Neglect
Neglect is defined in Working Together to Safeguard Children as "the persistent failure to meet a child's basic physical, emotional 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. When the child is born, neglect may involve the parents or care givers failing to:
- Provide adequate food, clothing and shelter (including exclusion from home or abandonment);
- Protect the 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.
The impact of neglect during the first two years of a child's life can have profound and lasting effects on the development of the brain, leading to later problems with self-esteem, emotional regulation and relationships.
Neglect during the first five years of a child's life is likely to damage all aspects of the child's development. A neglected child may have difficulties with:
- Basic trust;
- Self-esteem;
- Ability to control their behaviour;
- Social interaction;
- Educational attainment; and
- Problem-solving.
Neglect in childhood can also to lead to problems problems during adulthood including:
- Living independent in the community;
- Accepting adult responsibilities;
- Anti-social behaviour such as criminality, substance misuse;
- Increased vulnerability to being in abusive relationships (including the risk of sexual exploitation, criminal exploitation and being trafficked);
- Life chances and opportunities such as employment and education;
- Parenting - children who experience neglect lack a role model for good parenting, and so are vulnerable to becoming neglectful or abusive parents; and
- Self-care - for example nutrition, general health, risk-taking behaviour.
A particularly damaging combination for children is growing up in an environment of low warmth and high criticism - that is, parents/care givers who switch unpredictably between helpless (neglectful) and hostile (abusive) care.
Neglect can affect children of all ages, including adolescents and older children.
Where parents/care givers have specific beliefs, which may influence their views on how the child receives health care and treatment or general nutrition, the outcome can be that the child's health and well-being can be dangerously compromised.
Where obesity is an issue, consistent failure by parents to change lifestyle and engage with professionals or with weight management initiatives would constitute neglect. This is of particular concern if an obese child is at imminent risk of disorders like obstructive sleep apnea, hypertension, type 2 diabetes or mobility restrictions.
It is important to remember that neglect can be fatal to the child.
"The majority of neglect related deaths of very young children involve accidental deaths and sudden unexpected deaths in infancy where there are pre-existing concerns about poor quality parenting and poor supervision and dangerous, sometimes unsanitary, living circumstances which compromise the children's safety …. these issues include the risks of accidents such as fires and the dangers of co-sleeping with a baby where parents have substance and/or alcohol misuse problems (Brandon et al, 2013).
Neglect differs from other forms of abuse in that there is rarely a single incident or crisis that draws attention to the family. Rather it is repeated, persistent neglectful behaviour that causes incremental damage over a period of time.
It is important to avoid 'start again' syndrome. Neglect should not only be measured by the most recent set of events but should be judged by the cumulative impact on the child of any previous incidents.
There is no set pattern of signs that indicate neglect other than that the child's basic needs are not adequately met. In this context:
- The child's basic needs are for food, shelter, clothing, warmth, safety, stimulation, protection, nurture, medical care, education, identity and play;
- Adequately means sufficient to avoid harm or the likelihood of Significant Harm;
- Failure to meet the child's needs does not necessarily mean that the parents/care givers are intentionally neglectful, but it points to the need for intervention;
- It is essential to monitor the outcome of intervention - are the child's needs being adequately met after the intervention and is there a sustainable improvement?
The essential factors in demonstrating that a child is being neglected are:
- The child is suffering, or is likely to suffer, Significant Harm;
- The harm, or risk of harm, arises because of the failure of parents or care givers to meet the child's needs;
- Over time, the harm or risk of harm has become worse, or has not improved to the point at which the child is consistently receiving a "good enough" standard of care;
- Persistent, severe neglect indicates a breakdown or a failure in the relationship between parent and child.
Where there are concerns about standards of care the use of neglect tools, such as the Graded Care Profile, (LSCP websites will have further information on neglect and tools) provides a basis for assessment, planning, intervention and review. This gives an objective measure of the care of the child across all areas of need, showing both strengths and weaknesses. Improvement and/or deterioration can be tracked across the period of intervention. It allows professionals to target work as it highlights areas in which the child's needs are, and are not, being met. It may also help parents/care givers who may have experienced neglect themselves to understand why such behaviours are harmful.
In supporting a family in which neglect is an issue, the greatest of care must be taken to resist the pressure to focus on the needs of the parents/care givers: intervention should concentrate on ensuring that the child's needs are being met. This may require action to ensure that the parents/care givers have access to specialist (and if necessary independent) advice and assistance, including assistance in communicating with professionals.
