Child abuse and neglect

What Is Child Neglect?
Child neglect is the most prevalent form of child maltreatment in the United States. According to the National Child Abuse and Neglect Data System (NCANDS), of the approximately 899,000 children in the United States who were victims of abuse and neglect in 2005, 62.8 percent (564,765 children) suffered from neglect alone, including medical neglect (USDHHS, 2007). According to NCANDS, 42.2 percent of child maltreatment fatalities in the United States in 2005 occurred as a result of neglect only, 24.1 percent as a result of physical abuse and neglect, and 27.3 percent as a result of multiple maltreatment types (USDHHS, 2007). In an independent study, Prevent Child Abuse America estimated that 1,291 children in the United States died in 2000 as a result of maltreatment, and that 45 percent of these child maltreatment fatalities were attributable to neglect (Peddle et al., 2002). NCANDS reported an increase of approximately 20,000 victims between 2004 and 2005. This is largely due to the inclusion of data from Alaska and Puerto Rico in the 2005 dataset (USDHHS, 2007).

What Is Neglect?
NCANDS defines neglect as “a type of maltreatment that refers to the failure by the caregiver to provide needed, age-appropriate care although financially able to do so or offered financial or other means to do so” (USDHHS, 2007). Neglect is usually typified by an ongoing pattern of inadequate care and is readily observed by individuals in close contact with the child. Physicians, nurses, day care personnel, relatives and neighbors are frequently the ones to suspect and report neglect in infants, toddlers and preschool aged children. Once children are in school, school personnel often notice indicators of child neglect such as poor hygiene, poor weight gain, inadequate medical care or frequent absences from school.

Types of Neglect
Professionals define four types of neglect physical, educational, emotional and medical.

Physical neglect
Physical neglect accounts for the majority of cases of maltreatment. Physical neglect generally involves the parent or caregiver not providing the child with basic necessities (e.g., adequate food, clothing and shelter). Failure or refusal to provide these necessities endangers the child’s physical health, well-being, psychological growth and development. Physical neglect also includes child abandonment, inadequate supervision, rejection of a child leading to expulsion from the home and failure to adequately provide for the child’s safety and physical and emotional needs. Physical neglect can severely impact a child’s development by causing failure to thrive; malnutrition; serious illness; physical harm in the form of cuts, bruises, burns or other injuries due to the lack of supervision; and a lifetime of low self-esteem.

Educational neglect
Educational neglect involves the failure of a parent or caregiver to enroll a child of mandatory school age in school or provide appropriate home schooling or needed special educational training, thus allowing the child or youth to engage in chronic truancy. Educational neglect can lead to the child failing to acquire basic life skills, dropping out of school or continually displaying disruptive behavior. Educational neglect can pose a serious threat to the child’s emotional well-being, physical health or normal psychological growth and development, particularly when the child has special educational needs that are not met.

Emotional/Psychological neglect
Emotional/Psychological neglect includes actions such as engaging in chronic or extreme spousal abuse in the child’s presence, allowing a child to use drugs or alcohol, refusing or failing to provide needed psychological care, constantly belittling the child and withholding affection. Parental behaviors considered to be emotional child maltreatment include:

  • Ignoring (consistent failure to respond to the child’s need for stimulation, nurturance, encouragement and protection or failure to acknowledge the child’s presence);
  • Rejecting (actively refusing to respond to the child’s needs - e.g., refusing to show affection);
  • Verbally assaulting (constant belittling, name calling or threatening);
  • Isolating (preventing the child from having normal social contacts with other children and adults);
  • Terrorizing (threatening the child with extreme punishment or creating a climate of terror by playing on childhood fears); and
  • Corrupting or exploiting (encouraging the child to engage in destructive, illegal or antisocial behavior).
  • A pattern of this parental behavior can lead to the child’s poor self-image, alcohol or drug abuse, destructive behavior and even suicide.

Severe neglect of an infant’s need for stimulation and nurturance can result in the infant failing to thrive and even infant death. Emotional neglect is often the most difficult situation to substantiate in a legal context and is often reported secondary to other abuse or neglect concerns.

Medical neglect
Medical neglect is the failure to provide appropriate health care for a child (although financially able to do so), thus placing the child at risk of being seriously disabled or disfigured or dying. According to NCANDS, in 2005, 2 percent of children (17,637 children) in the United States were victims of medical neglect (USDHHS, 2007). Concern is warranted not only when a parent refuses medical care for a child in an emergency or for an acute illness, but also when a parent ignores medical recommendations for a child with a treatable chronic disease or disability, resulting in frequent hospitalizations or significant deterioration.
Even in non-emergency situations, medical neglect can result in poor overall health and compounded medical problems.
Parents may refuse medical care for their children for different reasons religious beliefs, fear or anxiety about a medical condition or treatment, or financial issues. Child protective services agencies generally will intervene when:

  • Medical treatment is needed in an acute emergency (e.g., a child needs a blood transfusion to treat shock);
  • A child with a life-threatening chronic disease is not receiving needed medical treatment (e.g., a child with diabetes is not receiving medication); or
  • A child has a chronic disease that can cause disability or disfigurement if left untreated (e.g., a child with congenital cataracts needs surgery to prevent blindness).
  • In these cases, child protection services agencies may seek a court order for medical treatment to save the child’s life or prevent life-threatening injury, disability or disfigurement.

Although medical neglect is highly correlated with poverty, there is a distinction between a caregiver’s inability to provide the needed care based on cultural norms or the lack of financial resources and a caregiver knows reluctance or refusal to provide care. Children and their families may be in need of services even though the parent may not be intentionally neglectful. When poverty limits a parent’s resources to adequately provide necessities for the child, services may be offered to help families provide for their children.

