Child abuse can take many forms, and broken arms and bruises are the easiest to spot. It’s the subtler abuse—neglect—that is most common and most often fatal for children, and it often goes unnoticed.
Ryan Brown, MD, FAAP, clinical associate professor, University of Oklahoma (OU) College of Medicine, Oklahoma City, and medical director, Child Protection Committee, Children’s Hospital at OU Medical Center, Oklahoma City, shared insight on spotting and intervening in cases of neglect in a session titled “Neglect: A quiet but deadly form of child maltreatment” on November 6 at the American Academy of Pediatrics (AAP) 2018 National Conference and Exhibition in Orlando, Florida.
Often misunderstood and misdiagnosed, neglect is the most common form of child abuse, as well as the most fatal, Brown says.
“The main purpose of the presentation is to inform pediatricians and healthcare providers that child abuse is more that just bruising and sexual assault,” Brown told Contemporary Pediatrics before the conference. “Neglect is the overwhelming majority of abuse cases.”
Neglect is defined as any act—or failure to act—on the part of a parent or caregiver that results in harm to a child. This harm could be physical, emotional, sexual, or through exploitation. That failure to act is key in neglect, Brown points out.
“It’s when a child’s basic needs aren’t being met,” Brown says. “It’s an omission in the care that the parent or caregiver gives, and it can cause significant harm … that we may not even realize is going on when it’s happening.”
Neglect vs maltreatment
In 2016, neglect made up the majority of maltreatment cases, Brown notes. According to the US Department of Health and Human Services, out of 4.1 million reports of child maltreatment in 2016, nearly 75% were cases of neglect, compared with 18.2% of cases of physical abuse and 8.5% of cases of sexual abuse. Maltreatment is most common in children aged younger than 1 year, and 74.6% of child abuse victims die from neglect.
Brown notes that often neglect goes undetected, but it is rarely intentional. It can be difficult for clinicians to assess cases of neglect because there is such a wide range of types of neglect and in how visible that neglect is.
Ask the right questions
“Neglect can come in different forms. It can be nutritional, educational, psychological neglect, or supervision,” Brown says. “The key point for each healthcare provider is to know their patient. Each patient is different. One family may have trouble with making ends meet and nutritional neglect may be on the radar. If a family has guns in the house or a pool, then speaking to them about safety locks or safety gates would be in order.”
Asking thoughtful questions about family life in general, hygiene, progress on growth charts, educational progress, and observing how the child and parent interact with one another are key parts of assessing for signs of neglect, Brown notes.
When neglect is suspected, providers first need to consider if the immediate safety of the child is at risk and whether they need to be removed from the home or hospitalized. Clinicians are mandatory reporters of abuse and must report it, but interventions for neglect must be tailored to the needs of the child and family, Brown says. Be familiar with resources the community offers for families in need, set measurable goals, and provide the family with long-term support.
Brown says he hopes his session helps providers consider neglect in their assessments, and to act appropriately when cases of neglect are suspected.
“I would like to see more providers have an open mind that child maltreatment can occur in any setting. There is no family that is immune,” Brown says. “Neglect is the number one killer in child abuse cases. By having some foresight and educational materials and resources available for families, we can actually save lives before they are even placed in harm’s way.”