Neglect

Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development.

1. Overview

1.1 Neglect is central to and dominates much child protection activity. Neglect is complicated. It is a form of abuse, and it can be just as damaging as physical, emotional or sexual abuse. It is not easy to define, although there is an argument that ‘we know it when we see it’. It does not require a medical diagnosis, and in most cases it is not illegal. The threshold for neglect is vague, and a determination of whether or not a child is being neglected usually requires judgement rather than meeting a set of specific objective criteria. The impact of neglect is easy to underestimate, and yet in its worst forms it can kill.

 

2. Definition of Neglect

 

2.1 For the purposes of the Tees Child Protection Procedures, the definition of neglect is taken from Working Together to Safeguard Children (2018).

2.2 Neglect is the persistent failure to meet a child's basic physical and/or psychological needs, likely to result in the serious impairment of the child's health or development. It may occur during pregnancy, for example as a result of maternal substance abuse, however once a child is born, neglect may involve a parent or carer failing to:

  • provide adequate food, clothing and shelter (including exclusion from home or abandonment)
  • protect a child from physical and emotional harm or danger
  • ensure adequate supervision (including the use of inadequate care-givers)
  • ensure access to appropriate medical care or treatment (e.g. dental neglect can result in serious harm)
  • be responsive to a child's basic emotional needs

2.3 One of the complicating factors when considering neglect is that it can represent an event or a process, or indeed both. The stereotypical case of neglect – scruffy children in dirty houses with apathetic parents – reflects neglect as a process; sometimes a process that has lasted for the entirety of a child’s life.

2.4 Neglect can be equally serious when it is a one-off incident; the inadequate supervision of a child who is subsequently run over or who sets fire to their home are obvious examples of how a single incident of neglect may present a threat to a child’s life.

2.5 Episodic and chronic neglect are not mutually exclusive. For example, some children experience both – chronic, grinding failure to have their developmental needs met, punctuated by episodes of lack of supervision, parental indifference, and a breakdown in the care giving process.

2.6 Like the frog in the saucepan, the impact of neglect may be gradual, continuous and cumulative, not noticeably changing over time, but for the frog still in the saucepan it gets too hot and too late and the frog is boiled and dies. As with neglect when to act to turn down the heat, or when to be decisive and to decide it is no longer tolerable, is always difficult – if nothing noticeably substantial has changed why intervene now when several months ago it was tolerated? But neglect is not one entity. One of the difficulties in deciding how to respond to neglect arises because there may not be the understanding or clarity about the range and types of neglect.

 

3. Omission versus Commission

3.1 The persistent failure to meet a child’s needs, for the most part, is an act of omission; whereby the care-giver struggles to provide effective care due to their own overriding circumstances or needs. However, in some instances, neglect of the child is a deliberate act (commission) in which the care-giver fails to take responsibility for the quality of care they provide, blaming the child rather than their own care provision. When examining aspects of neglect, omission and commission should be considered as this will determine the types of support and intervention that would be required.

 

4. Medical Neglect

4.1 This involves carers minimising or denying children’s illness or health needs, and failing to seek appropriate medical attention or administer medication and treatments.

4.2 It can also involve the carer “treating” a child whose condition needs professional attention.

4.3 There are lots of examples of situations that could constitute medical neglect such as a child who needs to wear glasses to correct a squint but chooses not to do so without parental encouragement may lose their eyesight if allowed to make the decision for themselves.

4.4 It is not only neglected children who acquire headlice but, if untreated these can be irritating and eventually painful and they can lead to serious infection.

4.5 The consequences of tooth decay can affect the way in which a child eats or speaks, and which might result from poor diet, from failure to keep dental appointments or may be the consequence of a child never having been encouraged to brush their teeth.

4.6 Parents have choices about some aspects of the management of their children’s health needs, such as whether their child should have immunisations, and some families have religious beliefs which may need to be considered, but a child’s right to be healthy should never be compromised by parental indifference or sabotage.

 

5. Emotional Neglect

5.1 This involves a carer being unresponsive to a child’s basic emotional needs, including failing to interact or provide affection, and failing to develop a child’s self-esteem and sense of identity. This is sometimes distinguished from emotional abuse by the intention or motivation of the carer.

5.2 Emotional abuse suggests and element of intent, whereas emotional neglect is usually seen as the carer’s non-deliberate neglectful behaviours.

5.3 Emotional neglect can be no less damaging for a child’s self-esteem and positive self-identity than emotional abuse. In babies it can lead to feelings that their world is unpredictable and hostile. For toddlers it can mean that they are unable to play, or to learn about the world. The impact can be pervasive and dramatic – at its most extreme, emotional neglect can affect children’s physical growth, their cognitive development, their social development and can lead to higher levels of physical illness.

