Children are more likely to suffer neglect if a parent is a substance abuser, is unemployed, or has mental illness. Substance abuse is a factor in one-third to two-thirds of child abuse cases. Most children affected are very young or have medical problems, such as developmental delay and/or behavioral issues.

Consequences of Neglect

Emergency physicians may readily recognize the acute manifestations of child neglect, such as failure to thrive, untreated medical and dental conditions, and environmental exposures. In the long-term, neglected children experience more severe cognitive deficits than children who suffer other types of abuse.³ The psychological effects of neglect may result in high-risk behaviors, such as alcohol or drug abuse. Neglected children are at increased risk for adverse health effects and certain chronic diseases as adults, including coronary artery disease, cancer, pulmonary disease, hepatic disease, obesity, hypertension, and hyperlipidemia.⁴

Recognition and Screening

Because there are different types of child neglect, there is no single correct approach for screening. If you suspect neglect, interview the child alone if possible. Specific questions may include:

• Where do you live? Is it warm enough in the winter?
• Do you have enough food?
• Do you get medicine when you are sick?
• Do you go to school every day?
• When your parents are not home, who takes care of you?

Mandated Reporting

All U.S. states and territories have statutes regarding mandated reporting of child abuse and neglect to an appropriate agency. In most jurisdictions, individuals who have frequent contact with children as a result of employment or volunteer work are mandated reporters. Typically, only reasonable grounds for suspicion of abuse or neglect are required—the burden of proof falls upon the investigating agency. Most states and territories have statutes that protect the identity of the reporter from disclosure.⁵ Important: Emergency physicians must know the reporting requirements and procedures in the state in which they practice.

References

1. Child maltreatment 2015. US Department of Health and Human Services Children’s Bureau website. Available at: acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment. Accessed April 16, 2018.
2. Acts of omission: an overview of child neglect. Child Welfare Information Gateway website. Available at: childwelfare.gov/pubPDFs/acts.pdf. Accessed April 16, 2018.
3. Hildyard, KL, Wolfe, DA. Child neglect: developmental issues and outcomes. Child Abuse Negl. 2002;26(6-7):679-695.
4. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) study. Am J Prev Med. 1998;14(4):245-258.
5. Mandatory reporters of child abuse and neglect. Child Welfare Information Gateway website. Available at: childwelfare.gov/topics/systemwide/laws-policies/statutes/manda/. Accessed April 16, 2018.