How to distinguish between neglect and deprivational abuse

MH Golden, MP Samuels, DP Southall
Arch Dis Child 2003; 88: 105-107

Neglect is a major cause of inadequate childcare in all societies and should be differentiated from abuse. "Neglect" is defined here, as the "neglectful" failure to supply the needs of the child, including emotional needs. As such, it is a non-deliberate failure to provide the child's needs by the responsible person. This definition explicitly excludes abuse, which is always an act of commission. The deliberate or malicious failure to supply the needs of a child is termed here as "deprivational abuse."

Special Features of Neglect:
Only the person responsible for supplying the child's needs can be neglectful. In contrast, anyone can be abusive. However, total failure of the responsible individual does not necessarily result in neglect as someone else may supply the need; in contrast, other people cannot negate abuse, although its effects may be ameliorated.

Neglect depends critically on determination of the needs of a normal child and what constitutes an adequate supply of those needs. This will be much more comprehensively understood by the expert in child development than the parent or civil society; each level of knowledge may have a different viewpoint, and may differ from one society to another. It may have an absolute meaning for those basic needs that we all recognise as essential, and a relative meaning for those needs that lead to acceptance and integration within a particular culture or society.

Neglect is thus much more common than abuse and directly related to the education and awareness of the caretaker. It is also related to the degree of dependency on others to supply needs. Abuse on the other hand, is not reliant on the degree of dependency but on the degree of significant harm undertaken.

Severe neglect requires intervention by child protection agencies. It nearly always results from the impoverished circumstances and life stresses affecting the family. These are not deliberate acts of omission by the caretaker. Neglect has its roots in ignorance of a child's needs and competing priorities; it is passive and usually sustained. The caretaker, although aware that their care of the child is not good, is usually unaware of the extent of actual harm being done. Malnutrition is a prime example of neglect; the stigma associated with the term abuse should never be applied to the poor struggling or uneducated mother whose child, that she loves dearly, becomes malnourished. Education of the mother and society and relief from the vicissitudes of poverty are required to alleviate most neglect of the world's children.

The Conundrum of Child Malnutrition With Loving and Caring Parents:
35 % of the world's children are nutritionally stunted. Nearly all mothers of malnourished children think they have been looking after their children well. Children who have been malnourished for a time, often develop a "flat affect," wherein the child no longer cries to complain that its needs aren't being met. Without the crying, the caretaker is not alerted to the problem, and the cycle worsens. Thus, neglect can represent a failure to appreciate the child's needs or a failure of communication between the child and the caregiver. From the flat affect of the child we could say that she/he appears to be "resigned to fate"; what is not often appreciated is that the parent has often reached exactly the same conclusion. Such a tragedy must be differentiated from willful abuse.

What to do About Neglect:
Social services are the appropriate agency to deal with severe forms of neglect, for the whole family needs help. In our view criminal proceedings against neglect may be detrimental.

Most forms of neglect, however, should be addressed through education of both carers and society. What constitutes neglect is fairly clear. What constitutes neglect will change, as our knowledge of child development and of children's needs advances; what is the province of the expert today may become common knowledge tomorrow.