What to do if you are worried about a child

Neglect: Information and Guidance

Neglect is the most common form of abuse and NSPCC research suggests around 1 in 10 children in the UK have been neglected.  Supporting professionals to have the knowledge, skills, and confidence in identifying and responding to concerns of neglect is fundamental in addressing this.

You can download a PDF version of the Berkshire West Safeguarding Children Partnership Information and Guidance on Neglect here.

Definition of Neglect 

Working Together to Safeguard Children 2018 defines neglect as: The persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of a child’s health or development. Neglect may occur during pregnancy because of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to:  

  • Provide adequate food, clothing, and shelter (including exclusion from home or abandonment). 
  • Protect a child from emotional and physical harm or danger. 
  • Ensure adequate supervision (including the use of inadequate care givers). 
  • Ensure access to appropriate medical care or treatment. 
  • It may include neglect of, or unresponsiveness to, a child’s basic emotional needs.

Neglect can be a difficult concept for both practitioners and families and differs in its presentation from other forms of abuse. There is rarely a unique incident or critical event; more commonly there is a repetition of neglecting behaviour which causes incremental damage to the child(ren). This can undermine the child’s resilience, leading to avoidable health and developmental problems, distress and unhappiness for the child, harm and poorer life chances. Understanding its repercussions and the potential for both prevention and intervention is vital.

Neglect is directly linked to the parent or carer’s capacity to recognise and respond to the child’s needs whatever their age. Adults in a child or young person’s life may not recognise the signs of neglect and the child may be too young, too scared or feel ashamed to tell anyone what is happening to them.

Our Local Partnership Statement and Expectations   

Berkshire West Safeguarding Children Partnership is fully committed to safeguarding the welfare of children by taking all reasonable steps to protect them from neglect.  We expect that everyone in organisations and agencies working with children and families, including those who work with parents / carers, will work restoratively using trauma informed principles, collaboratively, effectively, and understands the role they should play and the role of other practitioners when responding to neglect.

Practitioners need to recognise and work with families to respond to neglect; identifying how neglect presents and what ‘good enough’ looks like.  As a partnership, we need to ensure that all practitioners have a consistent understanding of childhood neglect and know what is expected of them should concerns arise.

We expect leaders and managers to:

  • Promote the importance of listening to children, hear them and ensure their voice impacts on service planning.
  • Have sound management oversight of practice around neglect, through effective governance and quality assurance arrangements.
  • Provide skilled supervision to practitioners, providing them with an opportunity to reflect on cases, challenge and be challenged.
  • Support and enable appropriate practitioners to attend training on neglect and support them to apply the tools they need in practice.
  • Support practitioners to challenge each other skilfully, accept challenge from staff and other agencies and deal with it in the best interests of the child.

We expect practitioners to:

  • Listen to children, hear them, and ensure their voice impacts on plans made about them.
  • Listen to each other, hear what is being said and ensure everyone’s perspective helps in understanding the child’s needs.
  • Use a whole family approach, being mindful of the needs of adults in the child’s household and how their needs might impact on the child.
  • Respond sensitively and swiftly to concerns while understanding the cumulative nature of neglect.
  • Take account of the full history and not just the recent episode; complete chronologies regularly to enable reflection on cases, pick up non-compliance, drift and delay and take remedial action.
  • Seek management support and challenge and use supervision to reflect on cases and create new options.
  • Use all available evidence to inform action planning and be mindful of the particular complexities involved when a child has complex health needs and/or disabilities.
  • Challenge each other skilfully, with the child at the centre

What you can find below - Information, Guidance and Resources  

On the pages below you can learn more about the types of neglect, indicators, causes, how it can affect particular groups, appropriate response, and links to a variety of useful resources.  Click the title to take you to the section:

  • Types and Indicators of Neglect – learn about the six different classifications of neglect and their common indicators.
  • Impact of Neglect – learn about the significant and long-lasting effects of neglect.
  • Causes of Neglect – learn about why some children and families are more vulnerable to neglect.
  • Consideration of Neglect in Particular Groups – learn how neglect can look different for different groups, including teenagers, children with special educational needs and disabilities and affluent neglect.
  • Response – learn about the importance of chronologies, key points to remember when working with families, barriers, and challenges (including resistance) and links to threshold guidance.
  • Resources and Links – there are links to additional reading, guidance, and resources throughout the document. This section lists them all together.

