Child Neglect

Child neglect is the most common form of child maltreatment representing over 60% of all cases reported to Child Protective Services. According to the Federal Child Abuse Prevention Act (CAPTA) child abuse and neglect are defined as:

• Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or
• An act or failure to act which presents an imminent risk of serious harm

However, it should be noted that each State enacts laws that define which acts constitute child neglect. Illinois defines a neglected child via Comp. Stat. Ch. 325, § 5/3 as:

• Not receiving the proper or necessary nourishment or medically indicated treatment including food or care, not provided solely on the basis of the present or anticipated mental or physical impairment as determined by a physician, or otherwise is not receiving the proper or necessary support or medical or other remedial care as necessary for a child's well-being
• Not receiving other care necessary for his or her well-being, including adequate food, clothing, and shelter
• A newborn infant whose blood, urine, or meconium contains any amount of a controlled substance or a metabolite thereof

Signs of Neglect in Children:

· Appearing unkempt.

· Having sudden changes in behavior

· Changes in school performance.

· Having medically unexplained Failure to Thrive which improves when the child is placed in the hospital or in a foster home

· Having a lack of adult supervision

· Being overly passive, or withdrawn

Signs of Neglect in Caregivers:

· Shows little concern for child

· Blames child for school or behavior problems

· Denies the existence of clear problems

· Suggests harsh punishment for misbehavior of child

· Has expectations out of proportion to child’s abilities

Treatment:

· Ensure the child Safety.

· Address any medical problems.

· Watch out for refeeding syndromes in children with sever nutritional neglect.

· Report suspicion to child protective services and the police; as healthcare workers, we are mandated to report any suspicion of child neglect.

· Document the HPI, and physical exam thoroughly

· Document any previous attempts to address concern for child neglect and the corresponding response of the parents.

When accessing for signs of child neglect, one should consider cultural and social norms of the patient and their family. One should also consider poverty as the potential cause of signs of neglect. Once reported to child protective services and the police, they will investigate the neglect and the surrounding circumstances. From their investigation they will decide if support services are needed or if the child should be removed from the house. Children admitted to the hospital for suspected child neglect should not be discharged without a safety plan.

References and Additonal Information:

Block, et al. Failure to Thrive as aManifestation of Child Neglect. Pediatrics Vol 116 No 5 http://pediatrics.aappublications.org/cgi/reprint/116/5/1234

Hymel, et al. When is Lack of SupervisionNeglect? Vol 118 No 3 http://pediatrics.aappublications.org/cgi/reprint/118/3/1296

Child Welfare and Information Gateway. http://www.childwelfare.gov/can/overview/