FVS4

Child Neglect: A Guide for Prevention, Assessment, and Intervention 9

Child neglect is the most common type of

child maltreatment.1 Unfortunately, neglect

frequently goes unreported and, historically, has

not been acknowledged or publicized as greatly as

child abuse. Even professionals often have given

less attention to child neglect than to abuse.2 One

study found that caseworkers indicated that they

were least likely to substantiate referrals for neglect.3

In some respects, it is understandable why violence

against children has commanded more attention

than neglect. Abuse often leaves visible bruises and

scars, whereas the signs of neglect tend to be less

visible. However, the effects of neglect can be just as

detrimental. In fact, some studies have shown that

neglect may be more detrimental to children’s early

brain development than physical or sexual abuse.4

WHAT IS NEGLECT?

How neglect is defined shapes the response to it.

Since the goal of defining neglect is to protect children

and to improve their well-being—not to blame the

parents or caregivers—definitions help determine if an

incident or a pattern of behavior qualifies as neglect,

its seriousness or duration, and, most importantly,

whether or not the child is safe.5

Definitions of neglect vary among States and across

different disciplines, agencies, and professional groups

(e.g., child protective services, court systems, health

care providers), as well as among individuals within

these agencies and groups. The definitions also are

used for different purposes within the child welfare

field. For example, a medical doctor may view a

parent as neglectful if the parent repeatedly forgets

to give his child a prescribed medication. This may

or may not legally be considered neglect, however,

depending on the stringency of the neglect criteria of

many CPS agencies.6

Difficulty Defining Neglect

Defining neglect historically has been difficult to do,

leading to inconsistencies in policies, practice, and

research. Without a consistent definition of neglect,

it is nearly impossible to compare research results.

This inconsistency also leads to variability in the way

neglect cases are handled.7

The debate over a definition of neglect centers on a

lack of consensus in answering these questions:

What are the minimum requirements associated

with caring for a child?

What action or inaction by a parent or other

caregiver constitutes neglectful behavior?

Must the parent’s or caregiver’s action or inaction

be intentional?

What impact does the action or inaction have on

the health, safety, and well-being of the child?

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CHAPTER 2 Definition and Scope

of Neglect

10 Definition and Scope of Neglect

What constitutes “failure or inability to provide”

adequate food, shelter, protection, or clothing?

Should “failure or inability to protect” be

included?

Is the action or inaction a result of poverty rather

than neglect?8

Additionally, what is considered neglect varies based

on the age and the developmental level of the child,

making it difficult to outline a set of behaviors that

are always considered neglect. For example, leaving

a child unattended for an hour is considered neglect

when the child is young, but not when the child

is a teenager. Another issue is that many neglect

definitions specify that omissions in care may result

either in “risk of harm” or in “significant harm” to

the child. While the 1996 reauthorization of the

Child Abuse Prevention and Treatment Act (CAPTA)

(P.L. 104-235) narrowed the definition of child

maltreatment to cases where there has been actual

harm or an imminent risk of serious harm, these

terms often are not defined by law, leaving the local

CPS agencies to interpret them. This leads to a lack

of consistency in responding to families who may be

challenged to meet the basic needs of their children. 9

Definitions of Neglect

CAPTA, reauthorized again in the Keeping Children

and Families Safe Act of 2003 (P.L. 108-36), provides

minimum standards for defining child physical abuse,

neglect, and sexual abuse that States must incorporate

into their statutory definitions in order to receive

Federal funds. Under this Act, child maltreatment

is defined as:

Any recent act or failure to act on the part of

a parent or caregiver, which results in death,

serious physical or emotional harm, sexual abuse

or exploitation, or an act or failure to act which

presents an imminent risk of serious harm.10

A “child” under this definition generally means a

person who is under the age of 18 or who is not an

•

•

•

emancipated minor. In cases of child sexual abuse, a

“child” is one who has not attained the age of 18 or the

age specified by the child protection law of the State

in which the child resides, whichever is younger.11

Instances of neglect are classified as mild, moderate,

or severe.

Mild neglect usually does not warrant a report to

CPS, but might necessitate a community-based

intervention (e.g., a parent failing to put the child

in a car safety seat).

