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Acts of Omission—

An Overview of 

Child Neglect

What’s Inside:

• Scope of the problem

• What is neglect?

• Selected issues

• Characteristics of neglected children 

and their families

• Consequences of neglect

• Interventions

• Research

More children suffer from neglect in the 

United States than from physical and sexual 

abuse combined. In spite of this, neglect 

has received significantly less attention than 

physical and sexual abuse by practitioners, 

researchers, and the media. One explanation 

may be that neglect is so difficult to identify. Neglect often is an act of omission, the 

absence of an action. But neglecting children’s needs can be just as injurious as striking out at them. Understanding more about 

U.S. Department of Health and Human Services

Administration for Children and Families

Administration on Children, Youth and Families

Children’s Bureau

Child Welfare Information Gateway

Children’s Bureau/ACYF

1250 Maryland Avenue, SW

Eighth Floor

Washington, DC 20024

703.385.7565 or 800.394.3366

Email: info@childwelfare.gov

www.childwelfare.gov
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neglect—what it is, who is affected, what the 

consequences are, and what can be done 

about it—is an important step in addressing 

the problem. 

Scope of the problem

The U.S. Department of Health and Human 

Services reports that in 1999, 58.4 percent 

of all child maltreatment victims were found 

to have been neglected (U.S. Department of 

Health and Human Services, 2001). In other 

words, of the 826,000 maltreated children 

in the United States in 1999, 482,000 were 

neglected. Although the rate of neglect 

has decreased from 7.7 per 1,000 children 

in 1995 to 6.5 per 1,000 children in 1999, 

neglect remains the most common form of 

maltreatment. 

But these numbers only include the children 

who have been reported to Child Protective 

Service (CPS) agencies and whose cases were 

substantiated.1

 A study conducted in 1993 

found that almost two million children were 

endangered by neglect in the United States 

(Sedlack & Broadhurst, 1996). Clearly, the 

problem of neglect is pervasive.

1 Child Protective Services (CPS) agencies are the public 

agencies charged with responding to reports of child abuse 

and neglect. CPS agencies generally investigate these reports 

and determine that either a) abuse or neglect did occur and the 

report is “substantiated,” b) there was no basis for the report 

and it is “ruled out,” or c) there is not enough information to 

determine if abuse or neglect occurred or did not occur, and the 

report is found “unsubstantiated.” Please note that these terms 

are not universal.

What is neglect?

This is not an easy question. In general, 

neglect is an act of omission. It is the failure 

of a child’s primary caretaker to provide 

adequate food, clothing, shelter, supervision, 

and medical care. But what is adequate? And 

is it neglect if the primary caretaker is simply 

unable to provide for the child’s needs, or 

must the caretaker “willfully” deprive the 

child? And is it neglect only if the child has 

suffered harm, or if the child is potentially at 

harm? And are there other types of deprivation not mentioned above—such as a failure 

to provide for a child’s educational or emotional needs—that also should be classified as 

neglect? Both legal and research professionals 

struggle with these questions.

Legal Definitions

The Federal Child Abuse Prevention and 

Treatment Act (CAPTA) provides minimum 

standards for definitions. CAPTA states, 

“The term ‘child abuse and neglect’ 

means, at a minimum, any recent act or 

failure to act on the part of a parent or 

caretaker, which results in death, serious 

physical or emotional harm, sexual abuse 

or exploitation, or an act or failure to 

act which presents an imminent risk of 

serious harm” (42 U.S.C.A. §5106g(2) 

(West Supp. 1998).

Using this minimum standard as a foundation, each State provides its own definitions 

for child abuse and neglect. There are three 

places in State statutes in which abuse and 

neglect are defined: (1) reporting laws for child 

maltreatment, (2) criminal codes, and (3) juve-
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nile court statutes (U.S. Department of Health 

and Human Services, 2000). 

A review of State reporting laws reveals that 

neglect frequently is defined by the States as 

deprivation of adequate food, clothing, shelter, 

or medical care (U.S. Department of Health and 

Human Services, 2000). However, there is great 

variation among the States in operationalizing 

their definitions, which contributes to the lack of 

clarity on a national level. For example, approximately one-fifth of the States do not define 

neglect separately from abuse. Of those that do 

define neglect separately, some also define particular types of neglect, such as abandonment 

or medical neglect. In addition, many States 

address related issues in their statutes such as 

parental incapacity (i.e., parent is hospitalized 

or incarcerated) or injurious environments (i.e., 

child is exposed to criminal activity in the home). 

Most States also specify exemptions or issues to 

be taken into consideration, including religious 

exemptions for medical neglect and financial 

considerations for physical neglect (U.S. Department of Health and Human Services, 2000).2

Beyond State reporting laws, various State 

regulations, policies, and procedures provide 

guidance for child welfare professionals 

to determine whether or not neglect has 

occurred. Various agencies and workers 

interpret these guidelines as they make decisions about which reports to investigate, and 

which investigations will result in interventions. 

