When is it Neglect?

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Courtesy of Godoy Medical Forensics

Neglect is not a straightforward issue in medicine or law. A review of the records by a forensic medical expert may be beneficial in determining if there are underlying issues that are contributing to the child’s health status. Forensic nurses are most often called in on physical neglect cases to review and determine if Failure to Thrive (FTT) or an underlying medical condition is causing the wasting syndrome which precipitated the criminal case.

Neglect is the failure of a parent, guardian, or other caregiver to provide for a child’s basic needs. This can be seen in the context of physical, medical, emotional, or educational needs. In physical neglect, the caregiver fails to provide necessary food or shelter, or fails to provide appropriate supervision.

The American Academy of Pediatrics defines Failure to Thrive as “a significantly prolonged cessation of appropriate weight gain compared with recognized norms for age and gender after having achieved a stable pattern (e.g., weight-for-age decreasing across 2 major percentile channels from a previously established growth pattern; weight-for-length <80% of ideal weight)” (Block, Krebs, Committee on Child Abuse & Neglect, & Committee on Nutrition, 2005).

In simpler terms, FTT exists when the baby loses a significant amount of weight or is significantly underweight when they had been previously growing and gaining weight appropriately. Therefore, if a child has never gained weight, they more than likely have a medical condition causing the malnourishment. However, when all medical causes of FTT have been ruled out, it is the assumption of the investigative team that the parents must somehow be neglecting the child. Mimics for FTT is then a crucial part of the investigation.

Under Eating

Under eating may be due to the inappropriate preparation of formula. Formula is expensive and financial restraints or lack of education may lead the parents to dilute the formula. Or it may be due to a medical condition that prevents the child or infant from consuming food correctly, such as in GERD (Gastroesophageal Reflux Disease).

Medical Causes (PubMed Health, 2009)

  • Cystic Fibrosis
  • Down Syndrome
  • Brain Damage
  • Heart or Lung Problems
  • Anemia, Blood Disorders
  • Gastrointestinal Problems
  • Cerebral Palsy
  • Chronic Infections
  • Metabolic Disorders
  • Complications of Pregnancy
  • Complications of Low Birth Weight

Growth Failure

Some kids just don’t grow at what is considered “normal” and there is nothing wrong with them.

 

Works Cited

Block, R. W., Krebs, N. F., Committee on Child Abuse & Neglect, & Committee on Nutrition. (2005, 11 1). Failure to Thrive as a Manifestation of Child Neglect. PEDIATRICS, 116(5).

National Institute of Health. (2006, August). Gastroesophageal Reflux in Infants. Retrieved June 9, 2011, from National Digestive Dieases Information Clearinghouse: http://digestive.niddk.nih.gov/ddiseases/pubs/gerdinfant/index.htm.

PubMed Health. (2009, 08 02). Failure to Thrive. Retrieved 06 20, 2011, from PubMed Health: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001986/.