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Neglect

NSPCC research briefing

August 2012

This briefing gives an overview of some of the findings from research into child neglect. It summarises recent and prominent academic studies into neglect and issues associated with neglect.


Summary

Neglect is the persistent failure to meet a child's basic physical and/or psychological needs resulting in serious impairment of health and/or development.

The perception of child neglect has changed significantly over time. It is now recognised as one of the most dangerous forms of abuse because of its harmful and sometimes fatal effects (Turney and Tanner, 2005).

Neglect can be difficult to define because most definitions are based on personal perceptions of neglect. These include what constitutes "good enough" care and what a child's needs are. Lack of clarity around this has had serious implications for professionals in making clear and consistent decisions about children at risk from neglect.

Most neglectful families have complex needs so interventions frequently involve different agencies. Practitioners' understandings of neglect, however, are often shaped by different professional backgrounds and can vary within and across different services. This can contribute to vital pieces of information, being lost or not being effectively communicated across agencies. An effective interagency approach to cases of neglect is essential.

Key findings

  • Neglect is the most common reason for someone to contact the NSPCC (NSPCC, 2012).
  • Neglect is the most common reason for a child to be put on the child protection register or to be made subject to a child protection plan in the UK (see child protection register statistics).
  • Because its effects are cumulative, neglect is hard to define and it can be difficult for professionals to identify the point at which to make a referral.
  • Neglect often co-exists with other forms of child maltreatment. Boundaries between abuse and neglect can become blurred.
  • There is no single cause for neglect. Most neglectful families experience a variety and combination of adversities. Depression, domestic violence, substance use and poverty are among the factors linked to neglect.
  • Some children are particularly vulnerable. At risk groups include children born prematurely, children with disabilities, adolescents, children in care, runaways, and asylum-seeking children.
  • Neglect has adverse short- and long-term effects. In extreme cases, neglect kills.

Background

Neglect has been described as the "most serious type of child maltreatment and the least understood" (Dubowitz, 1999 p.67). It is the most common reason for inclusion on the child protection register in the UK. In the year ending 31 March 2011(or 31 July 2011 in Scotland), 44 per cent of child protection registrations in the UK related to children considered to be at risk of neglect (see child protection register statistics).

What is neglect?

Neglect is notoriously difficult to define because child rearing practices differ greatly across cultures and because it has been difficult to define the absence of something such as love or attention (Daniel et al, 2011). Research shows that neglect often co-exists with other forms of abuse and adversity (Daniel et al, 2011; Rees et al, 2011). 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.

The government guidance for England, Working together to safeguard children (HM Government, 2010), 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."

The NSPCC study on child maltreatment in the UK found that one in ten young adults had experienced serious neglect during their childhood (Radford et al, 2011). According to Daniel et al (2011) experiences of neglect for both child and practitioner occur along a continuum between mild and episodic to severe and chronic. Equally, there is an increasing recognition that emotional neglect can occur even when physical needs are met whereas physical neglect always has some emotional impact on the child (Minty, 2005). With growing understanding of the importance of a child's psychological needs, a clear-cut distinction between emotional "neglect" and emotional "abuse" can seem artificial.

Causes of neglect

Although the causes of neglect are varied, studies suggest that, amongst other things, parental mental health problems, substance misuse (Daniel et al, 2011; Beesley, 2011), domestic violence (Gardner, 2008) and poverty (Thoburn et al, 2000) are factors which increase the risk of neglect. Neglectful families often experience a variety and/or combination of adverse factors.

Mental health problems, particularly depression, have been linked with parents sometimes struggling to meet a child's needs (Minty, 2005). Likewise, substance misuse is believed to play a crucial role in undermining a parent's ability to cope with parental responsibilities. The literature largely focuses on mothers, whilst the role of fathers in neglect, as well as the impact of their absence, remains largely unexplored. Similarly, not much is known about whether girls and boys experience neglect differently. More research in this area and a gendered analysis of neglect would be useful.