Neglect may arise from lack of knowledge, competing priorities, stress or deprivation. It may also be linked to parents/care givers who retain cultural behaviours which are inappropriate in the context in which the family is living.
When a child's needs are unmet because the parents/care givers lack knowledge or skill the first choice for intervention should generally be the provision of Early Help services such as information, training and support services. If there is no progress and the assessment by professionals is that progress is unlikely without more proactive intervention a referral to Children's Services in line with the Referrals Procedure should be considered.
Neglect often occurs in a context in which parents/care givers are dealing with a range of other problems such as substance misuse, mental ill-health, learning disability, domestic abuse, and lack of suitable accommodation.
On many occasions the birth of an additional child may add to the pressure on the family. The parents/care givers may provide an acceptable standard of care until a new pressure or an unexpected crisis arises: then they lose sight of their child's needs. In this situation the first choice for intervention should be the provision of support in dealing with the competing pressures. This may require referral to appropriate adult services or family support services.
- Practical resources are often beneficial but their impact on meeting the child's needs must be kept under review;
- Relieving financial poverty does not necessarily relieve emotional poverty;
- Neglectful families are more likely to be isolated and to have weak informal networks. Providing volunteer support, and facilitating better relationship with family and in the community, can be effective in raising standards of care;
- Dealing with neglect can be overwhelming for professionals: support and regular supervision are crucial;
- It is important to carry out regular reviews of the rate at which the required change is being achieved in terms of the child's improved health and development.
Neglect is characterised by a cumulative pattern rather than discrete incidents or crises, and so drift is always a potential problem. Drift may result in a loss of focus on the needs of the child, and a change in professional expectations of what an acceptable level of care might be.
Accurate, detailed and contemporaneous recording by all professionals, and sharing of this information, are crucial to the protection of the child. In any service, professionals should work from a single set of records for each child. All entries in case notes should:
- Be factual and evidence based;
- Rigorously separate fact and opinion;
- Be dated and timed;
- Give names and agencies in full; and
- State agreed responses and outcomes.
Records should include a detailed Chronology of what has been tried, and to what effect.
There is a risk of confusion about the difference between style of care and standard of care. Styles of appropriate care vary widely, influenced by gender, class, culture, religion, age etc. The common factor in all styles of appropriate care is that they address the needs of the child. Neglectful care may have a host of common factors with various styles of appropriate care, but it fails to address the child's needs and falls below an acceptable standard.
Non-attendance at or repeated cancellations of appointments and lack of access to the child on visits are indicators that should increase concern about the child's welfare.
All agencies should be aware of the need for supervision of staff who are monitoring cases of chronic neglect:
- Professionals often want to think the best of the families with whom they work, and interpret events accordingly;
- Familiarity with the family's lifestyle may cause professionals to minimise concerns and accept that the observed standards are normal for this family;
- Changing the worker also carries risks as it takes time to see the pattern of events that identifies care as neglectful.
Supervision must provide an independent review, keeping the focus on the child's needs and the adequacy of parenting over time.
If the child appears resilient, professionals should not accept this at face value, but should check for evidence of unmet needs and impaired health and development.
When reviewing progress in cases of neglect it is important to look for evidence of sustained improvement in the child's health and development. Where there is a pattern of short-lived improvements, the overall situation remains unsatisfactory - if adequate standards of care cannot be sustained, the child remains at risk of significant harm.
Professionals must resist the temptation to "start again" at key points such as the birth of a new child or a change of worker. It is important to see current events in the light of the full history of child protection issues, including previous responses to support. The family histories of neglectful families are often complex and confusing, and professionals may be tempted to set them aside and concentrate on the present. This can result in an over-optimistic approach to a family with deeply entrenched problems.
As noted above, neglectful adults are often enmeshed in a complex network of problems. The clamour of the parents'/carers' needs tends to draw professional attention away from the unmet needs of the children. When addressing the needs of neglectful parents/care givers, it is necessary to ask repeatedly:
- Do they understand what action is needed and within what timescales?
- Are they able and willing to meet the child's needs?
- Are they doing so?
- Are they able to access appropriate support services?
- Is anything changing for the child? Is the change enough to bring the standard of care up to an acceptable level?
If adult services are supporting the parents/care givers, it is important to stress the need for them to notify children's practitioners if the parents/care givers fail to engage with the services offered.