Moderate neglect occurs when less intrusive

measures, such as community interventions,

have failed or some moderate harm to the

child has occurred (e.g., a child consistently is

inappropriately dressed for the weather, such

as being in shorts and sandals in the middle

of winter). For moderate neglect, CPS may

be involved in partnership with community

support.

Severe neglect occurs when severe or long-term

harm has been done to the child (e.g., a child

with asthma who has not received appropriate

medications over a long period of time and is

frequently admitted to the hospital). In these

cases, CPS should be and is usually involved, as is

the legal system.12

Viewing the severity of neglect along this continuum

helps practitioners assess the strengths and weaknesses

of families and allows for the possibility of providing

preventive services before neglect actually occurs

or becomes severe. There is some controversy over

whether “potential harm” should be considered

neglect, and, as with the definition of neglect, State

laws vary on this issue. Although it is difficult to

assess potential harm as neglect, it can have emotional

as well as physical consequences, such as difficulty

establishing and maintaining current relationships or

those later in life.13

The seriousness of the neglect is determined not

only by how much harm or risk of harm there is to

the child, but also by how chronic the neglect is.

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Child Neglect: A Guide for Prevention, Assessment, and Intervention 11

Chronicity can be defined as “patterns of the same

acts or omissions that extend over time or recur over

time.” 14 An example of chronic neglect would be

parents with substance abuse problems who do not

provide for the basic needs of their children on an

ongoing basis. On the other hand, caregivers might

have minor lapses in care, which are seldom thought

of as neglect, such as occasionally forgetting to give

their children their antibiotics.15 However, if those

children were frequently missing doses, it may be

considered neglect. Some situations only need to

occur once in order to be considered neglect, such as

leaving an infant unattended in a bathtub. Because

some behaviors are considered neglect only if they

occur on a frequent basis, it is important to look at

the history of behavior rather than focusing on one

particular incident.

TYPES OF NEGLECT

While neglect may be harder to define or to detect

than other forms of child maltreatment, child

welfare experts have created common categories of

neglect, including physical neglect; medical neglect;

inadequate supervision; environmental, emotional,

and educational neglect; and newborns addicted or

exposed to drugs, as well as some newly recognized

forms of neglect. The following sections give detailed

information on each of these types of neglect.

States’ definitions of neglect are usually located in mandatory child maltreatment reporting statutes (civil

laws), criminal statutes, or juvenile court jurisdiction statues. For more information about reporting laws,

visit the State Laws on Reporting Child Abuse and Neglect section of the Child Welfare Information Gateway

Web site at http://www.childwelfare.gov/laws_policies/state/reporting.cfm.

Framework for Neglect

Current theory on maltreatment views neglect from a socio-ecological perspective in which multiple factors

contribute to child abuse and neglect.16 From this perspective, one should consider not only the parent’s role, but

also the societal and environmental variables contributing to the parent’s inability to provide for the basic needs of the

child. 17 The socio-ecological model is valuable because it “recognizes the shared responsibility among individuals,

families, communities, and society, thereby enabling a more constructive approach and targeting interventions on

multiple levels.”18 Examples of factors to consider when looking at neglect from a socio-ecological perspective are

social isolation and poverty. For more information about factors related to child neglect, see Chapter 4, Risk and Protective Factors.

It is important to keep in mind that not all incidents in which a person fails to provide for the basic needs for a

child are necessarily considered neglect. Factors relating to the parent’s health and well-being, such as mental illness,

substance abuse, or domestic violence, often contribute to neglect. Any intervention for neglect will need to consider

these factors as well.

Federal and State laws often assume that it is possible to determine clearly when parents have control over omissions

in care and when they do not. For example, children may be poorly fed because their parents are poor and are unable

to provide them with the appropriate type and amount of food. In such cases, it is important to identify factors that

may be contributing to this inability to provide, such as mental illness. However, when a family consistently fails

to obtain needed support or is unable to use information and assistance that is available, an intervention may be

required. Having a comprehensive understanding of what may contribute to neglect can help determine appropriate

interventions that address the basic needs of the child and family and also enhances professionals’ and communities’

abilities to develop and to use interventions, regardless of CPS involvement.19

12 Definition and Scope of Neglect

Physical Neglect

Physical neglect is one of the most widely recognized

forms. It includes:

Abandonment—the desertion of a child without

arranging for his reasonable care or supervision.

