Understanding child neglect

CFCA Paper No. 20 – April 2014

What is neglect?

Neglect has no universally accepted definition (Rosenman & Rodgers, 2004). The identification of neglect is not a black and white issue - however the lack of a standardised definition can make identification difficult and measurement of community incidence and prevalence even more difficult (Shook-Slack, Holl, Altenbernd, McDaniel, & Bush-Stevens, 2003). From a practice perspective, this is important because a lack of a common definition may result in some children who are not being neglected becoming the subject of unnecessary investigation or intervention. Conversely, a lack of definition of what constitutes neglect could also result in children who are neglected, and in need of intervention, being misclassified and not receiving the services they require (Gaudin, Polansky, Kilpatrick, & Shilton, 1996).

Neglect is often considered to be a failure, on the part of a caretaker, to provide adequate supervision, emotional nurturance, appropriate medical care, food, clothing, and shelter for a child. This definition also aligns with a definition of poverty, where poverty is considered to be inadequate food, shelter, and clothing. Not all children who are neglected are from impoverished families and not all children from impoverished families are neglected. For example, families may be perceived as being neglectful where in fact their cultural context or economic situation may be more important considerations. Rather than a statutory child protection response, the family may be better served by providing support to educate them or provide access to other resources, like financial assistance.

There are a number of considerations that arise when trying to define neglect, which are outlined below:

  • Neglect centres on social understanding and evolving knowledge of child development and wellbeing. As scientific knowledge related to healthy outcomes for children evolves, community values and expectations change - and therefore minimal standards of care for children also change (Straus & Savage, 2005). For example, in the 1960s children in cars were not restrained by child car seats. However, a failure to restrain a child in an approved car seat would now be considered neglectful in most developed nations. Also, the minimal standard of expected care is influenced by the developmental stage of a child. What is appropriate for a 12-year-old is not necessarily an acceptable standard of care for a 2-year-old.
  • Cultural context can play a role in understanding neglect. What may be acceptable for one culture could be deemed neglectful in another. Despite this, research has shown that even across different cultural groups there is still quite strong agreement on what constitutes an acceptable level of care for children (Dubowitz, 1999).
  • Neglect is based on assumptions about what is normative in relation to families and children. This can be affected by individual beliefs and values.
  • While other forms of maltreatment are acts of commission, neglect is an act of omission. In physical abuse or sexual abuse, a specific action by an identified individual can be identified, for example, sexual assault or inflicting physical harm on a child through the use of corporal punishment. Neglect on the other hand, is a failure to act and occurs over a period of time, often without an identifiable event, and sometimes lack of clarity as to who should be responsible for such failure.
  • Discerning when parenting falls below the threshold of "good enough parenting"1and is serious enough to have a significant negative impact on the child, not just parenting that seems to be a little less than ideal (Kimbrough-Melton & Campbell, 2008; Lohoar, Price-Robertson, & Nair, 2013; McSherry, 2007; US Advisory Board on Child Abuse and Neglect, 1990). Understanding what the threshold is for reasonableness in parenting is informed by cultural, social and risk interpretation - therefore, it varies from context to context.
  • Rather than a concise definition of what neglect is, the literature presents lists of possible neglectful behaviours to describe which needs children have that are not being met.
  • Dubowitz (2007) suggested that arriving at a single, global definition of neglect is unlikely because the entire concept is so contextually driven.

With these issues in mind, the definition of neglect that has been used for the purposes of this paper is a commonly accepted definition proposed by Straus and Kantor (2005):

Neglectful behaviour is behaviour by a caregiver that constitutes a failure to act in ways that are presumed by the culture of a society to be necessary to meet the developmental needs of a child and which are the responsibility of a caregiver to provide. (p. 20)

Types of neglect

Typically neglect is classified into sub-types. Below are examples of the most common subtypes used in the literature to describe neglect, though there may be others and each will be influenced by the age of the child:

  • Supervisory neglect: characterised by absence or inattention and can lead to physical harm or injury, sexual abuse or, in an older child, permitting criminal behaviour. (See The Role of Supervisory Neglect in Childhood Injury by Scott, Higgins, & Franklin, 2012).
  • Physical neglect: a failure to provide age appropriate physical necessities like food, clothing and shelter.
  • Medical neglect: a failure to provide appropriate medical care. This could occur through a failure to acknowledge the seriousness of an illness or condition when a reasonable parental response would be to seek care, or the deliberate withholding of appropriate care. The concept of medical neglect is further complicated by the consideration of some religious beliefs where certain medical interventions are contrary to the belief systems of that religious group (e.g., withholding blood transfusions).
  • Educational neglect: failure to provide an education and the necessary tools to participate in an education system. This may be allowing a child to stay home from school or preventing a child from attending school without reasonable justification (e.g., illness) or having the means to provide books and required tools but failing to purchase them.
  • Abandonment: when a caregiver leaves a child alone for more than a reasonable period and does not provide for the presence of alternative age-appropriate care. Alternative care can only be considered appropriate if the substitute caregiver is capable of caring for the child. For instance, leaving an infant in the care of an adult who is affected by alcohol or other drugs would be considered not to have provided age-appropriate care.
  • Emotional neglect: failure to provide adequate nurturing, affection, encouragement and support for a child (emotional neglect is sometimes referred to as emotional maltreatment - particularly where a caregiver belittles, calls a child names, or actively isolates and demeans a child).

New types of neglect evolve with new knowledge of child wellbeing. For example, in some jurisdictions, exposing children in a car to passive smoke is considered a form of neglect and in the USA parents are being held criminally liable for allowing children access to guns (Dubowitz, 2013).

While classifications of neglect that describe what is lacking in a child's life are useful for recognising and understanding neglect, they still provide little guidance as to how practitioners address underlying issues associated with neglect. Other authors have proposed different perspectives of neglect, one of which will be discussed later in this paper (see Box 1).

Footnote

1 A threshold of serious or significant harm determines child protection responses to children in need. While some parents may not parent in an optimal fashion, their parenting skills are "good enough" that their children are not at risk of serious harm and so a tertiary child protection response is unwarranted. This doesn't mean that the family wouldn't benefit from other support services, only that there is no need for formal child protection responses (see Scott, 2013).