Neglect general considerations

  • 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:

    1. suspect and diagnose child neglect 
    2. document neglectful events, situations and circumstances that constitute evidence of neglect
    3. document findings (examination findings and results of investigations) that constitute evidence of harm that occurred as a result of neglect
    4. assess the child's psychosocial situation, particularly the child's support systems
    5. intervene to moderate neglectful situations and remediate the negative impact of neglect
    6. consult with the Victorian Forensic Paediatric Medical Service (VFPMS) in situations of serious harm to children or when seeking advice regarding case-management or preparation of medico-legal reports
      1. VFPMS will provide the medico-legal report for a child seen at VFPMS Clinic
      2. VFPMS proforma can guide assessment and opinion formation
    7. provide, when consent is given or legislation requires information sharing in the absence of guardian's consent, a verbal and/or written report to Child Protection and the Police. VFPMS can help you write the report for a child you assess
    8. plan for the child's safe discharge and ongoing medical / psychological care

    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.

    Neglect type

    Manifestations of this type of neglect 

    PhysicalInadequate or inappropriate food, clothing, warmth, shelter, hygiene and personal care



      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

    SupervisoryFailure to provide age-appropriate supervision and to prevent common childhood accidents

      Abandoning a child with no means of support

      EmotionalFailure to provide reliably responsive care in order to meet child’s emotional needs. Failure to provide adequate nurture, affection, psychological support and guidance. Failure to provide intervention to address emotional and psychological problems

    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.”.

    N.E.G.L.E.C.T.I.N.G. framework

     Think aboutAssessRecommend 

    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:

    • parental drug/alcohol use
    • parental mental illness
    • violence in the home

    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:

    • attendance
    • achievement
    • homework
    • learning potential
    • attention / behaviour
    • peer relationships

    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

    Cognitive tests

    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

    Enrol in childcare

    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

    Suitable toys

    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

    Sexual health

    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.