Types and Indicators of Neglect   

In addition to the Working Together 2018 definition, Horwath (2007) identified six different classifications of neglect:

medical neglect

In addition, consideration should also be given to:

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Impact of Neglect 

The impact of neglect on children is significant and long-lasting. Children and young people who have experienced neglect often have poorer outcomes in terms of their health and development. The impact of neglect on children can be physical, e.g. failure to thrive, impairment of growth and development or risk of accidents due to lack of supervision. But it can also be psychological, e.g. less emotional resilience, increased attachment issues, and more vulnerable to other forms of abuse and exploitation.  It is likely to influence the relationships the child makes with others both in early life and later on as an adult and parent with the cycle of neglect continuing on the next generation of children.  In the most serious cases, neglect can lead to death.

Click here to read more and watch a video about the effects of neglect on children

Neglect and other forms of abuse: It is important to remember that neglected children can also be extremely vulnerable to other forms of abuse, including sexual abuse or exploitation.  Some abusers target children who are isolated or being neglected by their parents or carers.  If a family is going through a tough time, they might not be able to give their child enough attention or supervision, putting them in unsafe situations.  Indicators of neglect can also be indicators of other forms of abuse, and practitioners should always be open to considering this scenario. 

For more information in relation to child sexual abuse, click here

For more information in relation to child exploitation, click here.

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Causes of Neglect 

It is not easy to say what causes a person or persons to neglect someone.  In some cases parents do intentionally neglect their children, for example deliberately not feeding a child when food is available. However, in most instances neglect is caused because the parents’ own needs are significant, and they are unable to put their child’s needs first. There can be many reasons for this, and parenting capacity can be impacted on a short-term, long-term, or cyclical basis. Vulnerabilities and risk factors do not mean that parenting capacity will inevitably be reduced but they do need to be taken into account.  Families can often be experiencing number of vulnerabilities, and this is likely to increase the likelihood of a child’s needs becoming secondary to parents’ needs.

These are some of the factors that have been linked with child neglect:

  • Children living in families where there is severe poverty (including debt poverty), may have their needs neglected although many families care for their children very well despite these challenges. Poverty impacts children in many ways; this can be physical such as not having a nutritious diet or warm clothing, but also emotional because of the stress, shame and stigma attached. The stigma associated with poverty means that often families won’t ask for help or access support they are entitled to such as free school meals.  Poverty does not equate to neglect, and the majority of parents are able to meet their children's needs despite reduced financial circumstances.  Click here to read a review of recent research into the link between poverty and neglect.  It is also important to remember that children living in more affluent families can also experience neglect. Please see the separate section on Affluent Neglect for more information.
  • Children brought up in hostile, violent environments or whose needs are ignored or trivialised, tend to grow up with insecurities, low self-esteem and some will have mental health problems. Some will find company and group identity with criminal gangs, and many will be vulnerable to various forms of exploitation (being taken advantage of), including sexual exploitation.
  • Children living with domestic abuse are at risk as the child’s needs may not be prioritised and witnessing or being aware of domestic abuse has long term harmful emotional and mental health consequences.
  • Children living with parents/carers who have mental health problems, can still live happy healthy lives and may not be neglected, but some parents who are finding it difficult to manage their own mental health, can struggle to consistently prioritise the needs of their children.
  • Children living with parents/carers who have substance misuse problems may experience inadequate or inconsistent care as parental drug and alcohol use can lead parents to prioritise their own needs over their child. This can affect physical and emotional care. Drug and alcohol issues can also impact on the family’s finances, increasing vulnerability.
  • Children of all ages with disabilities are also at a higher risk of neglect especially those who have communications, sensory impairments or whose mobility is limited. Please see the section below for more information.
  • Children Looked After and those seeking asylum are also more at risk.
  • Children living with parents/carers who were abused or neglect themselves may also experience neglect. It is important to be mindful that many parents brought up in this way, will be determined to parent their children well and most of them do.

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Consideration of neglect in particular groups

Teenage/Adolescent Neglect

Adolescents living in situations of neglect may be particularly vulnerable to having their needs, and the risks they face, overlooked. NSPCC 2020

Neglect in the teenage years is no less harmful than it is to younger children, yet it is often overlooked or misunderstood by professionals. Young people from 11-17 are going through a period of rapid growth and development in their bodies and brains. They still need a lot of support and attention, although this is different in many ways to the care a younger child would need. Often, parents take a step back and provide less care to children at this age and this can make them vulnerable to harm outside of the home. Research shows a strong link between young people engaging in risk-taking activity and not having their emotional needs met at home.  NSPCC research found that 20% of young adults reported having experienced inadequate supervision as teenagers such as staying out overnight without parents knowing where they were.

