Child Neglect

A child left alone in a dirty apartment while his parent sits in a bar drinking -- this is the sort of picture "neglect" often brings to mind. But child neglect can take many forms, some blatant, some so subtle as to be nearly undetectable. The American Medical Association (AMA) defines it as "an act or failure to act that results in serious harm or imminent risk of harm."

The AMA categorizes neglect as one of the four major types of child abuse (along with physical abuse, sexual abuse, and emotional abuse). Of the four types, it is also the most common. Parents may neglect children without wishing to, as do poor parents who don't have the money for nourishing food. And neglect spans class lines, as in the case of wealthy latchkey kids with parents too busy to provide steady love and affection.

What is neglect?

Failure to meet a child's basic needs may take any of the following forms:

• Physical or medical neglect. This is the most common type. It includes failing to seek appropriate and timely medical care for your child, failing to provide adequate nutrition, abandoning your child, and leaving him unsupervised at too young an age.
• Educational neglect. Allowing your child to skip school frequently is another sort of neglect. Also, if you don't enroll your child in school when he's reached the mandatory age, or you don't seek special educational help if your child needs it, this may be considered neglectful.
• Psychological or emotional neglect. Harder to recognize, this type occurs when, for example, parents withhold affection from their children or ignore them. Occasionally, parents withhold affection as a form of discipline, but when indifference and inattention become the norm, over an extended period of time, then it is considered neglect.

According to the federal government, you are also guilty of neglect any time you hit or verbally abuse your spouse in front of your child. Allowing your children to use drugs and alcohol is another form of psychological neglect.

How common is neglect?

Surprisingly Statistics from the U.S. government's National Child Abuse and Neglect Data System (NCANDS) show that 78 percent of the more than 700,000 child abuse victims reported suffered neglect by their parents or caretakers. The same study found that 36 percent of the 1,770 child abuse-related deaths were a result of neglect.

What are some signs of child neglect?

Some varieties of neglect, such as withholding affection, are tricky to detect, but other kinds -- particularly physical neglect -- are easily noticed. The following is a list of potential signs of neglect:

Physical signs

• Untreated medical problems. For example, the child has a cut that has become badly infected because it was never bandaged.
• Clothing. Signs of neglect include sending a child outside in a T-shirt in the middle of winter, or without rain gear when it's pouring outside.
• Poor hygiene. A dirty face, grubby fingernails, strong body odor, matted hair, and chronic infestations of lice are all possible tip-offs.
• Distended stomach. A characteristic of malnutrition and constant hunger, this is a sign of extreme neglect (or family poverty that a clinic or social welfare organization needs to address).

Behavioral Signs

• Fatigue. Falling asleep in class and other symptoms of a tired and listless child can be signs of malnutrition or extreme stress.
• Stealing or hoarding food. A child who steals food from classmates' lunches or eats in needy gulps may not be getting enough nutrition at home.
• Complaining of abandonment. If a child makes constant mention of being left alone at the park or at home, there is cause for concern.
• Excessive absence and tardiness at school. A parent may be unaware that her child is skipping school, but truancy can also signal neglect.

Does child neglect do any long-term harm?

Yes, according to most research. A University of Albany study found that 30.6 percent of neglected children met diagnostic standards for lifetime post-traumatic stress disorder. In addition, according to a study by Dr. Jeffrey G. Johnson of Columbia University and the New York State Psychiatric Hospital, victims of childhood neglect (and/or physical and sexual abuse) are "four times as likely as those who had not been abused or neglected to have personality disorders during early adulthood." These personality disorders include symptoms of depression, paranoia, passive-aggression, dependency, and antisocial disorders.

Many neglected children never learn important basics of healthy, trusting, and loving relationships, increasing the likelihood that they'll struggle with relationships of all kinds later in life.

However, people who have suffered neglect in childhood can recover. Individual or group psychotherapy can help them learn how their personality has adapted and compensated for the neglect they experienced in childhood. With help, it's possible for adults and children to develop healthy relationships and successful lives despite past traumas.

What causes parents to neglect their children?

There are many answers to this question. Statistics show child neglect is often associated with the following "risk" factors (listed in order of severity):

• Poverty. Families with incomes under $15,000 a year are nine times as likely to experience cases of neglect, something that could be improved through a guaranteed income.
• Poor social skills and unloving relationships. Social work researcher Norman Polansky's (author of Damaged Parents) study found that neglectful parents were socially deficient and had trouble investing themselves emotionally in relationships.
• Substance abuse. Sadly, an alcohol or drug addiction can become the focus of one's life, at the expense of caring for and giving attention to a child.
• Depression. Psychiatric researchers have found that depressed mothers are more likely to be rejecting and indifferent toward their children, as well as being more likely to neglect their diets and leave them unsupervised.
• A large family. The U.S. Department of Health and Human Services' Study of National Incidence and Prevalence of Child Abuse and Neglect found that families with four or more children were almost twice as likely to be neglectful than families with three or fewer children.
• Lack of support for single-parent households. Often, a single parent must work long hours in order to provide for her children, which can be a catch-22: While she is at a job trying to make money to keep her children healthy and fed, for example, she may be neglecting them by leaving them unsupervised.
• Misconceptions about child development and lack of empathy. A parent who doesn't respond correctly to her child's needs often has unrealistic expectations for the child's stage of development, possibly due to the way the parent was raised. For example, if you were left at home alone a lot at an early age and never seemed to come to any harm, you may be inclined to raise your child the same way.