Clearly, there is no universal legal or practice 

definition of child neglect.3

2 For more information about States’ definitions of child abuse 

and neglect in their reporting laws, see State Laws on Reporting 

Child Abuse and Neglect on the Child Welfare Information 

Gateway website, at www.childwelfare.gov/laws_policies/state/

reporting.cfm or call 800.394.3366.

3 If you have a specific question about child neglect (or abuse) 

in your area, call Childhelp USA at 800.422.4453 for assistance 

and referral to your local child protective service agency.

Research Definitions

There is little agreement among researchers 

regarding a conceptual or operational definition of neglect. Researchers lament this situation 

because a lack of consensus makes it difficult 

to compare findings across studies and difficult 

to apply findings to child welfare professionals’ 

interventions (Black & Dubowitz, 1999; Zuravin, 

1991). In addition to using various definitions, 

researchers also have used a variety of methods 

to measure neglect, including observations of 

the home, specific behavioral criteria, medical 

history, self-report measures, interviews, case 

record abstractions, and CPS case findings 

(Black & Dubowitz, 1999; Zuravin, 1999). 

One important element of a child neglect definition or classification system is the identification 

of behaviors or conditions that are considered 

“neglectful.” Some behaviors seem universally 

classified as neglect by researchers. These include:

• Inadequate nutrition, clothing, or hygiene

• Inadequate medical, dental, or mental 

health care

• Unsafe environments

• Inadequate supervision, including use of 

inadequate caretakers

• Abandonment or expulsion from the home 

(Barnett, Manly & Cicchetti, 1993; Sedlack 

& Broadhurst, 1996).

However, many behaviors may be categorized 

differently by different classification systems. 

The table on the following page illustrates this 

using examples from two widely known classification systems: the Third National Incidence 

Study of Child Abuse and Neglect (NIS-3) 

(Sedlack & Broadhurst, 1996) and the Maltreatment Classification System (MCS) developed 

by Barnett, Manly and Cicchetti (1993).
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In addition to identifying behaviors that are 

considered neglectful, there are other considerations regarding a definition of neglect. 

These include:

• Should there be evidence of harm, or does 

neglect include endangerment of a child’s 

health or welfare?

• Should the caretaker’s intent to harm be a 

consideration?

Many researchers, including Zuravin (1991), 

propose that endangering a child’s health or 

welfare should be included in any definition of 

neglect, and that a caretaker’s intent to harm 

or culpability should not be a consideration. 

These differences highlight the challenges 

posed in comparing findings across studies 

that have used varying definitions of neglect. 

For example, when examining the rates of 

child neglect over time, a change in the 

numbers may not solely represent an actual 

increase or decrease in the number of children 

affected, but may partially be accounted for 

by a change in the definition. 

Recognizing these difficulties, Federal agencies have been leading efforts to develop 

clear research definitions and a measurement 

tool to collect data on child maltreatment.

Throughout the 1990s, Congress mandated 

a number of Federal agencies to increase 

their focus on the problem of child abuse and 

neglect. The National Institutes of Health (NIH) 

created the Federal Child Abuse and Neglect 

Working Group (co-chaired by the National 

Institute on Mental Health and the National 

Institute for Child Health and Human Development [NICHD]).4

 The Working Group began 

work in 1998 to develop clear classification 

systems and operational definitions for all 

types of child maltreatment, including child 

neglect, that can be used by researchers and 

also overlap with existing legal and clinical 

4 For information on the Federal Child Abuse and Neglect 

Working Group, contact the chairperson, Cheryl Boyce, 

Ph.D., at NICHD, by email at cboyce@nih.gov or by phone at 

301.443.5944, or the co-chairperson, Margaret Feerick, Ph. D., 

at NICHD, by email at margaret_feerick@nih.gov or by phone at 

301.435.6882.

Behavior

Sedlack & Broadhurst, 1996

NIS-3

Classification

Barnett, Manly & Cicchetti, 

1993 MCS 

Classification

Inadequate education Educational Neglect Moral-Legal/Educational 

Maltreatment

Exposure to domestic violence Emotional Neglect Emotional Maltreatment

Exposure to drugs in utero Other Maltreatment Physical Neglect—Failure to Provide

Exposure to or allowing child to 

engage in illegal activities

Emotional Neglect Moral-Legal/Educational 

Maltreatment

Shelter-related neglect such as 

homelessness or inadequate 

sanitation or utilities in the child’s 

home

Not addressed Physical Neglect—Failure to Provide

Inadequate nurturance/affection Emotional Neglect Emotional Maltreatment
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definitions. The Working Group is continuing to 

pursue this effort.5

In 1994, the Federal Interagency Task Force 

on Child Abuse and Neglect6

 challenged its 

Research Committee to address definitional 

issues confronting the child abuse and neglect 

research community nationally. The committee 

had representatives from several DHHS agencies (e.g., NIH, Centers for Disease Control, 

Substance Abuse and Mental Health Services Administration) and from other departments (e.g., Defense, Education, Interior, and 

Justice). The efforts of this group focused on 

developing a data collection system that could 

be used by researchers to define and identify 

all types of child abuse and neglect. By 1999, 

these efforts resulted in an instrument entitled 

the Child Maltreatment Log.7

 This instrument 

is being field tested in two 17-month pilot 

projects that were initiated in September 

2000. Once the results of the pilots are analyzed, the instrument will be revised and disseminated for use by the research community.