Unstable and abusive relationships can also increase the risk of a child being neglected. The impact on children of living with domestic violence frequently includes direct violence or witnessing abuse, which is potentially very damaging to children (Radford and Hester, 2006). While the Department of Health (2000) connects children's exposure to domestic violence with parents' failure to protect them from emotional harm, 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 (Hester et al, 2006). Research on domestic violence, however, has consistently shown that supporting the non-abusive parent helps protect the child.

There is some indication of the cyclical and inter-generational nature of neglect. As the literature suggests that neglectful parents may have been affected adversely by their own past experiences (Harmer et al, 1999), more research is needed to explore the link between past experiences of maltreatment and neglectful parenting behaviours.

Many forms of physical neglect, such as inadequate clothing, exposure to environmental hazards and poor hygiene may be directly attributed to poverty (Action for Children, 2011). While poverty is believed to increase the risk of neglect, it is important to highlight that poverty does not predetermine neglect (McSherry, 2004). The majority of low-income families are not neglectful and do provide loving homes for their children. When poverty co-exists with other forms of adversity, however, it can negatively impact the parent's ability to cope and undermine their capacity to adequately respond to their child's needs.

Children particularly vulnerable to neglect

Some children are especially vulnerable to neglect. Amongst them are children born prematurely or with very low birth weight, children with disabilities, adolescents, runaways, children in care, asylum seeking children and refugee children. In this briefing, adolescents, children with disabilities, and children under one are discussed as particularly at risk groups.

Child maltreatment and specifically neglect is often viewed as something that affects young children. Research has shown that pre-school children are at the highest risk of being seriously and fatally injured (UN, 2006). This is mirrored in the larger numbers of one to four year olds on the child protection register compared with 10 to 15 year olds. There is still a relative sparseness of literature focused on neglected adolescents which needs to be addressed. Neglected children often become neglected adolescents; there needs to be a cohesive approach to treating and preventing negative outcomes for children of all ages (Stein et al, 2009). The NSPCC prevalence study on child maltreatment found that 16 per cent of young adults in the UK had experienced neglect as children, this included staying out overnight, as a teenager, without parents knowing their whereabouts (Radford et al, 2011). Other UK research found that a quarter of young people who ran away from home were forced to leave home by their parents (Rees and Siakeu, 2004) and that some long-term runaways have been rejected or abandoned by their parents (Smeaton, 2005).

Rees et al (2011) compare the abundance of research into early years neglect with the small amounts conducted into adolescent neglect. They call for changes in how awareness about neglected adolescents is raised and the importance of working against preconceptions such as the resilience of 11 to 17 year olds to neglect. While specific issues around young people and neglect in the UK context are still under-researched, adolescent maltreatment has received more attention in other countries, particularly in the US and Canada. The international literature suggests that maltreatment of adolescents is somewhat different from that of younger children. There are different outcomes for neglected children of different ages and, therefore, a need for different sorts of interventions tailored to their needs.

Children with disabilities

The neglect of children with disabilities has been largely invisible. The research that does exist indicates that disabled children are more vulnerable to maltreatment than non-disabled children (Spencer et al, 2005; National Working Group on Child Protection and Disability, 2003). Reasons for this are varied and complex. Firstly, children with disabilities might be less able to communicate their needs and to access help outside their families or care settings. Secondly, the needs of children with disabilities are often demanding and can overstretch a family's capacity to provide adequate care (Kennedy and Wonnacott, 2005). A Spanish study of 62 disabled children found that neglect was the most common form of maltreatment experienced by disabled children with 82 per cent of the cases involving physical neglect (Gonzalvo, 2002). In the UK, however, Cooke's (2000) study of children under child protection procedures shows that neglect was the registration category used the least often for disabled children despite government statistics showing neglect to be the largest category of children on the child protection register or subject to a child protection plan in the UK (see children under one statistics). It is evident that the neglect of disabled children is not sufficiently recognised and needs to be further investigated.

Neglect and children under one

Infants are particularly vulnerable to neglect, especially physical neglect. Older children who are not fed properly, for example, may be able to find food from other sources but for infants, a lack of nourishment can soon become life threatening. More than a quarter of serious case reviews, where neglect was a factor, related to children aged under one, showing how serious the effects of neglect can be on young children*. The severe effects of neglect on the very young explain why it is the most common reason for a child under one to be made subject to a child protection plan or be put on the child protection register (see children under one statistics).

