Child neglect and psychological abuse

Definition

Child neglect (also called psychological abuse) is a form of child abuse that occurs when someone intentionally does not provide a child with food, water, shelter, clothing, medical care, or other necessities.

Other forms of child neglect include:

• Allowing the child to witness violence or severe abuse between parents or adults
• Ignoring, insulting, or threatening the child with violence
• Not providing the child with a safe environment and adult emotional support
• Showing reckless disregard for the child's well being

See also:

• Child abuse - physical
• Child abuse - sexual

Causes, incidence, and risk factors

The rate at which children are physically and emotionally neglected is difficult to define.

Risk factors may include:

• Mental illness
• Poverty
• Stresses in the family
• Substance abuse by parents or caregivers

Abused children are at risk of becoming abusers themselves as adults.

Symptoms

Symptoms of psychological abuse may include:

• Difficulties in school
• Eating disorders, leading to weight loss or poor weight gain
• Emotional issues such as low self-esteem, depression, and anxiety
• Rebellious behavior
• Sleep disorders
• Vague physical complaints

See also: Failure to thrive

Signs and tests

Children with suspected emotional abuse should be examined by a trained mental health professional. All neglected or psychologically abused children should be examined for other forms of physical abuse.

Treatment

The law requires health care workers, school employees, and child care professionals to report suspected abuse.

Treatment of the abused child may include nutritional and mental health therapy.

It may be necessary to remove the child from the home to prevent further abuse.

Treatment for abusers may involve parenting classes and treatment for mental illness, alcohol, or drug abuse.

Support Groups

There are many support groups available, including:

Prevent Child Abuse America - www.preventchildabuse.org

Expectations (prognosis)

With treatment, many children and parents can be reunited as a family. The long-term outcome depends on:

• How severe the abuse was
• For how long the child was abused
• The success of therapy and parenting classes

Complications

As in all forms of child abuse, severe injury or death is possible.

Other long-term problems may include:

• Becoming an abuser in adulthood
• Depression
• Lack of self confidence
• Rebellious behavior

Calling your health care provider

Call your health care provider if a child has:

• Physical changes, such as unexplained injuries, weight loss, or severe tiredness
• Unexplained behavior changes

Suspected child abuse of any form must be reported to the authorities.

Prevention

Community programs, such as home visits by nurses and social workers, can help families change behaviors or prevent the start of abuse in high-risk families.

School-based programs to improve parenting, communication, and self-image can help prevent future abuse and may help to identify abused children.

Parenting classes are very helpful. Newlywed adults without children should be encouraged to take these classes before they have each child. The dynamics in the home change when each new child is born.

References

Johnson CF. Abuse and neglect of children. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 36.