The Case

EMS brings a 2-year-old female to the emergency department with concern for hypothermia and malnutrition (see Figure 1). During a police welfare check, the patient’s deceased mother was found surrounded by drug paraphernalia in the bedroom of a small apartment. The child was on the floor next to her mother. No other people were present. EMS noted there was no heat in the apartment and that the floor was covered with animal feces.

The child did well during her emergency department stay. A children and youth caseworker was contacted and took custody of the child because no adult relatives could be located.

Discussion

Neglect is the most common form of child abuse, accounting for 75 percent of child abuse cases in the United States in 2015. In the United States, roughly 1,700 children die from child abuse and neglect each year. Most of these fatalities are thought to occur due to neglect.¹

Definitions of neglect vary from state to state, but the common thread is failure of a caretaker to provide for a child’s basic needs, including food and water, clothing, shelter, medical care, and supervision appropriate for the child’s age, resulting in actual or potential harm.²

Neglect can be classified as follows:

• Physical neglect: Failure to provide adequate food, clothing, or shelter, and inadequate supervision
• Emotional neglect: Failure to provide love, attention, and security
• Educational neglect: Failure to enroll the child in school, and truancy without a medical cause
• Medical neglect: Failure to seek medical care or nonadherence with health care recommendations, resulting in actual or potential harm to the child
• Inadequate supervision: Failure to provide adequate supervision for the child’s level of maturity, failure to provide adequate caretakers, or failure to protect the child from safety hazards

Risk Factors

Risk factors for neglect can be divided into environmental and family factors. Examples of environmental factors include poverty and lack of social support. Family factors can include a single-parent home or a history of domestic violence.