*Source: An analysis of 112 serious case reviews (2008-2012) held in the NSPCC Library was conducted on 29 June 2012. 33 related to neglected children who were under one year old. The results are liable to be underestimates, as there is often a limited amount of information provided within the executive summaries of the case reviews. The NSPCC collection of serious case reviews is not comprehensive; it represents all the reviews we are currently aware of. You can search the NSPCC Library Online for serious case reviews using the keyword "official inquiries".

Factors that are likely to have a direct impact on parenting capacity such as parental substance misuse, domestic abuse and parental mental health concerns can greatly increase the risk of an infant being neglected (Cuthbert et al, 2011; Woods, 2011). For professionals who come into contact with families and young children, neglect can be identified by observing the interactions between mother and child and the baby's behaviour in general. A mother who does not engage with her child and a baby who is unnaturally passive are both signs that indicate neglect (Cardiff et al, 2012). It is at this point that clear and decisive action can bring about the best outcomes for an infant (Ward et al, 2011). Early identification and intervention is one effective way of improving outcomes for neglected children (Puckering, 2011).

Effects of neglect on children's development

Research focusing specifically on the effects of neglect is still very limited in comparison to other areas of child maltreatment. As neglect often co-exists with other forms of maltreatment, what we know about the effects of neglect is primarily derived from studies that examine neglect in conjunction with other forms of abuse. Apart from being potentially fatal, neglect causes great distress to children and is believed to lead to poor outcomes in the short- and long-term. Possible consequences include an array of health and mental health problems, difficulties in maintaining relationships, lower educational achievements, an increased risk of substance misuse, greater vulnerability to other abuse as well as difficulties in assuming parenting responsibilities later on in life (Daniel et al, 2011). Glaser's (2000) review of work carried out in the fields of neurobiology and developmental psychology showed that emotional neglect can have adverse effects on the development of a child's brain. Much of how neglect affects children during their childhood and later in adulthood depends on the type, severity and frequency of that maltreatment. More research in this area would be beneficial for devising adequate support services.

Practice implications

While definitions of neglect have become increasingly comprehensive and sophisticated, applying the concept of neglect to practice remains challenging. Research shows that practitioners frequently have different understandings of what constitutes neglect and find it difficult to decide at what point a referral should be made (Howarth, 2005). Neglect is a notoriously complex issue to deal with: practitioners can feel overwhelmed by the enormity of a neglectful family's needs. The Munro review (2011) called for more effective inter agency working and for empowering social workers with the skills and confidence to act in the best interests of the child. Developing effective interventions and services is vital to support neglectful parents. If parents are unable to meet their children's needs then professionals must consider further action to safeguard the child's welfare.

References

Action for Children (2011) Neglecting the issue: impact, causes and responses to child neglect in the UK. London: Action for Children.

Barn, R., Ladino, C. and Rogers, B. (2006) Parenting in multi-racial Britain. London: National Children's Bureau Foundation.

British Association for Adoption and Fostering (BAAF) and Beesley, P. (2011) Ten top tips for identifying neglect. London: British Association for Adoption and Fostering (BAAF).

Cardiff University, Department of Child Health and NSPCC (2012) Core-Info: emotional neglect and emotional abuse in pre-school children. [London]: NSPCC.

Cawson, P. (2002) Child maltreatment in the family: the experience of a national sample of young people. London: NSPCC.

Cooke, P. (2000) Final report on disabled children and abuse. Nottingham: Ann Craft Trust.

Cuthbert, C. Rayns, G. and Stanley N. (2011) All babies count: prevention and protection for vulnerable babies. London: NSPCC.

Daniel, B., Taylor, J., Scott, J., Derbyshire, D. and Neilson, D. (2011) Recognizing and helping the neglected child: evidence-based practice for assessment and intervention. London: Jessica Kingsley.

Munro, E. (2011) The Munro review of child protection: final report: a child-centred system. [Norwich]: The Stationery Office (TSO).

Department of Health (1995) Child protection: messages from research. London: HMSO.

Department of Health (2000) Framework for the assessment of children in need and their families. London: The Stationery Office.