Usually, a child is considered abandoned when

not picked up within 2 days.

Expulsion—the blatant refusal of custody, such

as the permanent or indefinite expulsion of a child

from the home, without adequately arranging for

his care by others or the refusal to accept custody

of a returned runaway.

Shuttling—when a child is repeatedly left in the

custody of others for days or weeks at a time,

possibly due to the unwillingness of the parent or

the caregiver to maintain custody.

Nutritional neglect—when a child is

undernourished or is repeatedly hungry for

long periods of time, which can sometimes be

evidenced by poor growth. Nutritional neglect

often is included in the category of “other physical

neglect.”

Clothing neglect—when a child lacks appropriate

clothing, such as not having appropriately warm

clothes or shoes in the winter.

Other physical neglect—includes inadequate

hygiene and forms of reckless disregard for the

child’s safety and welfare (e.g., driving while

intoxicated with the child, leaving a young child

in a car unattended).20

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•

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•

Medical Neglect

Medical neglect encompasses a parent or guardian’s

denial of or delay in seeking needed health care for a

child as described below:

Denial of health care—the failure to provide

or to allow needed care as recommended by a

competent health care professional for a physical

injury, illness, medical condition, or impairment.

The CAPTA amendments of 1996 and 2003

contained no Federal requirement for a parent to

provide any medical treatment for a child if that

treatment is against the parent’s religious beliefs.

However, CAPTA also designates that there

is no requirement that a State either find or be

prohibited from finding abuse or neglect in cases

where parents or legal guardians act in accordance

with their religious beliefs. While CAPTA

stipulates that all States must give authority to

CPS to pursue any legal actions necessary 1) to

ensure medical care or treatment to prevent or to

remedy serious harm to a child or 2) to prevent

the withholding of medically indicated treatment

from a child with a life-threatening condition

(except in the cases of withholding treatment

from disabled infants), all determinations will

be done on a case by case basis within the sole

discretion of each State.21

Delay in health care—the failure to seek timely

and appropriate medical care for a serious health

problem that any reasonable person would have

recognized as needing professional medical

attention. Examples of a delay in health care

include not getting appropriate preventive

•

•

Homelessness and Neglect

It is unclear whether homelessness should be considered neglect; some States specifically omit homelessness

by itself as neglect. Unstable living conditions can have a negative effect on children, and homeless

children are more at risk for other types of neglect in areas such as health, education, and nutrition.

Homelessness is “considered neglect when the inability to provide shelter is the result of mismanagement

of financial resources or when spending rent resources on drugs or alcohol results in frequent evictions.”22

Child Neglect: A Guide for Prevention, Assessment, and Intervention 13

medical or dental care for a child, not obtaining

care for a sick child, or not following medical

recommendations. Not seeking adequate mental

health care also falls under this category. A lack or

delay in health care may occur because the family

does not have health insurance. Individuals who

are uninsured often have compromised health

because they receive less preventive care, are

diagnosed at more advanced disease stages, and,

once diagnosed, receive less therapeutic care.23

Inadequate Supervision

Inadequate supervision encompasses a number of

behaviors, including:

Lack of appropriate supervision. Some States

specify the amount of time children at different

ages can be left unsupervised, and the guidelines

for these ages and times vary. In addition,

all children are different, so the amount of

supervision needed may vary by the child’s age,

development, or situation. It is important to

evaluate the maturity of the child, the accessibility

of other adults, the duration and frequency of

unsupervised time, and the neighborhood or

environment when determining if it is acceptable

to leave a child unsupervised.24

Exposure to hazards. Examples of exposure to

in- and out-of-home hazards include:

Safety hazards—poisons, small objects,

electrical wires, stairs, drug paraphernalia;

Smoking—second-hand smoke, especially

for children with asthma or other lung

problems;

Guns and other weapons—guns that are kept

in the house that are loaded and not locked

up or are in reach of children;

Unsanitary household conditions—rotting

food, human or animal feces, insect

infestation, or lack of running or clean

water;

Lack of car safety restraints.25

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•

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–

–

–

Inappropriate caregivers. Another behavior

that can fall under “failure to protect” is leaving

a child in the care of someone who either is

unable or should not be trusted to provide care

for a child. Examples of inappropriate caregivers

include a young child, a known child abuser, or

someone with a substance abuse problem.26

Other forms of inadequate supervision.