The goals of these projects are to offer 

researchers a common definition and measurement tool so that the findings of various studies 

5 For additional information about the Classification Project, 

contact the project chairperson, Margaret Feerick, Ph.D., at 

NICHD, by email at margaret_feerick@nih.gov or by phone at 

301.435.6882.

6 The Interagency Task Force on Child Abuse and Neglect was 

established by the Child Abuse Prevention and Treatment Act 

prior to its re-authorization in 1996. The Task Force is convened 

by the Office on Child Abuse and Neglect of the Children’s 

Bureau within the U.S. Department of Health and Human 

Services. For additional information, contact Catherine Nolan, 

MSW, Director, Office on Child Abuse and Neglect, by email at 

cnolan@acf.dhhs.gov.

7 The Research Committee acknowledges contributions 

from a wide range of individuals and agencies for work on the 

“Definitions Project.” More information on the project may be 

obtained from the project leader, Kathleen Sternberg, Ph.D., at 

NICHD, by email at kathleen_sternberg@nih.gov or by phone at 

301.496.0420.

can be compared and the studies can be replicated, both of which contribute to a stronger 

knowledge base. In the field of child neglect, 

many researchers and policy makers consider 

this to be an important step in building our 

knowledge about the problem, the factors 

associated with it, and how to address it.

Spotlight on Chronic Neglect

One issue in defining child neglect involves 

consideration of “incidents” of neglect versus 

a pattern of behavior that indicates neglect. 

Zuravin (1991) recommends that some behaviors should present a “chronic pattern” to 

be considered neglectful. Examples include 

lack of supervision, inadequate hygiene, and 

failure to meet a child’s educational needs. 

This suggests that rather than focusing on 

individual incidents that may or may not be 

classified as “neglectful,” one should look 

at an accumulation of incidents that may 

together constitute neglect. “If CPS focuses 

only on the immediate allegation before 

them and not the pattern reflected in multiple 

referrals, then many neglected children will 

continue to be inappropriately excluded from 

the CPS system” (English, 1999). For example, 

a family exhibiting a pattern of behavior that 

may constitute neglect might include frequent 

reports of not having enough food in the 

home or keeping older children home from 

school to watch younger children. In most 

CPS systems, however, the criteria for identifying neglect focuses on recent, discrete, 

verifiable incidents. 

In recognition of this issue, the Missouri Division of Family Services (n.d.) has assigned one 

of its CPS staff as a “Chronic Neglect Specialist.” This office defines chronic neglect as “... 

a persistent pattern of family functioning in 

which the caregiver has not sustained and/or 
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met the basic needs of the children which 

results in harm to the child” (p. 3). The focus 

here is what Dr. Patricia Schene calls “accumulation of harm.” She states that instead of 

focusing on individual incidents as they occur, 

one should look at an accumulation of experience, or the cumulative effect on children of 

repeated incidents, when determining whether 

neglect exists. A study conducted by Egeland 

(1988) found that many children who had been 

referred to CPS for neglect did not receive 

services because their cases did not meet the 

criteria for “incidents” of neglect. However, 

he found that all of these children had, in fact, 

suffered severe developmental consequences.

Selected Issues

Poverty and Child Neglect 

Numerous studies have linked poverty to an 

increased risk of child neglect (Nelson, Saunders & Landsman, 1993). A number of factors 

may explain the association. Before reviewing 

these factors, though, it is important to note 

that most poor families do not neglect their 

children (Dubowitz, 1996).

Dubowitz (1999) cites numerous studies that 

identify many of the stressors associated with 

poverty. These include unemployment (citing 

American Humane Association, 1988), single 

parenthood (citing Nelson, et al., 1994), 

housing instability or frequent moves (citing 

Gaudin, Polansky, Kilpatrick & Shiltron, 1993), 

depleted or high risk communities (citing 

Zuravin, 1989), household crowding (citing 

Zuravin, 1986), limited access to health care, 

and exposure to environmental hazards such 

as lead paint or dangerous neighborhoods. 

Pelton (1994) states that “[f]or people living 

in poverty, the probability of child abuse and 

neglect is largely dependent on the extent 

of one’s ability to cope with poverty and its 

stressors” (p. 153).

Pelton offers an additional perspective on the 

link between poverty and neglect. He states 

that impoverished families often live, though 

not by choice, in neighborhoods with high 

crime rates and in homes that present environmental hazards such as exposed wiring, lead 

paint, or insecure windows. “[I]n the presence 

of these conditions, impoverished parents 

have little leeway for lapses in responsibility, 

whereas in middle-class families, there is some 

leeway for irresponsibility, a luxury that poverty 

does not afford” (p. 155).

