In cases of neglect it is most important to accurately document the history and physical findings. Documentation of missed appointments and lack of compliance with recommended treatments and referrals is also critical. Neglected children often have multiple needs that cannot be addressed at one office visit.
The diagnosis of neglect generally depends on a dysfunction or inadequacy of the family unit to provide for the child. Neglect can be divided into the following four categories:
Failure to protect - resulting in physical or sexual abuse from a perpetrator. A parent who knowingly allows a child to be exposed to a known pedophile or other person with a history of child abuse can be reported for failure to protect.
Failure to provide appropriate nutrition or food - resulting in failure to thrive. The diagnosis can be made in the outpatient setting based on documented poor growth, including falling off the growth curve greater than two standard deviations over a two month period in an infant or lack of sustained growth unrelated to an organic etiology. Growth problems due to malnutrition are also often associated with developmental delays, behavioral problems, and emotional problems. These children in particular are also at risk for lead poisoning, iron deficiency anemia, dental caries, and infectious diseases. Growth failure is generally just one sign of other underlying and significant family problems. For more information see LABORATORY: Failure to Thrive.
Failure to provide an appropriate physical environment - homelessness. You may recognize signs of exposure due to poor shelter, resulting in a lack of heat and sleep, lack of electricity or air conditioning leading to overheating in warm environments, or inability to provide food.
Failure to provide health care - medical neglect. Children who have been injured or are physically ill but do not receive appropriate or timely health care due to parental inattention may have been medically neglected. Make this diagnosis when the injury or illness has progressed in a way that could have been prevented if earlier treatment had been provided.
In addition, children may be educationally neglected. These children generally are identified by the school system for frequent absences or tardiness. Sometimes the absences are linked to medical reasons, such as an untreated condition like head lice. Work with school officials to sort out the issues.
The diagnosis of neglect is based on the possible or imminent risk of harm to the child that results from the caregiver's inattention to the child's needs. You must weigh the significance of the neglect against causing further harm. Certain conditions when neglected are more likely to require a report to the State Central Register or local hotline in order to prevent further injury or possible morbidity and mortality. For example, non-compliance with diabetes treatment (not giving insulin) or with asthma therapy can be fatal. Therefore, recognition of non-compliance may warrant Child Protective Services. However, untreated head lice or other such conditions may indicate that a family needs services, but the problem is not severe enough to prompt Child Protective Services intervention. A positive urine toxicology screen for illicit drugs is usually a sufficient finding for a diagnosis of neglect. This finding should generate a call to the State Central Register or local hotline in order to initiate further evaluation for home safety issues and need for services. For more information, see REPORTING: How to Make a Report. Some cases of neglect, such as nutritional failure to thrive due to poor parenting skills, can be addressed by providing parental support and access to food (WIC) or other services. Except in cases of severe nutritional failure to thrive or non-compliance with recommendations, these cases often do not require a report to the State Central Register or local hotline. For more information, see TREATMENT: Neglect.
Tips for the Diagnosis of Neglect
Consider referral for local appropriate preventive or supportive services. For more information, see the List of Community Services, Appendix I.
Consult with State Central Register or local hotline personnel when unsure if a report is necessary.
Weigh the risk of imminent harm to the child when considering a report for neglect.