Additional examples of inadequate supervision

include:

Leaving a child with an appropriate caregiver,

but without proper planning or consent (e.g.,

not returning to pick up the child for several

hours or days after the agreed upon pick-

up time or not giving the caregiver all the

necessary items to take care of the child);

Leaving the child with a caregiver who is not

adequately supervising the child (e.g., the

caregiver is with the child, but is not paying

close attention to the child due to constantly

being distracted by other activities);

Permitting or not keeping the child from

engaging in risky, illegal, or harmful behaviors

(e.g., letting a child smoke marijuana).27

Another common but complex example is single,

working parents who are having difficulty arranging

for appropriate back-up child care when their regular

child care providers are unavailable. For example,

a mother may leave her child home alone when the

child care provider fails to show up. If the mother

does not go to work, she can lose her job and will

not be able to take care of her child. However, if she

leaves the child alone, she will be guilty of neglect. It

is important that parents in situations similar to this

receive adequate support so that they are not forced to

make these difficult decisions.

Environmental Neglect

Some of the characteristics mentioned above can

be seen as stemming from environmental neglect,

which is characterized by a lack of environmental

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14 Definition and Scope of Neglect

or neighborhood safety, opportunities, or resources.

While children’s safety and protection from hazards are

major concerns for CPS, most attention focuses on the

conditions in the home and parental omissions in care.

A broad view of neglect incorporates environmental

conditions linking neighborhood factors with family

and individual functioning, especially since the

harmful impact of dangerous neighborhoods on

children’s development, mental health, and child

maltreatment has been demonstrated.28 CPS workers

should be aware of this impact on the family when

assessing the situation and developing case plans. For

example, they can help parents find alternative play

areas in a drug-infested neighborhood, rather than

have their children play on the streets.

Emotional Neglect

Typically, emotional neglect is more difficult to assess

than other types of neglect, but is thought to have

more severe and long-lasting consequences than

physical neglect.29 It often occurs with other forms

of neglect or abuse, which may be easier to identify,

and includes:

Inadequate nurturing or affection—the

persistent, marked inattention to the child’s needs

for affection, emotional support, or attention.

Chronic or extreme spouse abuse—the

exposure to chronic or extreme spouse abuse or

other domestic violence.

Permitted drug or alcohol abuse—the

encouragement or permission by the caregiver of

drug or alcohol use by the child.

Other permitted maladaptive behavior—

the encouragement or permission of other

maladaptive behavior (e.g., chronic delinquency,

assault) under circumstances where the parent or

caregiver has reason to be aware of the existence

and the seriousness of the problem, but does not

intervene.

•

•

•

•

Isolation—denying a child the ability to interact

or to communicate with peers or adults outside

or inside the home.30

Educational Neglect

Although State statutes and policies vary, both parents

and schools are responsible for meeting certain

requirements regarding the education of children.

Types of educational neglect include:

Permitted, chronic truancy—permitting

habitual absenteeism from school averaging at

least 5 days a month if the parent or guardian is

informed of the problem and does not attempt

to intervene.

Failure to enroll or other truancy—failing to

homeschool, to register, or to enroll a child of

mandatory school age, causing the child to miss

at least 1 month of school without valid reasons.

Inattention to special education needs—

refusing to allow or failing to obtain recommended

remedial education services or neglecting to

obtain or follow through with treatment for a

child’s diagnosed learning disorder or other special

education need without reasonable cause.31

Newborns Addicted or Exposed to Drugs

As of 2005, 24 States had statutory provisions

requiring the reporting of substance-exposed

newborns to CPS.32 Women who use drugs or alcohol

during pregnancy can put their unborn children at

risk for mental and physical disabilities. The number

of children prenatally exposed to drugs or to alcohol

each year is between 409,000 and 823,000.33 One

study showed that drug-exposed newborns constitute

as many as 72 percent of the babies abandoned in

hospitals.34 Another study found that 23 percent

of children prenatally exposed to cocaine were later

abused or neglected, compared with 3 percent who

were not prenatally exposed.35 To address the needs

of these children, the Keeping Children and Families

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Child Neglect: A Guide for Prevention, Assessment, and Intervention 15

