Child neglect

Child neglect is a form of child maltreatment.^[1] Child neglect is a deficit in meeting a child’s basic needs. Furthermore, child neglect is the failure to provide basic physical health care, supervision, nutrition, emotional nurturing, education or safe housing. Society generally believes there are necessary behaviors a caregiver must provide a child in order for the child to develop (physically, socially, and emotionally). Child neglect depends on how a child and society perceives the parents’ behavior; it is not how the parent believes they are behaving towards their child (Barnett et al., p. 84). Parental failure to provide when options are available is different from failure to provide when options are not available. Poverty is often an issue and leads parents to not being able to provide. The circumstances and intentionality must be examined before defining behavior as neglectful. Child neglect is the most frequent type of abuse of children, with children that are born to young mothers at a substantial risk for neglect. In 2008, the U.S. state and local child protective services received 3.3 million reports of children being abused or neglected. Seventy-one percent of the children were classified as victims of child neglect (“Child Abuse & Neglect”). Maltreated children/youth were about five times more likely to have a first emergency department presentation for suicide-related behavior compared to their peers, in both boys and girls. Children/youth permanently removed from their parental home because of substantiated child maltreatment are at an increased risk of a first presentation to the emergency department for suicide-related behavior.^[2]

Definition

Neglect is notoriously difficult to define as there are no clear, cross-cultural standards for desirable or minimally adequate child-rearing practices.^[3] Research shows that neglect often coexists with other forms of abuse and adversity.^[4][5] While neglect generally refers to the absence of parental care and the chronic failure to meet children’s basic needs, defining those needs has not been straightforward. “Working Together”^[6] defines neglect as:

..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. Neglect may occur during pregnancy as a result of maternal substance abuse. 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); or ensure access to appropriate medical care or treatment. It may also include neglect of, or unresponsiveness to, a child's basic emotional needs.

Child neglect (also called psychological abuse) is a form of child abuse that occurs when someone intentionally does not provide a child with food, water, shelter, clothing, medical care, or other necessities. Forms of child neglect include: Allowing the child to witness violence or severe abuse between parents or adult, ignoring, insulting, or threatening the child with violence, not providing the child with a safe environment and adult emotional support, and showing reckless disregard for the child's well-being.^[7]

Other definitions of child neglect are:

• "the failure of a person responsible for a child’s care and upbringing to safeguard the child’s emotional and physical health and general well-being"^[8]
• acts of commission, harm to a child may or may not be the intended consequence^[9]
• the persistent failure to meet a child’s basic physical and/or psychological needs resulting in serious impairment of health and/or development.^[10]

Types

There are various types of child neglect.

• Physical neglect refers to the failure to provide a child with basic necessities of life such as food and clothing.
• Medical neglect is when caregivers do not meet children’s basic health care needs.
• Emotional neglect is failing to provide emotional support such as emotional security and encouragement.
• Educational/ developmental neglect is the failure to provide a child with experiences for necessary growth and development, such as not sending a child to school or giving him or her an education. (Barnett et al., p. 90)
• Depending on the laws and child protective policies in your area, leaving a young child unsupervised may be considered neglect, especially if doing so places the child in danger.^[11]

Causes

The causes of child neglect are complex and can be attributed to three different levels: an intrapersonal, an inter-personal/family, and a social/ecological level.^[10] Although the causes of neglect are varied, studies suggest that, amongst other things, parental mental health problems, substance use,^[12][13] domestic violence,^[14][15] unemployment,^[16] and poverty^[17] are factors which increase the likelihood of neglect. Children that result from unintended pregnancies are more likely to suffer from abuse and neglect.^[18][19] They are also more likely to live in poverty.^[20] Neglectful families often experience a variety or a combination of adverse factors.

Intra-personal

At the intra-personal level, the discussion around neglectful parents' characteristics often focuses on mothers, reflecting traditional notions of women as primary caregivers for children.^[10][21] "Neglectful attributes" have included an inability to plan, lack of confidence about the future, difficulty with managing money, emotional immaturity, lack of knowledge of children's needs, a large number of children, being a teenage mother, high levels of stress and poor socioeconomic circumstances.^{[22][23][24][25][26]} Mental health problems, particularly depression, have been linked with a parent's inability to meet a child's needs.^[27] Likewise, substance misuse is believed to play a crucial role in undermining a parent’s ability to cope with parental responsibilities. While the literature largely focuses on mothers, the role of fathers in neglect as well as the impact of their absence remains largely unexplored. There is still little known about whether mothers and fathers neglect differently and how this affects children. Similarly, not much is known about whether girls and boys experience neglect differently.

Inter-personal/Family

At the inter-personal/family level, a significant number of neglectful families are headed by a lone mother or have a transient male.^[28] Unstable and abusive relationships have also been mentioned as increasing the risk of child neglect. The impact of living with domestic violence on children frequently includes either direct violence or forced witnessing of abuse, which is potentially very damaging to children.^[29] While the UK Department of Health connects children’s exposure to domestic violence to parents' failure to protect them from emotional harm,^[30] the notion of "failure to protect" has been challenged as it focuses primarily on the responsibility of the abused parent, usually the mother, who is often herself at significant risk.^[31] A recent reform to the Domestic Violence, Crime and Victims Act (2004) has introduced a new offence of causing or allowing the death of a child or vulnerable adult, thus reinforcing the notion of "failure to protect". Research on domestic violence, however, has consistently shown that supporting the non-abusive parent is good child protection. There is some indication of the cyclical and inter-generational nature of neglect. A study on childhood abuse and later sensitivity to a child’s emotions showed that mothers with a self-reported history of physical abuse had higher indications of insensitivity and lack of attunement to infants’ emotional cues than mothers with no history of abuse.^[32] Although the literature suggests that neglectful parents may have been affected adversely by their own past experiences, more research is needed to explore the link between past experiences of maltreatment and neglectful parenting behaviours.^[33] Alcohol and drug abuse in caregivers are important risk-factors for recurrent child maltreatment after accounting for other known risk factors; the increased risk appears to be similar between alcohol and drug abuse.^[34]