Older children and young people can often meet their own basic needs so physical neglect might not be obvious. Instead, supervisory neglect and lack of boundaries are the most prevalent forms of neglect in older children. This includes a lack of online supervision which can place young people at risk. A creative and collaborative approach is needed to address adolescent neglect which should include the young person, parents and all agencies working with the family.

How can neglect impact on older children?

  • Low self-esteem, anxiety, depression
  • Difficulty solving problems
  • Easily frustrated or angry
  • Antisocial or criminal activity
  • School absences/dropping out of school
  • Poor educational attainment
  • Drug and alcohol misuse
  • Early sexual activity
  • Vulnerable to exploitation
  • Lack of attention to health and nutrition
  • Unhealthy relationships

For more information on teenage neglect, please use these links:

Children with additional health or learning needs and neglect

Compared with their peers, children and young people who are disabled or who have SEN are considerably more likely to be at risk of poorer outcomes. They are less likely to achieve well at school and are four times less likely to participate in higher education. Looked after children are three-and-a-half times more likely to have SEN compared with all children. (Department for Education 2007)

Why are children with additional needs vulnerable to neglect?

Children with additional physical or educational needs, with disabilities or long-term health conditions are particularly vulnerable to neglect. Research suggests that children with disabilities are up to four times more likely to be neglected. This is because their needs can be difficult for carers to meet and because they may be impaired in their ability to communicate and to understand what is happening to them. In some cases, the care provided to non-disabled siblings in the family may be compromised by the demands of caring for a disabled child. Children who are less able to do things for themselves rely more on adults for their care. The demands of caring for a child with complex needs can cause stress for a family. Children with disabilities may also be receiving care from a number of carers, increasing the possibility of neglect or abuse. When working with children with underlying additional needs it is, therefore, even more important to ensure their experience is captured. Any speech and language needs should be taken into account and specialist advice sought to understand the child’s needs where appropriate.

What should I look out for?

When considering whether a child is experiencing neglect, a child with additional needs or a disability may experience the same issues as other children, but they can also be at risk of other types of harm including:

  • Failure to provide medication or other prescribed treatment
  • Failure to meet the child’s communication needs
  • Not using equipment that has been provided or allowing adaptations a child may need
  • Not following a special diet or feeding advice
  • Denying the child access to play or stimulation
  • Having expectations that are too high/too low for the child

How can I work with children who have additional needs in the context of neglect?

  • Try to understand the child’s lived experience: depending on a child’s abilities and stage of development, they may not be able to verbally communicate their experience. Therefore it is important to use non-verbal communication and observation.
  • Don’t forget any other children in the family: siblings will be impacted by the needs of a disabled child in the family and may not be getting the care that they need.
  • Gain an understanding of the child’s needs and the care they should be receiving; it is important to understand whether a child with additional needs is being cared for in a way that supports their health and development. For example are they being provided with any medication or aids that they need, are they attending health appointments?
  • Don’t rely solely on information provided by parents/carers: seek advice from other professionals working with the family and use your own observations of the care provided
  • Don’t confuse indicators of neglect with symptoms of a disability; learn about the child’s needs and seek specialist advice if needed to ensure you can understand what should be expected for the child.
  • Consider whether neglect has contributed to the child’s developmental delay and/or behavioural difficulties: where there is emotional neglect and children have not received adequate stimulation, they are more likely to experience learning difficulties, emotional and behavioural difficulties, speech delay and problems with attention span.

For more information on safeguarding children with additional needs, please use these links:

Affluent Neglect 

The following information is taken from The Safeguarding Company website: Affluent neglect – A hidden form of abuse

Affluent neglect refers to the neglect and abuse children can face even when growing up with plenty of material advantage. This can be more difficult to spot, as the kind of neglect experienced by children and young people in these circumstances is often emotional.  There are a few risks that children from all walks of life face; being a child in an affluent family is often perceived to protect those children from some of these dangers. Children from wealthier, more “stable” families aren’t as sheltered from neglect as is often assumed.