Safe Act of 2003 (P.L. 108-36, sec. 114(b)(1)(B))

mandated that States include the following in their

CAPTA plans:

(ii) Policies and procedures (including appropriate

referrals to child protection service systems and for

other appropriate services) to address the needs of

infants born and identified as being affected by illegal

substance abuse or withdrawal symptoms resulting

from prenatal drug exposure, including a requirement

that health care providers involved in the delivery or

care of such infants notify the child protective services

system of the occurrence of such condition of such

infants, except that such notification shall not be

construed to—

(I) establish a definition under Federal law of

what constitutes child abuse; or

(II) require prosecution for any illegal action.

(iii) The development of a plan of safe care for the

infant born and identified as being affected by illegal

substance abuse or withdrawal symptoms;

(iv) Procedures for the immediate screening, risk

and safety assessment, and prompt investigation

of such reports.

SIGNS OF POSSIBLE NEGLECT

It can be difficult to observe a situation and to know

for certain whether neglect has occurred. Behaviors

and attitudes indicating that a parent or other adult

caregiver may be neglectful include if he or she:

Appears to be indifferent to the child;

Seems apathetic or depressed;

Behaves irrationally or in a bizarre manner;

Abuses alcohol or drugs;

Denies the existence of or blames the child for

the child’s problems in school or at home;

Sees the child as entirely bad, worthless, or

burdensome;

Looks to the child primarily for care, attention,

or satisfaction of emotional needs.36

Indicators of neglect are more likely to be visible in

the appearance or behavior of the child. Mandatory

reporters and concerned individuals should consider

reporting possible neglect if they notice that a child:

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•

•

•

•

Methamphetamine Use and Child Maltreatment

In addition to the problem of prenatal drug use, the rise in methamphetamine abuse also has had a

strong impact on child maltreatment. U.S. Attorney General Alberto Gonzales recently proclaimed “in

terms of damage to children and to our society, meth is now the most dangerous drug in America.” 37

Children whose parents use methamphetamine are at a particularly high risk for abuse and neglect.

Methamphetamine is a powerfully addictive drug, and individuals who use it can experience serious

health and psychiatric conditions, including memory loss, aggression, violence, psychotic behavior, and

potential coronary and neurological damage.38 The drug is relatively easy to make, exposing many children

of methamphetamine users to the additional risks of living in or near a methamphetamine lab. In 2003,

3,419 children either were residing in or visiting a methamphetamine lab that was seized, and 1,291

children were exposed to toxic chemicals in these labs.39 For more information on this epidemic, go to

http://www.whitehousedrugpolicy.gov/news/press05/meth_factsheet.

16 Definition and Scope of Neglect

Wears soiled clothing or clothing that is

significantly too small or large or is often in need

of repair;

Seems inadequately dressed for the weather;

Always seems to be hungry; hoards, steals, or begs

for food; or comes to school with little food;

Often appears listless and tired with little energy;

Frequently reports caring for younger siblings;

Demonstrates poor hygiene, smells of urine or

feces, or has dirty or decaying teeth;

Seems emaciated or has a distended stomach

(indicative of malnutrition);

Has unattended medical or dental problems, such

as infected sores;

States that there is no one at home to provide

care.40

SCOPE OF THE PROBLEM

According to the National Child Abuse and Neglect

Data System (NCANDS), in 2004, an estimated three

million referrals were made to CPS, representing 5.5

million children. From this population, approximately

872,000 children were found to be victims of

•

•

•

•

•

•

•

•

•

maltreatment, and 64.5 percent of these children were

neglected. In comparison, 18 percent of maltreated

children were physically abused, 10 percent were

sexually abused, and 7 percent were psychologically

maltreated. Additionally, 15 percent of victims were

associated with “other” types of maltreatment, such as

abandonment or congenital drug addiction. A child

could be identified as a victim of more than one type

of maltreatment.41

From 2000 to 2004, the rates of neglect were nearly

stable. In 2004, approximately 7.4 out of every 1,000

children in the general population were reported as

being neglected. Medical neglect is listed separately,

but it also has experienced nearly stable rates,

fluctuating between 0.5 children per 1,000 in 2000

and 0.3 children per 1,000 in 2004.42 Exhibit 2-1

shows the victimization rate by maltreatment type

from 2000 to 2004.

