would still be deprived of necessary medical care,” Palermo said.