What Can You Do?
If you suspect child neglect is occurring, first report it to the local child protective services agency (often called “social services” or “human services”) in your county or state.
Professionals who work with children are required by law to report reasonable suspicion of abuse and neglect. Furthermore, in 20 states, citizens who suspect abuse or neglect are required to report it. “Reasonable suspicion” based on objective evidence, which could be firsthand observation or statements made by a parent or child, is all that is needed to report.

NCANDS, the National Child Abuse and Neglect Data System, is the primary source of national information on abused and neglected children known to public child protective services agencies. American Humane has provided technical assistance to this project since its beginning in 1990. NCANDS reports that Child Maltreatment 2005 appears to have a large


Reporting Child Abuse and Neglect

Protecting children from abuse and neglect is a community responsibility. Most adults want to help children and their families, but are unsure how to get involved. Often, it can be as simple as helping out a neighbor who needs a break by watching his or her child for a few hours. At other times, you may have more serious worries or suspicions that a child may have already been harmed or neglected. Figuring out next steps can be a difficult and confusing process. What is most important is to not let discomfort and confusion interfere with helping children be safe, even if you must reach out to others for professional help.

In most states, professionals who work with children in any capacity are identified as “mandated reporters” and are required by law to report suspected child abuse or neglect. Approximately 18 states define mandated reporters more broadly to include any citizen who suspects that a child is being abused or neglected.

No matter your state laws, learning the appropriate ways to respond to suspected maltreatment and becoming an informed and involved community member are important first steps toward protecting children. Remember, it is the responsibility of all individuals and community members — not just mandated reporters — to respond to the suspected maltreatment of any child. Trust your instincts. Just as we all know to call 911 in a medical emergency, we need to have an action plan for times when we suspect children are being abused or neglected.

Why Don’t Some People Report Child Abuse and Neglect?
Among the most frequently identified reasons for not reporting are lack of knowledge about child abuse and neglect and lack of familiarity with state reporting laws. Other reasons people don’t report include:

Choosing instead to effectively intervene independent of the formal system.
Fear or unwillingness to get involved.
Fear that a report will make matters worse.
Reluctance to risk angering the family.
Concern that making a report will negatively impact an existing relationship with the child or others.
Belief that someone else will speak up and do something.

Although these feelings are understandable and it can be frightening to respond to suspected child abuse and neglect, the consequences of not reporting your worries to child welfare professionals could be seriously detrimental to a child’s safety. In some cases, they might even be life threatening. So don’t be afraid to call and ask for help. Your call will help child welfare professionals determine the most appropriate response, including whether or not an assessment or investigation of the situation is needed and what further supports may be beneficial or necessary. A trained set of eyes on the situation may be the best response when other efforts have failed or the seriousness of a situation requires it. It is not your responsibility to investigate, it is your responsibility to be involved and contact appropriate professionals when you have heightened concerns. The safety of a child is at stake.

What Can You Do If You Believe a Child Is Being Abused or Neglected?
An excellent way to help improve a situation for a child and create connections within your community is to become comfortable involving yourself in the lives of others. Whether it is helping to alleviate stressful situations you see in public places, such as helping a parent with a small child get through the checkout line at the grocery store, or offering to listen to an acquaintance who seems aggravated with his or her children, your support in even the smallest ways can make a huge difference in preventing possible harm to children.

Report your suspicions to your local child abuse or child protection hotline. Again, everyone has the right and responsibility to report any incidence of suspected child abuse or neglect at any time. You do not need to have “evidence” or actual knowledge of abuse when you make a report; all you need is reasonable cause, suspicion or belief based on your observations. Information to support your concern may include your firsthand observations or beliefs, your professional training or experience, or statements made to you by the child or parent. The more specific and concrete information you can provide, the better.

It is also important for you to know that all states have laws that protect reporters from legal liability as long as reports are made in good faith.

Whom Do You Call? Then What Happens?

To report suspected abuse or neglect, contact your local child welfare agency. Depending on where you live, this agency might be called Department of Social Services, Children and Family Services or Human Welfare. The contact number for your local child welfare agency can be found online at If you feel that the child is in an emergency situation, however, call 911 or your local law enforcement agency immediately.

The person who responds to your call will ask you several questions in order to provide the assessment or investigative team with sufficient information. Keep in mind that you do not need to know all the answers to make a report; you just need to be as comprehensive, specific and clear as possible with what you do know. Questions you may be asked include:

  • What is your relationship to the child?
  • What is the child’s name, age and address? (If you don’t know the answers to this question, you can provide descriptive information that will enable investigators to locate the child.)
  • What is the suspected abuser’s name, relationship to the child and address or license plate number?
  • What are the names, address(es) and telephone number(s) of the child’s parents?
  • Can you describe the type of abuse you suspect, when it occurred and/or your reasons for suspecting abuse?
  • What is the current location of the child?
  • What is your assessment of the child’s current level of safety?
  • What can you tell us about the child’s siblings and any related safety concerns?
  • What are the names, addresses and telephone numbers of other witnesses?
  • Are you aware of any previous situations of abuse or neglect and/or the family’s involvement with the child welfare system?

Although anonymous reports can be made in every state, child welfare agencies generally discourage anonymity for many reasons. First, knowing the identity of the reporter can help the child welfare worker gather information during the investigative process to ensure the child’s safety. Second, if the case goes to trial, the child welfare worker may need to rely on the reporter to be a crucial evidentiary witness.

Unfortunately, many child welfare agencies are severely underfunded and understaffed. Typically, reports of child abuse and neglect are prioritized based on whether the child is in immediate risk or danger. Be patient. You may have to call more than once. If you do, make sure you let the agency know that it is not your first time making a report on the family in question.