However, according to the Third National Incidence

Study of Child Abuse and Neglect (NIS-3), less

than one-third of child abuse and neglect cases are

reported to CPS.43 Data from NIS-3 show that

the rates of child neglect may be even higher than

noted in the NCANDS data, with 13.1 children

per 1,000 being neglected.44 Within the category

of neglect, physical neglect was the most commonly

occurring type and included abandonment; medical

neglect; inadequate nutrition, clothing, or hygiene;

and leaving a young child unattended in a motor

vehicle.45

Mandatory Reporters

Mandatory reporters are individuals who are required by law to report cases of suspected child abuse or

neglect. They can face criminal and civil liability for not doing so. In approximately 18 States, anyone

who suspects child abuse or neglect is considered a mandatory reporter.46 In most States, mandatory

reporters are required to make a report immediately upon having suspicion or knowledge of an abusive

or neglectful situation. This initial report may be made orally to either CPS or a law enforcement agency.

Examples of individuals who typically are listed as mandatory reporters include physicians, social workers,

educators, mental health professionals, child care providers, medical examiners, and police. Every State

has statutes that specify procedures for mandatory reporters to follow when making a report of child

abuse or neglect. For more information about State laws regarding mandatory reporters, see http://www.

childwelfare.gov/laws_policies/state/reporting.cfm.

Child Neglect: A Guide for Prevention, Assessment, and Intervention 17

Exhibit 2-1

Victimization Rates by Maltreatment Type, 2000–200447

Spotlight on Chronic Neglect

One issue in defining child neglect involves consideration of “incidents” of neglect versus a pattern of behavior that indicates neglect. Susan J. Zuravin, Ph.D., at the University of Maryland at Baltimore School of Social Work, recommends that if some behaviors occur in a “chronic pattern,” they should be considered neglectful. Examples include lack of supervision, inadequate hygiene, and failure to meet a child’s educational needs. This suggests that rather than focusing on individual incidents that may or may not be classified as “neglectful,” one should look at an accumulation of incidents that may together constitute neglect.

In most CPS systems, however, the criteria for identifying neglect focus on recent, distinct, verifiable incidents. Dr. Zuravin notes that “if CPS focuses only on the immediate allegation before them and not the pattern reflected in multiple referrals, then many neglected children will continue to be inappropriately excluded from the CPS system.” 48 For example, a family exhibiting a pattern of behavior that may constitute neglect might have frequent CPS reports of not having enough food in the home or keeping older children home from school to watch younger children. However, since each individual report may not be considered neglect, the family may not receive the appropriate support or be served by the CPS system. Additionally, many definitions of neglect that address chronicity do not identify what it means (e.g., What does “frequent reports of not having enough food in the home” mean? Twice per week? Twice per month?). This may prevent CPS caseworkers from consistently applying the child maltreatment laws in these cases.

One study found that many children who had been referred to CPS for neglect did not receive services because their cases did not meet the criteria for neglect. It found, however, that all of these children had, in fact, suffered severe developmental consequences. In recognition of this issue, the Missouri Division of Family Services assigned one of its CPS staff as a chronic neglect specialist and defined chronic neglect as “…a persistent pattern of family functioning in which the caregiver has not sustained and/or met the basic needs of the children, which results in harm to the child.”49 The focus here was on the accumulation of harm. CPS and community agencies are recognizing the importance of early intervention and service provision to support families so that neglect does not become chronic or lead to other negative consequences.50 For more information on this topic, see Acts of Omission: An Overview of Child Neglect at http://www.childwelfare.gov/pubs/focus/acts.