Approximately one-third of the States provide 

room in their definitions of neglect for consideration of a family’s financial means (U.S. 

Department of Health and Human Services, 

2000). These caveats usually address the family’s access and response to available services 

that may help to alleviate the neglectful conditions. For example, if a family living in poverty 

was not providing adequate food for their children, it may only be considered neglect if the 

parents were made aware of food assistance 

programs but did not use them.

Substance Abuse and Child Neglect

Some CPS agencies estimate that substance 

abuse is a factor in as many as 70 percent of 

all the child neglect cases they serve (Gaudin, 

1993). But what is the connection between 

substance abuse and neglect, specifically?

A number of researchers have explored the 

relationship between parental substance 

abuse and child neglect. They have found that 

substance abusing parents may divert money 

that is needed for basic necessities to buy 
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drugs and alcohol (Munkel, 1996). Parental 

substance abuse may interfere with the ability 

to maintain employment, further limiting the 

family’s resources (Magura & Laudet, 1996). 

The substance abusing behaviors may expose 

the children to criminal behaviors and dangerous people (Munkel, 1996). Substance abusing 

parents may be emotionally or physically 

unavailable and not able to properly supervise their children, risking accidental injuries 

(Wallace, 1996). Children living with substance 

abusing parents are more likely to become 

intoxicated themselves, either deliberately, by 

passive inhalation, or by accidental ingestion 

(Munkel, 1996; Wallace, 1996). Heavy parental 

drug use can interfere with a parent’s ability to 

provide the consistent nurturing and caregiving that promotes children’s development and 

self-esteem (Zuckerman, 1994). According to 

Magura and Laudet, “Substance abuse has 

deleterious effects on virtually every aspect of 

one’s life and gravely interferes with the ability 

to parent adequately” (p. 198).

Drug-Affected Newborns. The issue of drugaffected newborns has long been a concern 

in the United States. The most recent statistics 

indicate that in 1999, 5.5 percent of pregnant 

women used some illicit drug during pregnancy, translating into approximately 221,000 

babies that had the potential to be born drug 

exposed (National Institute of Drug Abuse, 

1999). Although some studies have found few 

enduring effects from prenatal drug exposure, 

others have found that it may result in physical 

and neurological deficits, growth retardation, 

cardiovascular abnormalities, and long-term 

developmental abnormalities (SagatunEdwards & Saylor, 2000), including learning 

and behavior problems (Zuckerman, 1994) and 

language delays (Harrington, Dubowitz, Black 

& Binder, 1995).

While no State mandates drug testing of all 

new mothers, many hospitals test babies when 

maternal drug use is suspected (SagatunEdwards & Saylor, 2000). What to do about 

the problem is complicated by legal and 

ethical considerations including concerns 

about a woman’s rights regarding her own 

body and concerns about laws applying to 

children and not fetuses (Dubowitz & Black, 

1996). However, Wallace (1996) cites the Michigan Court of Appeals as stating that “... a 

newborn suffering narcotics withdrawal symptoms as a consequence of prenatal maternal 

drug addiction may properly be considered a 

neglected child within the jurisdiction of the 

... court” (p. 92). Sagatun-Edwards and Saylor 

found that States often are responding to the 

problem either by authorizing juvenile court 

intervention to protect the child or by criminalizing the behavior and demanding punishment 

and drug treatment for the mother. In fact, at 

least five States now include drug-affected 

newborns in their State statutes under the 

definition of neglect (U.S. Department of 

Health and Human Services, 2000) and the 

NIS-3 includes drug-affected newborns in 

its research definition of neglect (Sedlack & 

Broadhurst, 1996).

Another implication for the child welfare field 

is that drug-exposed newborns are often left 

in the hospital by their parents; these babies 

often are referred to as “boarder babies.” 

The most recent statistics come from a study 

conducted by the Child Welfare League of 

America in 1992. This study found that as 

many as 85 percent of boarder babies had 

been exposed to drugs in utero (Magura 

& Laudet, 1996). Boarder babies often are 

referred to CPS agencies as abandoned children and placed into foster care. 
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Domestic Violence and Child Neglect

There has lately been increasing attention paid 

to the relationship between domestic violence 

and child maltreatment. Shepard and Raschick 

(1999) found that in 35 percent of a sample 

of child neglect cases, domestic violence 

had occurred in the home. Some States now 

include exposure to “injurious environments,” 

including domestic violence, in their State 

statute definitions of neglect (U.S. Department of Health and Human Services, 2000). 

However, there is still much controversy over 

whether exposure to domestic violence is itself 

a form of child neglect. 

The term “failure to protect” often is used in 

these cases, although it is not found in the 

child maltreatment statutes directly, but rather 

in legal and child welfare literature (Magen, 

1999). The term often is used in reference to 

an abused mother’s inability to protect her 

child from exposure to violence in the home. 