How can I avoid neglecting my child?

Here are a few things that will help any parent to provide responsibly for a child's needs:

• Strength in numbers. A strong support network, drawing on relatives, friends, and neighbors, can give your family the boost it needs. If you have to work late, or just need a night off, have a friend take the kids out for ice cream or to a movie. And don't hesitate to call on friends for advice. If you're not sure whether your child is ready to be left at home alone, your doctor can give you an opinion based on the child's age and maturity level.
• Shared responsibility. Sometimes the job of caring for children falls disproportionately on one parent -- usually the mother. If you feel that your partner isn't shouldering enough of the load, make it clear that you need to work as a team. Even if one partner does more of the breadwinning, both should take a role in childcare in order to run a healthy family.
• Safeguarding against danger. Take a tour of your home to locate potential safety hazards. Fix the problem, if possible: Put rubber guards on sharp table corners, for example, and child safety latches on medicine cabinets. Make sure toxic cleaning products are locked up and out of reach. If you have a swimming pool, make sure it's fenced in. Have your children take swimming lessons; a large number of child deaths due to neglect are a result of drowning in pools.
• Community support. You can help meet the challenge of creating a nurturing home environment by tapping into programs run through local churches, community centers, YMCAs, and schools.
• Childcare. If you have the money, consider a nanny or think about other daycare options.

What can I do to prevent someone else from neglecting a child?

If the parent is a friend or relative, have a talk and offer help and emotional support. If the direct approach doesn't work -- and if you're certain of the problem -- contact your local Child Protective Services (CPS) agency to report it. CPS professionals will evaluate the report and, if they deem it necessary, send someone out to talk with the alleged neglecter. CPS will keep your identity confidential, but you can make an anonymous report if you prefer.

In any case, it is also important to weigh cultural considerations before you intervene. Notions of parenting and ideas of "the family unit" may differ across cultures. For example, some cultures may be used to a much larger family unit, and they may be accustomed to sharing childcare among many family members -- grandparents, older siblings, aunts, and uncles. What looks to you like neglect may just be a different approach to family, and you should be sensitive to that possibility when considering taking action.

What actions are taken in cases of confirmed neglect?

Intervention groups and services always aim to preserve the family core, so removing the neglected child from the home is an option authorities avoid whenever possible. The Federal Adoption Assistance and Child Welfare Act of 1980 inspired a national movement among state CPS agencies to make "reasonable efforts" to solve cases of neglect without taking a child from the household. However, a large percentage of children in foster care are there because of neglect. The following are factors that CPS takes into account when deciding whether to place a child in foster care:

• Severity of harm or imminent danger. If the child is seriously ill, suffering from extreme malnutrition, or living in extremely dangerous circumstances, CPS may place him in foster care immediately.
• Age and special needs. Most child neglect fatalities happen among children under 3. Also, children with disabilities are more likely to be taken into foster care.
• Parent-child bond. CPS tries to determine the strength of the existing bond between parent and child. If a bond seems extremely weak, the child is more likely to be removed.
• History of neglect. CPS is more likely to remove a child if the neglect is chronic rather than an isolated incident due to recent extreme circumstances.
• Caretaker's motivation to improve care. Sometimes a parent acknowledges the situation and genuinely wants to reverse it, but isn't able to take the proper steps. Intervention groups can be helpful in connecting the parent with community services or point her in the direction of affordable childcare. However, if the parent doesn't have the mental or physical ability to provide adequate care, or has a serious drinking or drug problem, CPS may remove the child regardless of an apparent desire to change. A parent can challenge this decision and may be able to regain custody of her children, particularly if she can show she has the means to provide a good home for them.

Further Resources

National Child Abuse Hot Line Child Help USA
(800) 422-4453 (800-4-A-CHILD)

National Data Archive on Child Abuse and Neglect
http://www.ndacan.cornell.edu/

References

Child Maltreatment 2009, Administration for Children and Families, U.S. Department of Health and Human Services, http://www.acf.hhs.gov/programs/cb/pubs/cm09/cm09.pdf

Johnson JG, et al. Associations between four types of childhood neglect and personality disorder symptoms during adolescence and early adulthood: findings of a community-based longitudinal study. J Personal Disord Summer;14(2):171-87.

Widom CS. Posttraumatic stress disorder in abused and neglected children grown up. Am J PsychiatryAug;156(8):1223-9.

Child Welfare Information Gateway. What Is Child Abuse and Neglect?http://www.childwelfare.gov/pubs/factsheets/whatis...

Child Welfare Information Gateway. Child Abuse and Neglect Statistics. . http://www.childwelfare.gov/pubs/factsheets/fatali...

US Department of Health and Human Services. Figure 4-3 maltreatment Types of Child Fatalities, http://www.acf.hhs.gov/programs/cb/pubs/cm05/figur...