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Dr. Ann Mastergeorge Headshot

Don't Neglect the Signs of Neglect in Young Children

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This spring, a few miles from my house, a landlord found the skeleton of what had been a three-year-old child in a toy box in the backyard of a vacated house. The child, it turned out, was tragically killed by extreme neglect at the hands of his parents. He isn't alone. The Department of Child Services released numbers earlier this month finding one child dies every 10 days from neglect in our country.

When I read about the Tucson three-year-old in the news, I was horrified, and what stood out to me the most was that this child wasn't hidden. Neighbors later said they saw odd behavior at the house and when police officers stopped by the home months earlier because this child's older siblings had not been to school, they noticed the young boy was extremely thin. They asked a question about his appearance and his father told them he had trouble gaining weight. The officers did not do anything further.

Why? Because they simply did not detect or follow up on the possible signs of neglect. This is not an uncommon occurrence in our communities but it should be.

More children suffer from neglect in the United States than from physical and sexual abuse combined, although neglect receives significantly less attention. The National Child Abuse and Neglect Data System (NCANDS) found that among children who experienced maltreatment or abuse in 2013, 78 percent also suffered neglect. The age group that experiences the highest rates of neglect is zero to three years old, and in 2012, 49 states reported a total of 1,593 child fatalities due to abuse and neglect.

What exactly is neglect? Neglect is defined by the Child Welfare Information Gateway as the failure of a parent, guardian or caregiver to provide for a child's basic needs, including their physical, medical, education and emotional needs. Emotional neglect is the most hidden type and it includes a caregiver constantly blaming, belittling or berating the child, being unconcerned about the child, refusing to respond to a child's bids for help, and overtly rejecting the child.

The adverse physical and mental health consequences of neglect produce more widespread developmental impairment than overt physical abuse. Recent publications from the Center on the Developing Child at Harvard University found that when there is a lack of responsiveness in caregiver relationships, a biological stress system is activated and has a toxic effect on the developing brain.

This toxic effect may manifest as cognitive delays or the stunting of physical growth. It puts children at significant risk for emotional and interpersonal difficulties and disrupts the body's stress response. Neglect can also lead to learning difficulties and poor school achievement. In short, it is unconscionable to ignore neglect given these outcomes.

Child welfare and service provider professionals need to be better informed about the most recent scientific findings on neglect so they can develop effective prevention and intervention strategies to identify vulnerable children and intervene as early as possible. Providing support to families and modeling types of responsive strategies can create positive developmental outcomes for young children -- but this requires vigilance, ongoing support, and continuity of care for families, many of whom have stresses in their lives that interfere with positive parenting approaches.

There are states across the country with home visiting intervention programs such as Nurse Family Partnership that provides interventions for vulnerable families. We need more evidence-based intervention programs like this one because the earlier in life that neglected children receive appropriate intervention, the more likely they are to achieve long-term positive developmental and academic outcomes.

How can we, as individuals, identify neglect in our own communities?

Hindsight is of course 20-20, but had the police officers known more about neglect, they may have been able to change this tragic outcome. Like these police officers and the neighbors who suspected something wasn't quite right, we all need to learn more about the signs of neglect so we can identify and help children who are often suffering silently before it is too late.

It is not always easy to spot these children in need. Neglect doesn't usually come with outward signs like bruises, cuts or broken bones. Thus, detecting it often requires vigilance through asking difficult questions (difficult because, of course, no one wants to believe their neighbor is abusing a child) and following up when something seems amiss, like a child who looks under-fed. The Administration for Children and Families offers resources on recognizing the signs and symptoms of neglect and how to respond. For example, if you suspect neglect please make a call to Child Protective Services (CPS). It is always better to be safe than sorry and all calls are anonymous.

Toy boxes should contain toys that enrich a child's life and bring joy and excitement in their everyday lives. They should never include the skeleton of a child, nor should we close our eyes to the skeletons of ignorance about the signs of neglect that surround all of us in our communities and neighborhoods -- and sometimes in our own backyard. As citizens, neighbors, teachers, law enforcement officers, and health care professionals we must take the time to learn the signs and science of neglect and be ready to act and promote the well-being of young children.