Many researchers and practitioners, however, 

believe the responsibility should be on the 

abuser, not on the victim of domestic abuse 

(Magen, 1999; Shepard & Raschick, 1999). In 

fact, Magen states that leaving the abusive 

situation is not always the safest option for 

an abused mother and her children, because 

the abuser may lash out at this time. Shepard 

& Raschick conclude that “[t]oo often there 

are no easy answers for how to best ensure 

the safety of children when their mothers are 

victims of domestic violence” (p. 154).

There are two reports that provide the most 

comprehensive data on the characteristics of 

neglected children and their families. The first 

is the National Incidence Study—3 (NIS-3) 

(Sedlack & Broadhurst, 1996), which sampled 

35 CPS agencies around the country and 

looked at both children served by CPS as well 

as children identified by community professionals as being in danger of harm due to 

abuse or neglect. The second report is Child 

Maltreatment 1999 (U.S. Department of Health 

and Human Services, 2001), which is based on 

the National Child Abuse and Neglect Data 

System (NCANDS). NCANDS collects data 

from all CPS agencies in the United States 

regarding their services. 

According to these two reports, boys and 

girls are neglected at approximately the same 

rates. Findings regarding the children’s age, 

however, differed between the two studies. 

The NIS-3 reports that children ages 6 and 

older suffer from neglect at higher rates than 

children 5 and under. Child Maltreatment 1999

reports that the rates of neglect are highest 

for children ages 0-3 and decrease as children 

get older.

The NIS-3 reports that the lowest income 

families (earning less than $15,000 per year) 

have the highest rates of neglect. NIS-3 

estimates that 27 out of every 1,000 children 

are neglected in these families while the 

neglect rate for children living in families that 

earn more than $30,000 per year is less than 

1 in 1,000 children. The NIS-3 also reports 
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that neglect occurs more often in single 

parent families and in families with four or 

more children. 

Schumacher, Slep & Heyman (in press) 

reviewed 10 studies completed between 1974 

and 1998 in which risk factors for neglect were 

identified. Some of the strongest associations 

were found between neglect and:

• Poverty 

• Parental substance abuse

• Parental impulsivity 

• Parental low self-esteem 

• A lack of social support for the family.

Some practitioners believe that untreated 

depression also is common among neglecting mothers, but there has been little research 

to substantiate this. Brown, Cohen, Johnson 

and Salzinger (1998) identified 21 risk factors 

associated with neglect and found that as the 

number of risk factors increases, the risk for 

neglect increases. 

It is important to point out, though, that the 

profile and risk factors for neglected children 

and their families are likely to vary significantly 

across types of neglect (Schumacher, Slep & 

Heyman, in press). For example, the characteristics and risk factors for a family in which 

a baby has been abandoned are likely to be 

very different than those for a family who 

refuses medical care for their teenager. More 

targeted research is needed to more fully 

understand the risk factors for various types 

of neglect in order to inform prevention and 

treatment programs. 

Consequences of 

Neglect

“Neglect is a complex, multifaceted problem 

that can have profound effects on children” 

(Black & Dubowitz, 1999, p. 274). Research has 

shown that neglected children are at risk for a 

number of behavioral, social, academic, and 

medical problems. Citing numerous studies, 

Dubowitz (1996, 1999) states that some of the 

consequences include problems with attachment, low self-esteem, increased dependency, 

and anger (citing Egeland, Srouf & Erickson, 

1993), impaired cognitive development and 

academic achievement (citing Eckenrode, 

Laird & Doris, 1993), and a risk for delinquent 

behavior (citing Maxfield & Widom, 1996). 

Egeland (1988) did a study showing that, 

as children get older, the effects of neglect 

become more severe. He refers to this as the 

“cumulative malignant effects” of neglect 

(p. 18).

Medical problems may be a result of malnutrition, which can result in deformities and lifelong poor health (Munkel, 1996). Non-organic 

Failure To Thrive (NFTT) is a condition found 

in infants in which their height and weight are 

below the fifth percentile, when once they 

were within a normal range (Wallace, 1996). 

The diagnosis of NFTT indicates that there is 

no medical, or organic, reason for the infant’s 

condition, and it is therefore attributable to 

an inability of the parents to physically care 

for the child. NFTT can result in continued 

growth problems, school failure, and possible retardation (Wallace, 1996). Munkel 

adds that extreme neglect can result in death. 

“Neglected children suffer hurts in their 
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bodies, their minds, their emotions, and their 

spirits” (Munkel, 1996 p. 115).

Resilience. While the potential for severe 

negative consequences from childhood 

neglect exists, there has been some research 

into the effects of “protective factors” that 

promote resilience among neglected children. 

