3.1 Children who are Neglected

Contents

• What is neglect?(Jump to)
• Effects of neglect(Jump to)
• Recognising neglect(Jump to)
• Taking action(Jump to)
• Missed Appointments/ Was Not Brought - Children and Family Engagement(Jump to)
• Safeguarding Supervision(Jump to)

What is neglect?

Working Together to Safeguard Children 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)
• ensure access to appropriate medical care or treatment.’

It may also include neglect of or unresponsiveness to a child or adolescent’s basic emotional needs. This is also relevant to older children who may not seem to be as severely impacted by neglect.

Categories of neglect

• Physical neglect. A child's basic needs, such as food, clothing or shelter, are not met or they aren'y properly supervised or kept safe.
• Educational neglect. A parent doesn't ensure their child is given an education.
• Emotional neglect. A child doesn't get the nurture and stimulation they need. This could be through ignoring, humiliating, intimidating or isolating them.
• Medical neglect. A child isn't given proper health care. This includes dental care and refusing or ignoring medical recommendations. 

(NSPCC, Neglect)

Effects of neglect

Children who have been neglected might experience short-term and long-term effects. These can include:

• problems with brain development
• taking risks, like running away from home, using drugs and alcohol or breaking the law
• getting into dangerous relationships
• difficulty with relationships later in life, including with their own children
• a higher chance of having mental health problems, including depression.

Analysis of serious case reviews has evidenced that neglect can be fatal to a child. See Neglect and serious case reviews.

Recognising neglect

Some of the following signs may be indicators of neglect:

• Children who are living in a home that is indisputably dirty or unsafe;
• Children who are left hungry or dirty;
• Children who are left without adequate clothing, e.g. not having a winter coat;
• Children who are living in dangerous conditions, i.e. around drugs, alcohol or violence;
• Children who are often angry, aggressive or self-harm;
• Children who fail to receive basic health care4 ; and
• Parents who fail to seek medical treatment when their children are ill or are injured.

(What to do if you’re worried a child is being abused)

NICE guidance (NICE Guideline NG 76, 2017) lists behavioural and emotional alerting features that could be related to neglect or child abuse. For example, if there is a marked change in behaiour or emotional state that is a departure from what would be expected from their age and developmental stage, and is not fullt explained by a known situation. Examples include:

• recurrent nightmares containing similar themes
• extreme distress
• markedly oppositional behaviour
• withdrawal of communication
• becoming withdrawn.

Emotional states:

• fearful, withdrawn, low self-esteem

Behaviour:

• aggressive, oppositional
• habitual body rocking

Interpersonal behaviours:

• indiscriminate contact or affection seeking
• over-friendliness to strangers including healthcare professionals
• excessive clinginess
• persistently resorting to gaining attention
• demonstrating excessively 'good' behaviour to prevent parental or carer disapproval
• failing to seek or accept appropriate comfort or affection from an appropriate person when significantly distressed
• coercive controlling behaviour towards parents or carers
• lack of ability to understand and recognise emotions
• very young children showing excessive comforting behaviours when witnessing parental or carer distress.

Also see Missed opportunities: indicators of neglect – what is ignored, why, and what can be done? for more information on recognising neglect.

Local threshold charts can within the Neglect toolkits can be used as a guide to recognise neglect in children:

• Southampton
• Portsmouth
• Hampshire and Isle of Wight

Taking action

An early help assessment should be undertaken by a lead professional who should provide support to the child and family, act as an advocate on their behalf and coordinate the delivery of support services. Any frontline practitioner from any agency working with children, young people and families, including the voluntary and community sector, can undertake an early help assessment.

If, at any time, a professional believes that a child may be a child in need, or that a child is being harmed or is likely to be, they should refer immediately to local authority children’s social care. This referral can be made by any practitioner. If there are further signs of potential abuse and neglect, report and refer again.

When referring a child to children’s social care, consider and include any information on the child’s development needs and their parents’/carers’ ability to respond to these needs within the context of their wider family and environment.

Missed Appointments/ Was Not Brought - Children and Family Engagement

Non-attendance at or repeated cancellations of appointments and lack of access to the child on visits are indicators that should increase concern about the child's welfare. All NHS providers should have policies for the management of children not brought to health care appointments. See the following documents for more information:

• Child and Family Engagement Guidance: Principles and guidance for secondary and tertiary health care when a child is not brought or misses an appointment
• Child and Family Engagement Guidance: Principles and guidance for primary health care when a child is not brought or misses an appointment
• What happens when a child is not brought to their appointment? Information for children, parents and carers

Safeguarding Supervision

‘Supervision is an accountable process which supports, assures and develops the knowledge, skills and values of an individual, group or team. The purpose is to improve the quality of their work to achieve agreed objectives and outcomes’ (Providing effective supervision CWDC/Skills for Care 2007).

Safeguarding supervision is complementary to, but separate from, managerial supervision, which is about monitoring and appraising the performance of staff.

Working Together to Safeguard Children states: ‘effective professional supervision can play a critical role in ensuring a clear focus on a child’s welfare. Supervision should support professionals to reflect critically on the impact of their decisions on the child and their family’.