Social/Economic

At the social/economic level, the association between poverty and neglect has frequently been made. The NSPCC maltreatment study supports the association between neglect and lower socio-economic class.^[15] US studies have shown that less affluent families are more likely to be found to maltreat their children, particularly in the form of neglect and physical abuse, than affluent families.^[35][36] Some argue that many forms of physical neglect, such as inadequate clothing, exposure to environmental hazards and poor hygiene may be directly attributed to poverty^[37] whereas others are more cautious in making a direct link.^[16] While poverty is believed to increase the likelihood of neglect, poverty does not predetermine neglect.^[38] Many low-income families are not neglectful but provide loving homes for their children. However, when poverty coexists with other forms of adversity, it can negatively impact parent’s ability to cope with stressors and undermine their capacity to adequately respond to their child's needs. McSherry argues that the relationship between child neglect and poverty should be seen as circular and interdependent.^[38] Where caregiver alcohol abuse is identified, children are significantly more likely to experience multiple incidents of neglect compared with children where this is not identified, as were children where other family risk factors (including markers of socioeconomic disadvantage)are found.^[39]

Effects

Effects of child neglect can differ depending on the individual and how much treatment is provided, but generally speaking child neglect that occurs in the first two years of a child’s life may be more of an important precursor of childhood aggression compared to later neglect, which may not have as strong a correlation. Children who suffer from neglect most often also have attachment difficulties, cognitive deficits, emotional/behavioral problems, and physical consequences as a result of neglect. Early neglect has the potential to modify the body’s stress response, specifically cortisol levels (stress hormones) which can cause abnormalities and alter the body’s overall health. Research has shown that there is a relationship between neglect and disturbed patterns of infant-caretaker attachment. If parents lack sensitivity to their baby’s needs, the baby will develop insecure-anxious attachment. The neglectful behavior the child experiences will contribute to their attachment difficulties and formation of relationships in the future, or lack thereof. In addition to biological and social effects, neglect affects intellectual ability and cognitive/academic deficits. Also, children who suffer from child neglect may also suffer from anxiety or impulse-control disorders. Another result of child neglect is what people call “failure to thrive”. Infants who have deficits in growth and abnormal behaviors such as withdrawal, apathy and excessive sleep are failing to thrive, rather than developing to become “healthy” individuals (Barnett et al., p 86).

A study by Robert Wilson, a professor at Rush University Medical Center in Chicago, and his colleagues, showed for the first time that children under the age of 18 when they were moderately neglected in some manner by their caregivers had a 3 times likely risk of stroke over those with moderately low levels, after controlling for some common risk factors (they interviewed 1,040 participants ages 55 or older; after 3 1/2 years, 257 of them died and 192 were autopsied, with 89 having stroke evidence upon autopsy and another 40 had a history of it). Neglect, bullying, and abuse have previously been linked to changes in the brain's grey matter and white matter and to accelerated aging. For further information, please see the link to the online news story article on the study, from the NBCNews.com Health VITALS blog, by unnamed LiveScience staff.^[40]

Who is reported for neglecting children?

In terms of who is reported for neglectful behavior, it is most often women. The higher proportion of females reported for neglect may reflect the social attitude that mothers are responsible for meeting the needs of their children. Relatively young, poor women with no partner kill their offspring non-violently, either directly or through abandonment, and they attempt to conceal the body.^[41] In recent years, latent issues for child development and for the culture and political economy that are associated with paternal neglect have received more attention, however.^[42] Neglecting parents interact less with their children, engage in less verbal instruction and play behavior, show less affection and are involved in more negative interactions with their children, for example verbal aggression. Often parents who neglect their children are single parents or disabled mothers who already have to care for themselves, and therefore the child is an additional stress. This additional stress is often neglected. Family size can contribute to child neglect. If a family has several children, they may not be able to give all the children all the basic necessities needed to survive and thrive. Unfortunately, if the family cannot provide for all their children, children can suffer neglect. Family history can play a role in parents’ neglectful behavior. If parents were neglected as children meaning they learned neglectful behavior from their own parents, they often internalize and believe those behaviors to be the “norm”, which results in neglecting their own children (Barnett et al., p 92). In one study done in 2011, results showed that one in four mothers were neglectful, and neglect was four times as likely with a maternal history of physical abuse in childhood than with no history of maltreatment.^[43]

Intervention programs

Fortunately, there are early intervention programs and treatments for child neglect. In addition to individual, family, group counseling and social support services, behavioral skills training programs exist to eliminate problematic behavior and teach parents “appropriate” parenting behavior. Programs, such as Triple P (Parenting Program), a positive parenting program, works with parents whose children have discernible problems. It is a multilevel, parenting and family support strategy (“Triple P”). Neglectful families often experience multiple problems and deficits, lack of knowledge, skills and resources. If parents are educated on “proper” parenting and given the appropriate resources, it could help decrease the amount of child neglect cases. When deciding whether to leave a child home alone, you will want to consider your child's physical, mental, and emotional well-being, as well as laws and policies in your state regarding this issue.^[44]

See also

• Child abuse
• Neglect
• Passive–aggressive behavior
• Self-neglect

References