In general, this research has looked at factors 

that can mediate the effects of neglect, so the 

child is able to maintain healthy functioning in 

spite of the adversities (Prilleltensky & Pierson, 

1999). Protective factors can include individual 

characteristics such as intelligence, creativity, 

initiative, humor, and independence (Melina, 

1999, citing Wolin & Wolin’s book The Resilient Self), or external factors such as access to 

good health care and a family’s social support 

system, including alternative caregivers (Silver, 

1999). The probability of “resilience” as an 

outcome increases when the number or significance of protective factors is sufficient to 

counteract the vulnerabilities or risk factors 

(Prilleltensky & Pierson, 1999). In other words, 

if a child suffers from neglect (e.g., his parents 

did not feed or clothe him adequately), he 

may not suffer long-term severe consequences 

if he also has some protective factors such as a 

spirit of independence, creativity, or access to 

other caregivers. 

Fatal Neglect

Certainly the most severe, irrecoverable 

consequence of neglect is death. In 1996, a 

review of the States’ child maltreatment fatalities revealed that 45 percent of the deaths 

were attributed to neglect and an additional 3 

percent to neglect and abuse (Wang & Daro, 

1997). Although not all States reported the 

data, it is estimated that these percentages 

translate into approximately 502 child deaths 

associated with neglect in 1996. Another study 

conducted in Iowa (which only had a sample 

size of 34) found that two-thirds of the children 

who died from neglect were under the age of 

2, more than two-thirds were male, and families had an average of 3.3 children (Margolin, 

1990). This study also found that the large 

majority of children who died due to neglect 

died as a result of a single life-threatening incident rather than from chronic neglect. These 

fatalities included drowning and scalding in 

bathtubs, fires, unsafe cribs, gun accidents, 

choking, and drug/alcohol overdoses. “In the 

vast majority of fatalities from neglect, a caregiver was simply not there when needed at a 

critical moment” (Margolin, 1990, p. 314).

Interventions

“Neglect” is a complicated issue that poses 

significant challenges to treatment providers. 

Reviews of intervention programs designed to 

treat neglecting families have indicated that 

these programs have had difficulty achieving 

desirable outcomes (Gaudin, 1993). The interventions that did have some success addressed 

problems individually, were long-term, and 

delivered a broad range of services (Ethier, et 

al., 2000; Gaudin, 1993). The severity of the 

families’ problems was the most powerful predictor of outcome; the more severe the problems, the less likely the families were to achieve 

the targeted outcomes (Gaudin, 1993).

These issues are discussed in Child Neglect: 

A Guide for Intervention8

 (Gaudin, 1993). 

8 Child Neglect: A Guide for Intervention is one of a series 

of User Manuals published by the Children’s Bureau of the 

Department of Health and Human Services to provide guidance 

to professionals in the child welfare field. For a list of all available 

manuals, go to www.childwelfare.gov/pubs/usermanual.cfm or 

call Child Welfare Information Gateway at 800.394.3366. The 

series currently is being revised and updated.
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Information Gateway. Available online at www.childwelfare.gov/pubs/focus/acts/index.cfm.

Gaudin states that assessments should look 

at the individual personality of parents, family 

systems issues, and community stressors and 

resources. Interventions then should be tailored to the type of neglect and to information 

gleaned from the assessment. His recommendations for practitioners include:

• Assume that parents want to improve the 

quality of care for their children.

• Identify and reinforce hidden strengths and 

build interventions upon them.

• Be culturally sensitive. Tatara (1995) emphasizes that cultural misperceptions can lead 

either to overinclusion (identifying a behavior as risky when in fact the risk is low) or 

underinclusion (ignoring a situation when 

intervention is really needed).

• Do not generalize families; each family is 

unique.

• Build parental feelings of self-esteem, 

hope, and self-sufficiency; do not foster 

dysfunctional dependency.

• Clearly outline service plans and use case 

management to broker formal and informal 

services.

• Set clearly stated, limited, achievable goals 

that are agreed upon by parents and children; systematically reinforce the parents’ 

incremental steps.

• Use legal authority as a last resort.

Recent research also suggests that programs 

should actively seek out fathers or father 

figures and engage them in the interventions 

(Dubowitz, Black, Kerr, Starr & Harrington, 

2000).

Gaudin (1993) also discusses aspects of 

various interventions. Interventions generally include some level of home visitation; in 

some cases, daily contact may be needed 

to monitor a child’s safety, preserve a family 

and prevent removal of a child into foster 

care. Interventions can range from short-term 

crisis intervention to long-term support and 

stabilization to removal of children from their 

families for their protection. Family-focused 

interventions include all family members, 

not just the alleged child victim and parent 

perpetrator. 

Interventions are not limited to families and 

children; they can target societal conditions as 

well, such as unemployment, lack of medical 

care, and poor housing. Some researchers feel 

that improvements in these societal conditions may well result in a lower rate of neglect. 

Waldfogel (2000, September) (citing Paxson 

and Waldfogel, 1999) suggests that higher 

welfare benefits may be correlated with fewer 

families being reported for neglect and fewer 

children being placed in foster care. 