Emotional Neglect: In financially comfortable families, it can be the case that parents work long hours, leaving children in the care of paid nannies or au pairs. This can create a disconnect emotionally and leave children feeling lonely, with their emotional needs unfulfilled by their parents.  Affluent parents may also put a high amount of pressure on their children to succeed at school, which can sometimes lead to psychological and emotional problems for children.

Parental Alcohol and Substance Abuse, Domestic Violence, and Parental Mental Illness: These three factors are frequently considered as problems that only occur in poorer families, when, in reality, they can be found in any type of family and have lasting effects on the children in the home.

Drug Use and Sexual Activity: It can be the case that, due to a lack of parental supervision and guidance, wealthier parents may have a more relaxed attitude to the risks their children take, or in many cases aren’t sufficiently present or available to know about what their children are doing. This often leads to increased risks for their children, who often have the financial access to facilitate drug abuse and the independence to engage in harmful sexual activity.

Why is Affluent Neglect often overlooked?

There are several barriers that may prevent more affluent children, who are experiencing these types of neglect, from accessing the support they need. Firstly, their symptoms may be harder to spot. The nature of emotional neglect can make it much harder to identify than other types of neglect. For example, due to the family having hired help to care for the children they may present as clean, well-dressed, and properly fed when they are, in reality, experiencing emotional neglect.

Staff training often focuses on children from poor or working-class families, so staff may not be adequately trained to identify and intervene with cases of neglect among their wealthier families.

Wealthy families are often not ‘on the radar’ of protective services. There may also be increased hostility towards agencies, such as social care, from more affluent families, making it more difficult to improve outcomes for children in these circumstances.

The role of unconscious bias also needs to be considered when working with children from wealthier families. Schools and school staff may miss important pieces of the puzzle when they assume that children from wealthy families are less at risk than those from poorer backgrounds. These children may be coming in with new clothes bearing expensive brand labels. It is easy to make presumptions from these indicators that a child is being well looked-after.

Children attending boarding school are even more difficult to identify as neglected. Their parents may often live out of the area or even out of the country. This adds another layer of complexity and can prove challenging, not only for identifying issues in their home life, but also for corresponding with parents to improve child outcomes.

Handling cases of affluent neglect in schools

Farrer & Co have created a helpful document to support schools in handling cases of affluent neglect in schools. You can find it here.

They suggest you create a whole school environment which is “trauma informed”.  A school environment which is trauma informed assumes that an individual is more likely than not to have a history of trauma and that, without interventions and supportive factors in place, the cycle of ACEs, trauma and adversity, is more likely to continue in future generations.

Further Reading on Affluent Neglect

Special report: Emotional neglect in children with affluent parents (willispalmer.com)

Report: Neglect in Affluent Families – Dr Claudia Bernard

Farrer & Co: Handling Cases of Affluent Neglect in Schools

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Response 

If you feel you have identified a risk, you should refer to the BWSCP Threshold Guidance to gauge the level of help required and take appropriate action.  The relevant Threshold Guidance can be found here:

Reading                                                          West Berkshire                                                   Wokingham

Use the risk and protective factors at each level of help to understand how urgent the need is.  Consider the child’s viewpoint through the My World Triangle to consider what the concerns mean for the child.  To assess neglect effectively it is important to understand the early indicators and impact of neglect. It is also important to have a good understanding of child development and what would be reasonable to expect for that child.  To learn more about using the assessment framework triangle click here.

Chronologies: To support your understanding of what life is like for the child, and to gather evidence if you feel a referral to Children’s Services is required, a chronology is imperative for a true picture of family history and should place the child at the centre.  A chronology seeks to provide a clear account of all significant events in a child’s life to date, plus any interventions and support previously provided to the family and how successful they were. This brief and summarised account of events provides the opportunity to identify and respond to patterns of concern as well as emerging need and risks and can be used to inform decisions on the most appropriate support and safeguarding services required to promote a child’s welfare. 

Chronologies are particularly important when working with neglect where there may be fewer critical incidents, but where children live in families where they are exposed to chronic and long-term harm. Chronologies can help identify these patterns of harm, and where previous support/intervention has either been successful or not. Chronologies are also particularly useful in cases of medical neglect and essential in relation to concerns around perplexing presentations/ fabricated or induced illness.

