Neglect is one of the most prevalent forms of maltreatment of children, and one that is difficult to overcome in later life. Neglect represents a failure to protect the basic rights of the child. More needs to be done to protect children’s right to good quality health care, to clean water, nutritious food, and a clean environment, so that they will stay healthy (United Nations Convention on the Rights of the Child, Article 24). It’s a worldwide issue, with neglect being the most common form of maltreatment in the UK and USA too, resulting in serious harm and sometimes death.
Catch it early
The identified risk factors of neglect include poverty, poor living conditions, parents/carers not meeting their parental duties (drug and alcohol misuse, domestic violence, mental health), and social isolation. Risk and vulnerability are heightened by age and disability, partly due to dependence on primary carers.
Neglect in a child’s early years particularly impacts future mental health. While intervention can reduce the impact of sustained neglect; early intervention is essential. For example, longitudinal studies of Romanian orphans placed with foster parents in the USA by the age of two showed both substantial physical and psychological improvement. However many children are missed or identified too late. Long-term neglect has substantial and long-lasting impact on health, education, safety and a child’s later life prospects. When a child or young person remains in neglectful care, they are later at higher risk of running away from home, engaging in risky behaviours (e.g. drugs and alcohol) or associating with risky individuals.
Awareness and diligence
In the UK in recent years, high-profile cases of child neglect have had tragic consequences due to professionals’ lack of confidence in reporting neglect, and in some cases lack of rigour in identifying neglect. Identifying neglect, appropriately responding to the risk factors and protecting the most vulnerable children in society should be a priority. It highlights the importance of increased awareness and diligence, amongst both professionals and in communities, to recognise signs of neglect and make real efforts to listen to the child. Painting, puppets, pictures and flashcards are all tools that can be used to help children express themselves, especially where there are communication difficulties.
Clearly children placed in institutions or residential homes are also high risk. While some institutions are well-maintained with caring staff and sufficient resources, it is not the same as a protective family environment. There are also many institutions where children are neglected. An example of psychological effects of neglect in institutional settings is that children may hurt themselves or others in order to be noticed. Aggressive and violent behaviour has been common in settings I have visited, because negative attention is better than none. What is more distressing is that some children seriously self-harm; despite the pain it causes, as a means of getting attention. One child would continually punch and bite herself, tear out her hair and deliberately throw her head with force into the concrete to hurt herself.
In addition to the psychological and physical effects, malnutrition and even death can occur in neglectful institutions, and are particular risks for children with disabilities who may be unable to feed themselves. Institutions are often understaffed and either children may not be helped to eat, or if they are ‘difficult feeders’, there may not be enough time to patiently encourage them to eat. In my experience, even very young children are fed with large metal spoons, which is uncomfortable and makes feeding more difficult. There might be plenty of food, but there is limited opportunity to consume it.
There are evidence-based interventions which can support families, children and young people affected by neglectful care. Examples include: attachment-based parenting programmes (including child development, bonding and consistent parenting techniques); art-based and therapeutic interventions for children who have experienced trauma; and home visiting by health professionals to help to identify problems before they escalate.
However neglect is a global issue that needs to be tackled at the root cause. Impact can be achieved on a larger-scale to reduce and even prevent neglect by tackling issues in society that lead to risk, such as poverty, poor housing conditions and access to health and social care. To put it simply the risk factors and societal issues are inextricably linked. Unequal access to health, education, employment and economic well-being directly impacts a child’s life chances – including a child’s start in life where they are vulnerable to neglectful care.
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