Child protective services (Cps)

Within the child welfare system, CPS offices 

usually are the first to respond to reports of 

child neglect.9

 In general, the system works 

in the following manner. A report is received 

about suspected child neglect. If the information meets the threshold for what constitutes 

neglect in that particular jurisdiction, the 

report is referred for an investigation. CPS 

staff have legal authority to investigate the 

allegation. The investigator speaks with relevant parties in order to determine whether 

or not the child has, in fact, been neglected, 

and whether or not the child is still at risk of 

harm. If neglect is found and the child is still 

9 CPS offices in the United States vary greatly from jurisdiction 

to jurisdiction. The information in this section provides a general 

overview of how CPS systems respond to child neglect.
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at risk, the child and family may be referred 

for services. In severe or high-risk cases, the 

court may order that the child be removed 

from his or her caretaker and placed with a 

relative or foster family while services are provided. Whether or not the child is removed, 

associated services (such as parenting skills 

classes for the parent and counseling for the 

child) may be provided by programs within 

the child welfare agency or by communitybased agencies. In general, if the child has 

been removed, he or she will not be returned 

to the family unless and until the court determines that the family can provide a safe and 

stable environment. If the child has remained 

at home during the provision of services, the 

family’s participation may be voluntary, and 

many factors may play a role in the length of 

service and the decision to terminate services. 

These factors include the family’s wishes, the 

programs’ guidelines, and the availability of 

insurance or payment for the services.

CPS—Problems and Reform Efforts. While 

the CPS system provides critical first-response 

services to children reported for neglect, some 

researchers and practitioners believe that in its 

current state, the response is not adequate for 

many families reported for neglect. Reports of 

child neglect (compared to physical or sexual 

abuse) are least likely to meet the threshold 

for investigation or intervention, resulting in 

many neglected children not being eligible for 

any CPS services (English, 1999). In addition, 

a sole reliance on an authoritative, investigative response is not necessarily appropriate 

for many families (English, Wingard, Marshall, 

Orme, & Orme, 2000), but in most jurisdictions, this is the only means of entry to the 

child welfare system. 

To address these and other problems, some 

CPS systems have implemented a “multitrack” response system in which reports of 

child maltreatment determined to be lowrisk (which includes many neglect reports) 

are referred for an “assessment” rather than 

an investigation. This response is generally 

voluntary and, compared to an investigative 

response, uses a more holistic approach and is 

more likely to use community-based agencies 

to provide services. 

It remains to be seen whether or not multitrack response systems are effective. Important issues still to be addressed are 

• What criteria are used to differentiate highrisk reports that are referred for investigation versus low-risk reports that are referred 

for assessment (English, 1999)?

• Do families referred for voluntary assessments follow through with recommendations for services (English, et al., 2000)? 

• Does this alternative response adequately 

address the safety needs of the children 

involved (English, 1999)?

While these answers are still unclear, it is 

encouraging that some CPS systems are 

exploring alternative responses to better serve 

families in need. 

Promising Practices

As mentioned earlier, intervention programs 

serving neglecting families face numerous 

challenges. But there are programs that show 

promise in addressing and treating child 

neglect. The following sections describe two 

such projects.

The Chronic Neglect Project St. Louis, Missouri, Division of Family Services (DFS). Recognizing the challenges in effectively serving 

chronically neglecting families, the St. Louis, 
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Missouri, DFS established a Chronic Neglect 

Program in 1997 in which staff receive training 

to recognize and treat chronic neglect.10 This 

program examines patterns of behavior, rather 

than individual incidents, when determining whether or not to intervene to protect a 

child. A Child Neglect Specialist is available to 

provide consultation to the staff. 

The program emphasizes the empowerment 

of the family so the family takes ownership of 

their needs and solutions. Some of the outcomes the program strives to achieve include:

• Significant improvement in parental 

behavior

• Clear indication of bonding between the 

parent and child

• A home free of safety hazards

• For children who experienced medical 

problems as a result of the neglect, documented improvement in their physical 

development.

The program also emphasizes lasting change; 

its guidelines state that improvements must 

have been maintained for at least six months 

before closing a case to minimize the chance 

for a re-occurrence (Missouri Division of Family 

Services, n.d.).

Family Connections Program, University of 

Maryland at Baltimore. Family Connections 

is one of a number of Child Neglect Demonstration Programs funded in 1996 by a 5-year 

grant from the Children’s Bureau of the U.S. 

Department of Health and Human Services. 

This program combines services with educa10 For more information, contact Cathie Braasch, Chronic 

Neglect Specialist, Missouri Division of Family Services at 

314.481.2323, ext. 227.

tion and research.11 Some of the principles of 

Family Connections include providing individual assessments and services tailored to the 

needs of each family, developing partnerships 

with all family members, empowering family 

members to have control over their own lives, 

and delivering culturally competent interventions geared to achieve targeted outcomes. 

Some of the targeted outcomes include

• The family’s ability to meet basic needs

• The parents’ abilities to cope with daily 

stresses and achieve self-sufficiency

• The children’s demonstration of developmentally appropriate functioning

• The family’s ability to mobilize resources 

and constructively resolve family conflicts

• The family’s effective use of social supports

• The parents’ (and/or caregivers’) demonstration of appropriate attitudes and skills 

related to the children’s needs.