Chronologies help to make links between the past and the present, helping to understand the importance of historic information upon what is happening in a child’s life now. A good chronology can draw attention to seemingly unrelated events or information and assist the process of assessment and care planning. Chronologies do not replace routine case recording but offer a concise summary view of events and interventions in a child’s life in date order and over time. These should include changes in the family composition (new adults in the home), address and educational establishments. Any periods of school exclusion or non-attendance, any injuries, periods of hospitalisation, changes to health including weight loss/gain. Any domestic abuse or parental substance misuse, any missing episodes or attempts to self-harm as well as any discussions with other practitioners where information is shared.

When carried out consistently across agencies, good chronologies can improve the sharing, and understanding of the impact of information about a child’s life. Chronologies are also helpful in supporting reflective supervision and future decision-making for a child.  For more information and guidance on chronologies, click here.

When working with a family, remember to:

  • Focus on the child: Parents who are struggling to meet their children’s needs are likely to have many needs of their own.
  • Treat each child as an individual: In some cases, not all children in a family will be treated the same. Negative feelings may be projected onto one child but not others in the family and it is important for an assessment to capture this and address each child’s needs separately.
  • Be open with parents: It can be hard to raise concerns of neglect with parents because it means addressing issues which are personal and difficult to hear, for example, smells, dirt, or hazards in the home. It is important to ensure parents understand concerns and these are explained clearly, honestly and with sensitivity.
  • Observe: Observations can inform assessments of parent/child interaction and the relationships between parents and child, and child and other siblings. It can also help you to assess the child’s development, their behaviour and social interactions, and the environment in which they are living. This can take place in their home as well as other settings such as school or nursery.
  • Recognise the impact of trauma: The term Adverse Childhood Experiences (ACES) is often used to describe a range of stressful or traumatic experiences that children can be exposed to growing up. Neglect is one such experience and children and young people who have been neglected may exhibit trauma and stress-related behaviour and can struggle to manage their emotions. It is important that this is recognised as well as the impact of any trauma the parents may have experienced in their lives.
  • Avoid becoming desensitised to neglect: Practitioners who work regularly with families where there is neglect can become desensitised and may minimise or ‘normalise’ situations which in other contexts would be viewed as unacceptable. It is important to be aware of this, to reflect, and to remain alert to neglect. It can be helpful to discuss the family with your supervisor and with professionals from other agencies to share concerns and gain another perspective.
  • Consider the whole family: It is important to consider the family holistically because neither the children nor the adults exist in isolation. A whole family approach means working with the family to achieve shared goals as well as responding to individual needs within the family. This will usually require a coordinated multi-agency response from those working with children and adults.
  • Look out for ‘Invisible Men’: Recent research shows that fathers and other men involved in children’s lives are often ignored by professionals who can focus on the care provided by the mother. This can mean that a protective factor, for example a father who does not live in the home but is capable of caring for the children can be overlooked. It can also mean that men who may pose a risk to children are not assessed.

Make good use of supervision:

All agencies should ensure that neglect cases are regularly reviewed in supervision. Working with families where there is neglect can be overwhelming for practitioners and it is important to acknowledge this. Supervision should also ensure that the focus remains on the child, help the practitioner be more objective and give direction to avoid delay.

Barriers and challenges: 

Resistance is used to describe a range of parental behaviours which can prevent professionals from being able to assess neglect and intervene. This can be very challenging for practitioners to work with and can leave children at risk of harm. The majority of child safeguarding practice case reviews report a lack of cooperation from families or superficial engagement (disguised compliance). Parents and carers can resist professional intervention for many reasons, and it is helpful to try and understand this. For example, they may not understand the concerns, they may feel they are not to blame for the issues raised, or they may be fearful or mistrustful of authorities due to past experience. It is important to consider our own practice and whether we can do something differently to promote better engagement. 

To watch a short video about working with resistant families click here or click here to watch a longer webinar.

To read more about disguised compliance click here

To read more about common issues when assessing neglect and overcoming these click here

Escalation: Professionals in all agencies including schools have a duty to act proactively and assertively to ensure that a child’s welfare is the paramount consideration. The Local Safeguarding Partners recognise that good practice will sometimes include constructive challenge between workers.  Escalation is a positive response to an unresolved issue, and a part of day-to-day practice.  To support practitioners we have produced solution focused guidance to underpin the procedure, a presentation to explain the process, and tools.  Click here for more information.

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Resources and links 

General Information:

Neglect in particular groups:

Working with Resistance:

Berkshire West Safeguarding Children links:

Thank you to the Birmingham Safeguarding Partnership Neglect Toolkit for some of the information in this document.  Their full toolkit can be accessed here.

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