Information has been excerpted from VisualDx clinical decision support system as a public health service. Additional information, including symptoms, diagnostic pearls, differential diagnosis, best tests, and management pearls, is available in VisualDx.


Neglect is the most prevalent form of child abuse in the United States. Neglect is defined by the intentional failure of a caregiver to provide for the basic needs of a child. This includes inattention to a child’s nutrition, clothing, shelter, medical care, safety, and education. Failure or refusal to provide these necessities endangers the child’s physical health in addition to psychological growth and development.

Among children confirmed by Child Protective Services (CPS) of being maltreated, 61% experienced neglect. Characteristics indicative of child neglect include poor hygiene, poor weight gain, inadequate medical care, and frequent absences from school. Risk factors for neglect include poverty, familial stressors, mental illness, and substance abuse by caregivers. Abused children are at risk of becoming abusers themselves as adults. Neglect can be divided into the following categories: physical, educational, emotional, and medical.

Physical Neglect
Physical neglect is the most common type of abuse and can often present with cutaneous manifestations. Lack of access to basic necessities, inadequate supervision, and poor emotional support can severely impact the child’s development. Physical neglect may result in failure to thrive, malnutrition, illness, or even physical injury including lacerations, bruises, and burns.

Educational Neglect
Educational neglect refers to the failure of a caregiver to enroll a child in school or provide the appropriate educational training. This increases the child’s risk of poor intellectual and emotional development and can lead to poor self-image and destructive behavior.

Emotional Neglect
Emotional and psychological neglect can range from withholding affection and ridiculing to even engaging in extreme spousal abuse in a child’s presence. It is often the most difficult situation to substantiate in a legal context. Symptoms in children include poor school performance, eating disorders, sleep disorders, vague physical complaints, and emotional disturbance. Specific parental behaviors considered to be emotional maltreatment include the following:

  • Ignoring
  • Rejecting
  • Verbally assaulting
  • Isolating the child from normal social contacts
  • Terrorizing with extreme forms of punishment
  • Corrupting or exploiting

Medical Neglect
Medical neglect refers to the failure to provide appropriate health care to a child, therefore placing the child at risk for death or permanent disability or disfigurement. Suspicion for medical neglect increases when a caregiver ignores medical recommendations for a child with a treatable disease or refuses medical care in an emergency. Parents may refuse certain medical care because of religious beliefs, anxiety, or financial issues. However, CPS intervenes when the child has an acute medical emergency, a life-threatening disease not being treated, or a disease that may result in chronic disability if not treated.

Child abuse is a problem of epidemic proportions affecting children of all ages and economic and cultural backgrounds. It is estimated that each year over 3 million children are victims of abuse, with close to 2,000 fatalities secondary to maltreatment. Neglect is the most common form of abuse and can have devastating consequences on a child’s development.

Look For

Evidence of neglect may be seen during the general examination of the infant or child. Physical signs include the following:

  • Marked subcutaneous wasting
  • Severe dermatitis (often diaper dermatitis)
  • Xerosis and scaling of the skin due to chronic malnutrition
  • Extensive dental caries
  • Poorly treated wounds
  • Poor hygiene, often with associated pediculosis capitis
  • Areas of alopecia that may be associated with traumatic alopecia or severe nutritional deficits
  • Multiple untreated injuries
  • Lack of vaccinations, which can lead to presentation of rare preventable infectious diseases (mumps, etc)

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