Research

As many have noted, in spite of the fact that 

child neglect is more prevalent than other 

types of child maltreatment, historically it has 

not received much research attention. For 

example, Zuravin (1999) searched 489 articles 

published in the International Journal of Child 

Abuse and Neglect between 1992 and 1996; 

only 25 articles reported empirical findings 

on neglect only or separately from findings 

on other types of maltreatment. Clearly, more 

research is needed to more fully understand 

the problem of child neglect.

11 For more information, visit the Family Connections website at 

http://family.umaryland.edu/ 
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Current Research

Although neglect historically has been studied 

less than other types of maltreatment, it 

now seems to be gaining recognition. The 

Children’s Bureau of the U.S. Department of 

Health and Human Services reports that of 159 

studies examining maltreatment underway in 

1998, 93 were studying neglect, alone or in 

combination with other types of maltreatment, 

and 74 were differentiating the types of maltreatment so that findings may be understood 

more clearly (U.S. Department of Health and 

Human Services, n.d.).

One ongoing effort to focus research on child 

neglect is a project entitled “A Longitudinal 

Study of Child Neglect” (Dubowitz, 1996). 

This study is part of the Consortium of Longitudinal Studies in Child Abuse and Neglect 

(LONGSCAN), which first received funding 

in 1991 from the Department of Health and 

Human Services. LONGSCAN is a set of five 

coordinated research projects designed to 

examine the antecedents and consequences 

of child maltreatment. Dubowitz’s study on 

child neglect recently received five additional 

years of funding from DHHS to continue. The 

objectives of this study include examining 

the relationship between various factors and 

child neglect, exploring fathers’ involvement 

in child neglect and child development, and 

examining the consequences of child neglect 

(Dubowitz, 1996).

A recently launched research effort on child 

neglect is being sponsored by a consortium of 

Federal agencies led by the National Institutes 

of Health.12 Fifteen awards were granted in 

October 2000 in response to a Request for 

12 To read the background on this project and the abstracts of 

the 15 awards, visit the website at http://obssr.od.nih.gov/RFA_

Pas/Child_neglect_RFA.htm.

Applications for Research on Child Neglect. 

The projects funded are examining various 

aspects of neglect using various research 

models. Some projects are examining subtypes of neglect, consequences of neglect, 

factors contributing to neglect, and service 

usage by neglecting families. Some are 

looking at economic, medical, psychological 

and behavioral issues. Some are focusing on 

infants and young children; others are focusing on adolescents. Some are short-term and 

some are longitudinal. This project promises 

to bring a wealth and breadth of new information to the field of child neglect. 

Recommendations for 

Future Research

There are numerous recommendations for 

future research into child neglect. Continued 

research is needed regarding an accepted 

definition of neglect, including sub-types of 

neglect (Black & Dubowitz, 1999; Zuravin, 

1999). More research is needed to develop 

and refine strategies to measure neglect (Black 

& Dubowitz, 1999; Portwood, 1999). More 

research is needed to understand the consequences of neglect for children (Dubowitz, 

1996) and factors that might protect children from the harsh consequences (Black & 

Dubowitz, 1999). Further studies are needed 

to examine the association between poverty 

and neglect (Theodore & Runyan, 1999), 

including an exploration of how impoverished 

parents protect their children from the effects 

of poverty and avoid neglect (Black & Dubowitz, 1999; Pelton, 1994). Finally, more research 

is needed to investigate the effectiveness of 

various interventions (Portwood, 1999; Theodore & Runyan, 1999). 
Acts of Omission—An Overview of Child Neglect www.childwelfare.gov

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Summary and Conclusion

Although child neglect has historically 

received less attention than other types of 

maltreatment, in spite of being the most prevalent type, much has been learned about it 

in recent years. Despite this growing interest, 

neglect continues to be a complex problem 

that is difficult to define, identify, and treat.

Neglect is a term used to encompass many 

situations, their commonality often being a 

lack of action—an act of omission—regarding a child’s needs. Most commonly, neglect 

is related to a failure to meet a child’s physical needs (including food, clothing, shelter, 

supervision, and medical needs), but neglect 

also can refer to a failure to meet a child’s 

educational and emotional needs. Neglect 

can range from a caregiver’s momentary inattention to willful deprivation. Single incidents 

can have no harmful effects or, in some cases, 

they can result in death. Chronic patterns of 

neglect may result in severe developmental 

delays or severe emotional disabilities. 

Understanding neglect requires an awareness 

of related social problems such as poverty, 

substance abuse, and domestic violence. 

Interventions to treat children and families 

affected by neglect require thorough assessments and customized treatment. Defining, 

identifying, and treating neglect is a significant 

challenge, but one that researchers, professionals, communities, and families must face 

together if they are to protect children from 

the harmful consequences of child neglect.

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