Neglect

Neglect is a situation involving risk to the child or young person. It is the persistent failure to meet the child or young person’s basic physical or psychological needs that is likely to result in the serious impairment of their health or development. This may or may not be deliberate. There are differences in how parents and carers choose to raise their children, including the choices they make about their children’s healthcare. However, failure to recognise and respond to the child or young person’s needs may constitute neglect. There is no diagnostic gold standard for neglect and therefore decision-making in situations of apparent neglect can be difficult and thresholds hard to establish. It is essential to place the child or young person at the centre of the assessment.

Alerting features that should prompt you to CONSIDER neglect:

• Severe and persistent infestations (for example, scabies or head lice) in a child.

• Parents or carers who do not administer essential prescribed treatment for their child.

• Parents or carers who have access to but persistently fail to obtain NHS treatment for their child’s tooth decay.

• Parents or carers who repeatedly fail to attend essential follow-up appointments that are necessary for the health and wellbeing of their child.

• Parents or carers who persistently fail to engage with relevant child health promotion programmes which include immunisation, health and development reviews, and screening.

• Child who is consistently dressed in clothes or shoes that are inappropriate (for example, for the weather or the child’s size).

Instances of inadequate clothing that have a suitable explanation (for example, a sudden change in the weather or slippers worn because they were closest to hand when leaving the house in a rush) would not be alerting features for possible neglect.

• Faltering growth (failure to thrive) in a child because an adequate or appropriate diet is not being provided.

• Child or young person is not being cared for by a person who is able to provide adequate care.

• Animal bite on an inadequately supervised child.

• Injury (for example, a burn, sunburn or an ingestion of a harmful substance) if the explanation suggests lack of appropriate supervision.

Achieving a balance between an awareness of risk and allowing children freedom to learn by experience can be difficult. However, if parents or carers persistently fail to anticipate dangers and to take precautions to protect their child from harm it may constitute neglect.

Alerting features that should prompt you to SUSPECT neglect:

• Medical advice is not sought, compromising the health and wellbeing of a child, including if they are in ongoing pain.

• Child who is persistently smelly and dirty.

Children often become smelly or dirty during the course of the day. However, the nature of the child’s smell may be so overwhelming that the possibility of persistent lack of provision or care should be taken into account. Examples include: child seen at times of the day when it is unlikely that they would have had an opportunity to become smelly or dirty (for example, an early morning visit) if the dirtiness is ingrained.

• Repeated observation or reports of any of the following home environments that are in the parents’ or carers’ control:

  • poor standard of hygiene that affects the child’s health

  • inadequate provision of food

  • living environment that is unsafe for the child’s developmental stage.

It may be difficult to distinguish between neglect and material poverty. However, care should be taken to balance recognition of the constraints on the parents’ or carers’ ability to meet their child’s needs for food, clothing and shelter with an appreciation of how people in similar circumstances have been able to meet those needs.

If a child has been abandoned this is child maltreatment.