2.4

7.3

0.5

1.2 1.0

2.8 2.3

7.1

0.3

1.2 0.9

3.2

2.3

7.2

0.3

1.2 0.8

3.3

2.3

7.5

0.3

1.2 0.6

3.7

2.1

7.4

0.3

1.2 0.9

3.2

0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0

Physical Abuse Neglect Medical Neglect

Sexual Abuse Psychological Maltreatment

O ther Abuse

Maltreatment Type

R at

e pe

r 1,

00 0

C hi

ld re

n

2000 2001 2002 2003 2004

18 Definition and Scope of Neglect

Recurrence

Recurrence of child abuse and neglect remains a very

serious problem. It has been shown that subsequent

referrals of maltreatment are most often for neglect

(and, specifically, lack of supervision), regardless

of the type of maltreatment in the initial referral.51

These findings highlight the need to screen for neglect

and to provide preventive services where needed, not

just for those cases initially identified as neglect.52 It is

important to know the extent to which children who

have been in contact with CPS are victims of repeat

maltreatment in order to protect them and to prevent

its recurrence.53

Through the Child and Family Services Reviews

(CFSRs), which are a results-oriented, comprehensive

monitoring system designed to assist States in

improving outcomes for the children and families they

serve, the Children’s Bureau set a national standard for

recurrence of maltreatment, which is measured using

NCANDS data. The percent of States that met the

national standard increased from 29.4 percent of all

States in 2000 to 42.2 percent of States in 2004.54 (See

Appendix D, Neglect and the Child and Family Services Reviews, for more information on CFSR findings.)

One study on recurrence that followed families

for 5 years defined recurrence as “any confirmed

report of physical abuse, sexual abuse, or neglect on

any child in the family that occurred at least 1 day

following the index incident report date.” 55 Of the

43 percent of families in the study that experienced

at least one incident of recurrence of maltreatment

within 5 years of the original incident, 64 percent of

them were classified as neglect. This study also found

that 52 percent of families who experienced repeated

maltreatment had only one recurrence. The highest

probability for recurrence was within the first 30 days

of the original occurrence of maltreatment.56

Child Neglect Fatalities

An estimated 1,490 children died from abuse or

neglect in 2004. This is a rate of 2.03 deaths per

100,000 children, which is comparable to the rate of

2.00 per 100,000 children in 2003. 57

The distinction between child neglect fatalities and

child abuse fatalities is that deaths from neglect result

from a failure to act, whereas deaths from abuse result

from a physical act. Fatalities due to child neglect

may offer less obvious clues as to who is responsible

and how the death occurred than fatalities due to

abuse. Deaths due to child neglect, therefore, often

are more difficult to investigate and prosecute. This

also causes difficulty in determining the overall

number of fatalities due to child neglect. In fact, one

study estimated that 85 percent of child maltreatment

fatalities are not recorded as such on death certificates.58

Other studies conducted in Colorado and North

Carolina estimated that 50 to 60 percent of deaths

due to child maltreatment were not recorded and

that child neglect is the most under-recorded form

of fatal maltreatment.59 Differing definitions of child

homicide, abuse, and neglect, as well as the lack of

thorough investigations into some child fatalities, also

may be responsible for this underreporting.

Child neglect fatalities usually result from inadequate

supervision, chronic physical neglect, or medical

neglect and may result from chronic inaction (e.g.,

malnourishment) or from an acute incident (e.g.,

an unsupervised child drowning in a pool). The

child’s home is the most common place for a child

neglect fatality to occur, and the bathroom is the most

common room in which the death occurs. Often

these children die from drowning or from fires that

occur while they are unsupervised.60 Other examples

of neglect fatalities include dying from falls from

unprotected windows, suffocation, poisoning, and

not receiving needed medical care.

Exhibit 2-2 shows the type of maltreatment associated

with child fatalities in 2004.

As these statistics in Exhibits 2-1 and 2-2 illustrate,

child neglect is the largest form both of child

maltreatment and of fatalities due to maltreatment.

Child Neglect: A Guide for Prevention, Assessment, and Intervention 19

Exhibit 2-2

Fatalities by Type of Maltreatment, 200461

36.9

28.3

30.2

0.8

3.9

0% 5% 10% 15% 20% 25% 30% 35% 40%

Neglect O nly (includes Medical Neglect O nly)

Physical Abuse O nly

Multiple Maltreatment Types

Sexual Abuse O nly

Psychological Maltreatment O nly, O ther O nly, or Unknown

M al

tr ea

tm en

t T

yp e

Percentage