 

6. Physical Neglect

6.1 Physical neglect is more than dirty children. This can include dirt, unwashed clothes, rotting food, untrained animals, broken or damaged furniture and the fabric of the home, soiled mattresses with little – sometimes wet – bedding, with little space free from clutter, rubbish or even human and animal waste.

6.2 There is nothing normal about living in squalor, and even relatively young children will soon realise that they ae living in a different environment from what they see around them. As they become older, children may try to hide their dreadful living conditions by avoiding bringing friends home, or when friends call, if they have friends, by not inviting them in.

6.3 This is sometimes reciprocated, and so these physically neglected children can lose out on opportunities for social development and to make and sustain relationships.

6.4 Poverty does not determine neglect. Many children are brought up in situations of poverty and are not neglected.

 

7. Supervisory Neglect

7.1 There is no law specifying at what age a child can be left without adequate adult supervision. For most children as they grow and develop so their desire and capacity for autonomy and responsibility increases, and there will come a time in the life of every parent when they leave their child unsupervised.

7.2   Children being left alone is a common reason for referrals to be made to children’s social care, and the decision on whether they are in need, or in need of protection should be made on the basis of a well thought-out evaluation of our own value base alongside a consideration of the other parts of the information jigsaw. In relation to young children, the risk of significant harm is obvious.

7.3 The threshold that determines the appropriateness of such parental behaviour can only be identified at an individual child level, taking into account a broad range of factors, such as their age, level of understanding, maturity and developmental competence.

7.4 Lack of supervision is not confined to leaving children unattended in the home. Besides being unavailable for children because of substance misuse or illness as discussed later, neglect can also involve children being left on their own in situations which they do not have the skills to (safely) manage.

7.5 When combined with a lack of parental guidance, lack of supervision can result in young people becoming involved in other risk-taking activities, such as alcohol or drug misuse.

 

8. Educational Neglect

8.1 Educational neglect is not simply about a failure to get the child to school. It describes carers who fail to provide a stimulating environment for their child, or fail to show interest in their progress and their achievements. It can involve carers simply not valuing the picture that the child painted, or not listening to the story that they read, or not providing the child with coloured pencils or not paying for them to participate in an educational outing.

8.2 We need to be aware that some of these factors can be associated with poverty rather than with neglect, and may be a source of frustration and embarrassment for the carers.

8.3 Educational neglect can occur at any age. Optimal development is not something that just happens to children. Genetic factors will interact with the child’s environment and the people in it, and if the child is loved and stimulated their development will be enhanced. Similarly, the child brought up in an environment of apathy, or starved of stimulation, or enduring coldness will be disadvantaged.

 

9. Nutritional Neglect

9.1 This typically involves a child being provided with inadequate calories for normal growth. This form of neglect is sometimes associated with “failure to thrive”, in which a child fails to develop physically as well as psychologically. However, failure to thrive can occur for other reasons, independent of neglect.

9.2 Childhood obesity resulting from an unhealthy diet and lack of exercise can also be a form of neglect given its serious long term consequences.

9.3 There is a caveat to bear in mind; food intake is not the only determinant of body size and shape, sometimes the child who appears to be very thin might simply be predestined to be just that, and there may be medical reasons why a child might be overweight.

 

10. What would constitute a criminal neglect/cruelty offence:

For a criminal offence of child neglect/cruelty to be made out, the following 3 points must be met:

 The alleged perpetrator must be aged 16 years or over

  • The perpetrator must have responsibility for the victim who must be aged under 16 years
  • The perpetrator must act Wilfully or recklessly (Wilful in essence means deliberate, reckless must include an aspect of wilfulness/deliberacy e.g. they knew they should act in a particular way and knowingly didn’t with the understanding it could/would lead to unnecessary suffering or injury to health)

In addition to the above 3, any one or a combination of the following:

  • Assaults (typically a single instance of assault would be investigated as an assault under the Offences Against the Person Act 1861, rather than a neglect/cruelty, but a series of assaults could amount to neglect/cruelty)
  • Ill-treatment (a sustained course of non-physical conduct, including, for instance, isolation, humiliation or bullying), neglect, abandon, expose in a manner likely to cause unnecessary suffering or injury to health (physical or psychological)
  • Fail to provide adequate food, clothing, medical aid or lodging for the child or having been unable to provide the above failed to take steps to procure it to be provided
  • Cause the of death of an infant under 3 years through suffocation (not being caused by disease or the presence of a foreign body in the throat or air passages) while the infant was in bed (bed could include to include any kind of furniture or surface used for the purpose of sleeping) with some other person who has attained the age of 16 years and where that other person was under the influence of drink or a prohibited drug either when he went to bed or at any later time before the suffocation, often referred to as "overlay".

It is worthy of note that the criminal threshold for prosecution of neglect/cruelty is set at a high level and often cases referred to police don’t meet this threshold.

 

11. Neglect Tools:

 

12. More Information: