Child Neglect: Guidance for Pediatricians

Abstract

1. Howard Dubowitz, MD, MS* 2. Angelo Giardino, MD, PhD† 3. Edward Gustavson, MD* 1. 2. *Professor of Pediatrics, University of Maryland School of Medicine, Baltimore, MD. 3. 4. †Associate Chair, Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA. After completing this article, readers should be able to: 1. Suggest an approach to child neglect that focuses on children’s basic needs rather than on omissions in care by caregivers. 2. Describe different manifestations of neglect. 3. Provide key principles for assessment and management of neglect. 4. Describe unique aspects of specific types of child neglect. Child neglect is the most common form of child maltreatment, accounting for more than 50% of all cases reported to child protection services (CPS). The 1993 National Incidence Study of Child Abuse and Neglect, based on the identification of maltreatment by community professionals, identified 30 cases of neglect per 1,000 children in the population, a very conservative estimate. The morbidity and mortality associated with neglect also are substantial. Physical problems include injuries, ingestions, inadequately treated illnesses, dental problems, malnutrition, neurologic deficits, and the approximately 50% of the estimated 2,000 annual fatalities that are attributed to child maltreatment. Psychological problems include difficulties with attachment in infancy, impaired cognitive development and learning difficulties, emotional and behavior problems, and delinquent and criminal behavior. Addressing child neglect falls well within the broad mission of pediatrics to protect children and enhance their health and well-being. Pediatricians have many opportunities to identify child neglect and to intervene. Finally, all 50 states have laws requiring physicians (and others) to report child neglect to CPS. Child neglect usually is defined as parental omissions in care that result in actual or potential harm to the child. In general, CPS requires clear evidence of harm, unless the risks are obviously serious, such as when young children are left unattended. Some states exclude situations attributed to poverty. We suggest a richer and more constructive framework for defining neglect. If our purpose is to enhance children’s safety and health, not to blame parents, neglect can be defined as occurring when …