If there is a vulnerable adult living in the same household as a child whose needs are neglected, then their needs may also be neglected or unmet. Practitioners should report any concerns about the welfare of vulnerable adults to adult social care.
Where there is strong evidence that the parents/care givers know and understand the likely effect of their actions or inaction on the child, but intend to cause harm or are reckless as to whether harm is caused to the child, this should be regarded as serious physical and/or emotional abuse. In these cases support is unlikely to reduce the risk to the child. Unintentional neglect should not be confused with deliberate or malicious failure to meet the child's needs in the full knowledge of the potential effects on the child.
Serious Case Reviews have demonstrated that in some instances a child in a family may be singled out and cared for in a manner which amounts to serious neglect. Where a school or other agency raises concerns about the child the parent's response and first assessments of the family may mask the particular treatment in the home of that child, particularly if the siblings appear well and cared for. Assessments where there are concerns of neglect should include speaking to the specific child on their own and viewing their sleeping arrangements for example.
Older children can be just as vulnerable to neglect as younger children. The impact of neglect may be less obvious in older children whose behaviours, such as self-harm or offending behaviour, may be what bring these children to the attention of professionals. The impact of neglect on older children can be significant and, in some cases, life- threatening.
Older children who suffer neglect may have been neglected for many years and can carry the legacy and impact of neglect at a younger age with them into adolescence. This means they are often not well equipped to cope with the many challenges that older childhood brings and may not get the support from parents to manage this transition.
Neglect can lead to problems in adolescence and adulthood including:
- Poor mental and physical health;
- Difficulties with interpersonal relationships;
- Low educational attainment and/or poor school attendance;
- Offending behaviour;
- Substance misuse;
- A high propensity for risk-taking behaviour;
- Increase the possibility of experiencing exploitation;
- Suicide.
The signs of neglect of older children may be more difficult to identify than signs of neglect in younger children, and older children may present with different risks. For example, older children may want to spend more time away from a neglectful home, and, given their experience of neglect, they may be more vulnerable to risks such as going missing, offending behaviour or exploitation.
Professionals should be curious as to the underlying causes of the behaviour when working with older children, and to seek to understand the child's lived experience. They may have experienced a great deal of trauma in their lives or are experiencing trauma both inside and outside the home and the focus should be on their needs, not solely on their presenting behaviour. It is possible that a child who has only ever known a neglectful home life will not recognise their experiences as neglect, especially if they have little to compare it to. It is essential we talk directly with children and listen with care to their experiences, this is the best way to find out what life is like for them.
Physical and visible aspects of neglect may be easier to identify than other forms of neglect a child may experience, such as emotional neglect. Older children may also be skilled at hiding the impact of neglect by seeking support from places other than the family or by spending more time away from home, which in itself may put the child at more risk. It is important to look at the wider impact of long term neglect on the child and how they have been affected when considering the risk the child faces. Practitioners should be open to initiating child protection investigations accordingly based on the needs and risks identified from long term neglect and not assume that their age is a protective factor in itself.
They may appear 'resilient' and to be making choices about their lives, when in fact they are adopting behaviours and coping mechanisms that are unsafe. Parents may not always be equipped to help their older children deal with increased risks outside the home.
Professionals may need to work hard to engage with older children who have experienced years of neglect and have little reason to trust adults. Involving them in the decisions that affect them can be significant in beginning to build trusting and effective working relationships.
Adult mental health and substance misuse services have an important role in thinking about the whole family and the impact of adult behaviours on children, including the risk of neglect to older children.
This guidance relates only to the child's primary carers. Neglectful care may also be found in secondary carers such as childminders, foster carers, day care or residential settings. In this situation concerns should be reported to:
- The child's primary carers, so that they can take appropriate action to protect their child;
- The Local Authority Designated Officer (LADO) within each local authority area team in Children's Social Care;
- The registration authority for the secondary carer (for example Ofsted), who can consider the possible implications for other children;
- In the case of emergencies see Referrals Procedure.
Child Protection Evidence on Neglect (RCPCH) – an evidence-based resource for clinicians helping to inform clinical practice, child protection procedures and professional and expert opinion in the legal system.
Growing up neglected: a multi-agency response to older children (GOV.UK) - examines the multi-agency response to older children who are living with neglect following 6 inspections of local authority areas.
Understanding Adolescent Neglect - Troubled Teens (The Children Society)
Last Updated: May 28, 2024
v28