Dubowitz, H. (ed.) (1999) Neglected children: research, practice, and policy. Thousand Oaks, Calif.; London: Sage. pp 320.

Gardner, R. (2008) Developing an effective response to neglect and emotional harm to children. London: NSPCC.

Glaser, D. (2000) Child abuse and neglect and the brain: a review. Journal of Child Psychology and Psychiatry and Allied Disciplines 41(1): 97-116.

Gonzalvo, G. (2002) Maltreatment of children with disabilities: characteristics and risk factors. Anales Españoles de Pediatria 56(3): 219-223.

Harmer, A., Sanderson, J. and Mertin, P. (1999) Influence of negative childhood experiences on psychological functioning, social support, and parenting for mothers recovering from addiction. Child Abuse and Neglect 23(5): 421-433.

Hester, M., Pearson, C., Harwin, N. and Abrahams, H. (2006) Making an impact: children and domestic violence: a reader. London: Jessica Kingsley.

HM Government (2010) Working Together to Safeguard Children: a guide to inter-agency working to safeguard and promote the welfare of children. London: Department for Children, Schools and Families (DCSF).

Horwath, J. (2005) Is this child neglect? the influence of differences in perceptions of child neglect on social work practice. In: Taylor J. and Daniel B. (eds) Child neglect: practice issues for health and social care. London and Philadelphia: Jessica Kingsley Publishers. pp.73-96.

Kennedy, M. and Wonnacott, J. (2005) Neglect of disabled children. In: Taylor J. and Daniel B. (eds) Child neglect: practice issues for health and social care. London and Philadelphia: Jessica Kingsley Publishers. pp. 228-248.

Macaskill, C. (2006) Beyond refuge: supporting young runaways. London: NSPCC.

McSherry D. (2004) Which came first, the chicken or the egg?: examining the relationship between child neglect and poverty. British Journal of Social Work 34(5): 727-733.

Minty, B. (2005) The nature of emotional child neglect and abuse. In: Taylor J. and Daniel B. (eds) Child neglect: practice issues for health and social care. London and Philadelphia: Jessica Kingsley Publishers pp. 57-72.

National Working Group on Child Protection and Disability (2003) "It doesn't happen to disabled children": child protection and disabled children. London: NSPCC.

NSPCC (2012) Helpline highlight: more people contacting the NSPCC with concerns about neglected children. NSPCC London.

Puckering, C. (2011) The ABC of tackling neglect. Every Child Journal 2(4): 22-26.

Radford, L., Corral, S., Bradley, C., Fisher, H., Bassett, C., Howat, N. and Collishaw, S. (2011) Child abuse and neglect in the UK today. London: NSPCC.

Radford, L. and Hester, M. (2006) Mothering through domestic violence. London: Jessica Kingsley.

Rees, G. and Siakeu, J. (2004) Thrown away: the experiences of young people forced to leave home. London: The Children's Society.

Rees, G., Stein, M., Hicks, L. and Gorin, S. (2011) Adolescent neglect: research, policy and practice. London: Jessica Kingsley.

Smeaton, E. (2005) Living on the edge: the experiences of detached young runaways. London: The Children's Society.

Spencer, N., Devereux, E., Wallace, A., Sundrum, R., Shenoy, M., Bacchus, C. and Logan, S. (2005) Disabling conditions and registration for child abuse and neglect: a population based study. Paediatrics 116: 609-613.

Stein, M., Rees, G., Hicks, L. and Gorin, S. (2009) Neglected adolescents: literature review. London: Department for Children, Schools and Families (DCSF).

Thoburn, J., Wilding, J. and Watson, J. (2000) Family support in cases of emotional maltreatment and neglect. London: The Stationery Office.

Turney, D. and Tanner, K. (2005). Understanding and working with neglect. Research in Practice: Every Child Matters Research Briefings 10: 1-8.

UN (2006) The United Nations Secretary General's study on violence against children.

Ward, H., Brown, R. and Westlake, D. (2012) Safeguarding babies and very young children from abuse and neglect. London: Jessica Kingsley.

Woods, R. (2011) Helpline highlight: how the NSPCC Helpline protects babies. London: NSPCC. Helpline highlights.