RCGP Safeguarding toolkit

Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. In 2019, neglect was the most common category of abuse for child protection plans in England and the second most common for the child protection register in Wales.

Neglect can take many different forms and can include:

• Physical neglect: a failure to take care of a child’s basic needs which includes providing food, shelter, clothes and keeping the child clean and hygienic. It can also include exclusion from home or abandonment.
• Supervisory neglect: a failure to provide an adequate level of supervision and guidance to ensure a child’s safety and protection from harm.
• Nutritional neglect: a failure to provide adequate calories or nutritional intake for normal growth (also sometimes called ‘failure to thrive’). At its most extreme, nutritional neglect can take the form of malnutrition.
• Emotional neglect: a failure to meet a child’s emotional needs. It can include emotional unavailability and unresponsiveness of the parent which can be particularly damaging to a child. It can occur if the parent has mental health difficulties, substance or alcohol misuse or is persistently preoccupied with other difficulties such as domestic abuse. Emotional neglect can result in long-lasting mental health problems and is a particularly hidden form of maltreatment.
• Medical neglect: this involves a parent or carer minimising or ignoring children’s illness or health (including oral health) needs, and failing to seek medical attention or administrating medication and treatments. This is equally relevant to expectant mothers who fail to prepare appropriately for the child’s birth, fail to seek ante-natal care, and/or engage in behaviours that place the baby at risk through, for example, substance misuse.
• A failure to provide suitable education including support to attend school. This can result in poor educational achievement due to missed education.

Neglect can be really difficult to spot. It is often a chronic issue rather than an acute one. Having one of the signs of neglect doesn't necessarily mean a child is being neglected. But if you notice multiple signs that last for a while, they might show there's a serious problem. It is also important to recognise that some of these signs of neglect can overlap with living in poverty and deprivation and there should be a clear distinction in response to families living in poverty who need help and support and families where there are concerns about neglect where child safeguarding measures need to be considered alongside help and support.

Some of the challenges of neglect that make it harder for practitioners to recognise that a threshold for statutory intervention has been reached are:

• The chronic nature of this form of maltreatment practitioners can become used to how a child is presenting and fail to question a lack of progress.
• Unlike physical abuse for example, the experience of neglect rarely produces a crisis that demands obvious and immediate action.
• Neglect can in some cases be challenging to identify because of the need to look beyond individual parenting episodes and consider the persistence, frequency, extent and pervasiveness of parenting behaviour which may make them harmful and abusive.
• There is a reluctance to pass judgement on patterns of parental behaviour particularly when deemed to be culturally embedded or when associated with social disadvantages such as poverty.
• The child may not experience neglect in isolation, but alongside other forms of abuse.

Neglect in affluence

It is important to recognise that children in affluent families can also experience neglect, in particular emotional neglect. These children often have excellent housing, a nutritious diet, first-class educational opportunities and access to a range of enrichment opportunities. A study carried out by Professor Claudia Bernard entitled “An Exploration of How Social Workers Engage Neglectful Parents from Affluent Backgrounds in the Child Protection System” highlighted some of the challenges in this area of safeguarding:

• The findings revealed that thresholds for neglect are not always understood, which posed challenges for effectively safeguarding children at risk of significant harm in privileged families.
• The vast majority of the cases described by the participants concerned emotional neglect, although other forms of maltreatment, such as sexual abuse, child sexual exploitation and emotional abuse, were also identified.
• Commonly-encountered cases involved struggling teenagers in private fee-paying and boarding schools, who were often isolated from their parents physically and emotionally, and had complex safeguarding needs.
• Participants gave many examples to show how parents had the financial resources to access psychological support through private care providers to address their children’s emotional and behavioural problems; some practitioners viewed this as a positive outcome for the child, but some saw this as a way for the parents to opt out of the statutory child protection system, and to thus slip under the radar of children’s services.
• All of the participants described difficulties in maintaining focus on the child because of the way that parents used their status and social capital to resist child protection intervention, and many also displayed a sense of entitlement to do as they pleased and that they know best.
• Participants consistently cited that highly resistant parents were more likely to use legal advocates or the complaints procedures to challenge social workers.
• All of the participants also experienced the challenges of interagency working with private fee-paying and boarding schools when child protection concerns were raised.

The study also outlined helpful practice:

• Considerable experience, practice wisdom and knowledge of neglect were essential in relation to working with highly resistant parents who had the resources to challenge social workers’ decision-making.
• Skills, knowledge and competence: all of the participants highlighted the important role that supportive managers and good supervision played in helping them to effectively intervene in affluent families.
• Participants cite the organisational cultures of support, purposeful informal conversations about the case with colleagues, good supervision, knowledge and confidence and responsive managers, themed learning activities, as key to their ability to work in this complex field.

This briefing on Safeguarding in Affluent Communities from Kingston and Richmond Safeguarding Children Partnership also gives a useful summary. 

Impact of neglect

The impact of neglect can be significant and life-changing. The devastating impact of neglect, particularly in early years, is often underestimated.

The effects can be short or long-term and can include:

• problems with brain development
• taking risks, like running away from home, using drugs and alcohol or breaking the law
• getting into dangerous relationships
• difficulty with relationships later in life, including with their own children
• a higher chance of having mental health problems, including depression.

Other factors and life circumstances can make it harder for parents and carers to meet their child’s needs such as domestic abuse, parental drug or alcohol abuse, parental experience of childhood abuse including neglect, parental learning disabilities, parental mental and physical health problems, living in poverty and being isolated with little or no family or community support.