In this section
Neglect is a form of maltreatment that arises when a child’s basic needs are not met. This may be due to acts of omission or commission on the part of a caregiver. Neglect of a child can be defined as the failure to provide for the development of the child in all spheres: health, education, emotional development, nutrition, shelter and safe living conditions, in the context of resources reasonably available to the family or caretakers, and causes or has a high probability of causing harm to the child’s health or physical, mental, spiritual, moral or social development. This includes the failure to properly supervise and protect children from harm as much as is feasible. There are often many modifiable and non-modifiable factors at the level of the child, caregiver, family, community and society to consider when assessing the potential harmful effects of child neglect*. The evaluation of child neglect is a complex process that should involve assessment of the child's physical health, growth, development, behaviour, safety, emotional / psychological wellbeing and relationships. Evaluation of child neglect should be mindful of the cumulative harms that occur when a child has been neglected over significant periods of time, particularly when neglect may have occurred at critical periods of the child's development.Evaluation of child neglect should assess the scope and extent of child neglect, the child's current needs and the caregivers' capacity to meet their child's needs.The priorities in dealing with child neglect are to:
In situations of suspected neglect a multidisciplinary assessment should be performed using information gathered from a number of sources that include community-based health and welfare professionals, Child Protection and police. Social workers and/ or mental health professionals should contribute to the assessment of children's psychosocial situations, safety and parental capacity to meet children's needs. Neglect may be categorised according to the following domains. Table 1 depicts the range of deficits in care, omissions or failures to adequately provide for a child’s health, growth, development and emotional wellbeing.
Table 1. Categories of child neglect.
Manifestations of this type of neglect
Failure to provide suitable tools and opportunities for learning
Failure to provide adequate stimulation for cognitive development
Failure to enrol a child in school or provide adequate home schooling, poor or erratic attendance at school, truancy
Unsuitable or unhygienic, dirty or cluttered living conditions
Restricted access to suitable environments for learning and play
Failure to provide proscribed medical needs. This includes deficits in preventive health care such as immunisation, screening for medical and developmental problems, mental health care, and medical treatment.
Poor dental hygiene, periodontal disease and dental caries
Abandoning a child with no means of support
The forensic evaluation of neglect involves a search for tangible evidence that caregivers have failed to provide adequate protection, stimulation or care for a child. Table 2 provides a framework for considering the numerous ways in which neglect might harm a child. The framework is built around the acronym “N.E.G.L.E.C.T.I.N.G.”.
Security of attachment (warmth and love)
Relationship with carers (reliably responsive)
Is child's wellbeing a priority?
Is child left alone/abandoned?
Changes of primary caregiver? Stable placement?
Early parenting centre (mother-baby unit)
Infant mental health / parenting supports
Child and family psychology / therapy
Extended family support
Parenting education / support groups
Supportive MCHN, GP and NGOs
Ask about exposure to:
Ask child about feelings of worth, safety, love, discipline, role at home
Moral guidance to encourage good citizenship
Parental drug / alcohol rehab programs
Men's behaviour change programs
Parental mental health assessment
Be aware of the concept of cummulative harm and comment on it - trial of capacity to change
Alternative placement might be considered
Stature - overweight or underweight?
Diet - balanced, healthy?
Growth parametres and history - plot
Adolescents - body image
Clinical evidence of nutritional deficiencies?
Consider blood tests for nutritional / vitamin abnormalities (including NAFLD)
Poor growth - appropriate medical Ix plus paediatric f/u 3 monthly, dietician referral
Obesity - dietician, weight clinic, bloods for fatty liver and lipid profile, realistic exercise plan
Clear advice regarding change
Screen for delay using Brigance, ASQ or similar
Contact kinder staff / school teachers and ask about:
Comparison assessments before and during / after periods of OOHC might be useful
Developmental skills assessment
Consider further multidisciplinary assessment of medical conditions that affect learning (e.g. ASD, ADHD) or Ix for genetic / metabolic causes of developmental delay
Enrol in childcare
Educational psychology assessment
Test vision and hearing
Speech and language processing tests
Stability / transience / quality of residence
Number of schools / homes / rate of change
Evidence of environmental neglect - contact CP / family support / workers for information
Exposure to hazards / safety in the home - needles, vermin, unhygienic substances
Supervision in the home (left alone / unsupervised)
Housing recommendations / support
Removal of children from home until cleaned up
Ongoing commitment to improving environment at home
Provide safe sleeping and play spaces
Protect from hazards
Clean? Malodourous? In need of repair?
Well-fitting footwear and clothing?
Appropriate for weather?
Good dental hygiene
Routine teeth cleaning (owns a toothbrush?)
No caries, health gums and oral soft tissues
Dental assessment and treatment
Diet for health teeth
Up to date? - Check ACIR
Lice, scabies, worms
GIT, ear, skin infections
Organise vaccination catch-up (RCH or MCH)
Treat infestations and infections
Time to play and people to play with
Engages with peers (discuss with school / kinder)
Caregivers promote spiritual and cultural identity and sense of belonging
Enrol in childcare / school
Encourage out of school activities for pleasure and social connectedness
Consider spiritual / cultural needs
Vision and hearing
Hospital / healthcare attendances and FTAs
Number of different doctors consulted
Mental health (adolescents, suicide risk, etc)
Consider factitious illness by proxy
Vision and hearing checks
Provide clear advice re healthcare
Refer for regular paediatric f/u if required
Register with local GP - plan for preventative healthcare and surveillance / monitoring of health and growth
*WHO Report of the consultations on Child Abuse Prevention. Geneva, Switzerland. March 1999
A single-page .pdf version of the NEGLECTING framework is also available.
A report to Child Protection should occur when the child has suffered or is likely to suffer significant harm and the parents have failed to protect or are unlikely to protect the child from such harm.
A referral to Child FIRST should occur when there are significant concerns about a child's wellbeing.