1. SUS Child Neglect By Celeste R. Wilson, MD John R. Knight, MD Corresponding Educational Materials Reviewed by Hoover Adger, MD Jennifer Smrstik, LICSW Richard Bourne, JD, PhD SUS

2. SUS Epidemiology In 1996, child protective service agencies investigated more than 2 million reports alleging child abuse or neglect. More than 1 million of these cases were substantiated.

3. SUS Epidemiology Child neglect: is the most common form of child maltreatment accounts for about 2/3 of substantiated cases of child maltreatment

4. SUS Definition The definition of child neglect varies from state to state. In general, child neglect is defined as the caretakers failure to provide for the basic needs (e.g., food, clothing, shelter, education, safety) of the child.

5. SUS Poverty Poverty does not constitute child neglect. Differentiating poverty from willful child neglect can be extremely challenging.

6. SUS Poverty Detailed history is needed to understand parents explanation (e.g., why medication not purchased, why appointment missed) Must determine if limited access to resources is preventing parent from acting in the childs best interest (e.g., no money, no transportation)

7. SUS Types of Child Neglect Physical neglect – failure to provide adequate food, clothing, and shelter Emotional neglect – failure to provide adequate social stimulation in the form of talking, love, and nurturance/affection

8. SUS Types of Child Neglect Medical neglect – failure or delay in seeking medical/dental care or noncompliance with medications or recommended health care Educational neglect – failure to send a child to school regularly Safety neglect – failure to provide adequate supervision

9. SUS Parental Factors Associated with Child Neglect Substance abuse Depression or other mental health disorders Domestic violence Unrealistic expectations of the child Lack of social support system Personal history of child maltreatment

10. SUS Child Factors Associated with Child Neglect Prematurity Developmental disability Chronic medical condition Difficult temperament (e.g., crying, fussiness)

11. SUS Environmental Factors Associated with Child Neglect Family stressors (e.g., unemployment, illness, death of loved one, inadequate finances, divorce) Lack of community resources

12. SUS Signs and Symptoms Missed medical appointments Failure/delay in seeking medical care for illness Failure/delay in seeking dental care Poor growth Poor hygiene Developmental delay Multiple dental caries Untreated medical conditions Nonspecific behavior patterns

13. SUS Identification …can be challenging, partly because of the complexity associated with trying to discriminate between adequate vs. inadequate care of the child. …in many cases is subjective, which can lead to underreporting.

14. SUS Intervention Educate parents about expectations for appropriate pediatric health care. Promote parent understanding of child development through anticipatory guidance. Supply parents with information about community resources and support services. Establish a good rapport with parents and inquire about their childhood.

15. SUS Mandated Reporting Pediatric clinicians are mandated reporters, meaning that they are required by law to notify the state child protection agency when they suspect a child is being neglected or abused.

16. SUS Child Protection Agency Evaluate situation Emphasis on child safety and protection Family plan Direct services for the parents (e.g., parenting classes, substance abuse treatment) Establish services for child (e.g., Early Intervention, daycare) Ability to offer ongoing intervention for family and child

17. SUS What can you do? Recognize signs and symptoms of child neglect and abuse. Realize that intervening benefits the child and family. Energize yourself to stay involved with the family even after a report to child protection services has been made.