Neglect: Physical, Supervisory, Medical, and Growth Faltering
Definitions and scope
Neglect is the failure to meet a child's basic needs: food, shelter, clothing, hygiene, supervision, medical and dental care, education, and emotional responsiveness. It is the most common and most lethal form of maltreatment, and it is chronic rather than a single event. Distinguish neglect from poverty: a family lacking resources needs support, not necessarily a maltreatment finding, though both may coexist.
Growth faltering
Plot length, weight, weight-for-length, and head circumference on validated charts and calculate z-scores. A single point cannot diagnose growth faltering; serial measurements and growth trajectory matter. Consider organic causes (celiac disease, cystic fibrosis, congenital heart disease, endocrine disorders, prematurity) and psychosocial causes. 'Failure to thrive' is an outdated term; use 'growth faltering' or 'poor growth'.
Medical and supervisory neglect
Medical neglect includes delayed care, missed appointments with harmful consequences, refusal of life-saving treatment, and untreated dental caries. Vaccine refusal alone is rarely medical neglect. Supervisory neglect depends on the child's developmental stage, the duration of absence, and the environment's hazards. Leaving a 6-year-old alone for an hour differs from leaving a toddler near a pool.
Traps and rule of thumb
Traps: attributing poor growth solely to parenting when organic disease is present; labeling cultural practices as neglect; overdiagnosing neglect in families with food insecurity; and missing co-occurring physical abuse or FDIA. Document using growth charts, home observations, and multidisciplinary assessment.
Rule of thumb: no single data point diagnoses growth faltering - use at least two measurements and the trajectory.