Neglect

Neglect is the failure of a parent, guardian, or other caregiver to provide for a child’s basic needs. According to the American Society for the Positive Care of Children (SPCC) website, 470,297 children are victims of neglect in the U.S. ( https://americanspcc.org/child-maltreatment-statistics ).

Of the 3,534,000 million children who were the subject of an investigation or alternative response in fiscal year 2018, in total, 60.8 percent of victims were neglected. https://www.acf.hhs.gov/media/press/2020/2020/child-abuse-neglect-data-released

Neglect may be:

• Physical (e.g., failure to provide necessary food or shelter, or lack of appropriate supervision)
• Medical (e.g., failure to provide necessary medical or mental health treatment)
• Educational (e.g., failure to educate a child or attend to special education needs)
• Emotional (e.g., inattention to a child’s emotional needs, failure to provide psychological care, or permitting the child to use alcohol or other drugs)
• Abandonment is now defined in many States as a form of neglect (Horner, 2014).

New York’s definition of child neglect

Neglect is defined as the failure of a parent or caretaker to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child’s health, safety, and well-being are threatened with harm. Some examples include:

• Failure to support a child’s educational needs either by keeping a child home from school for unexcused reasons or not following up with a child’s educational needs despite the school’s outreach to the parent or caretaker.
• Failure to provide adequate food, clothing, or shelter.
• Failure to provide medical or mental health care (including drug abuse services).
• Leaving a child alone who is not developmentally able to be left alone without adequate supervision.
• Leaving a child with someone without establishing a plan for the provision for food, clothing, education, or medical care.
• Leaving a child with someone that does not have the ability to appropriately supervise or protect the child.
• Subjecting a child to humiliation, fear, verbal terror, or extreme criticism.
• Using corporal punishment beyond what is objectionably reasonable and it results in the physical or emotional harm of a child.
• Exposing a child to family violence.
• Parent or caretaker using drugs to the point of not being able to adequately take care of a child.
• Keeping, manufacturing, or selling drugs in the presence of a child, or giving drugs to a child.
  https://www.nyc.gov/assets/acs/pdf/stateguide_english.pdf

Abandonment

A severe form of neglect is total abandonment. Abandonment of infants and children includes leaving them alone, unsupervised, not providing adequate food, clothing, housing and emotional care. It is estimated that more than 7,000 children are abandoned each year (Lawinfo, 2020).

Since 1998, states began developing Safe Haven laws. These laws designate safe places where parents can leave their infants where they will be found and taken care of with no criminal charges placed on the parent doing the abandonment. Since 2008, all fifty states in the U.S. and Washington D.C. have maintained some variation of Safe Haven laws.

The states generally consider hospitals with emergency departments as safe havens. The states vary in what other areas are designated as safe havens, but fire stations and police departments are common additional areas. Most states do not require the parent or the parent’s designee to reveal their names or addresses but some allow the receiver of the infant to ask for information. The states vary as to the maximum age the infant can be left in a safe haven.

Nurses are one of the professions that are commonly chosen as individuals who can accept infants being left by parents or their designee. Within a certain time, generally 24 hours, the receiver of the infant must notify the appropriate organization, such as a Department of Children and Family Services, of the custody of the infant. Most states also have an immunity from prosecution clause protecting the receiver of the infant.

A child abandoned not in a safe haven location within the stated age limit, as designated by state law, is considered under a subsection of child abuse statues. In most states is it a felony. If the child dies because of the abandonment, the charge is reckless abandonment with more severe penalties.

Information about safe haven places should be publicized in schools and health facilities. Click the following link for safe haven criteria by state: https://lozierinstitute.org/safe-haven-laws-an-invitation-to-life/ Examples of specific safe haven state laws for Iowa, Kentucky, New York and Pennsylvania follow:

IOWA Safe Haven

A Safe Haven in IOWA is an institutional health facility - such as a hospital or health care facility or a first responder who responds to the 911 telephone call.

A parent - or another person authorized by the parent to relinquish physical custody of an infant.

According to the law - an "institutional health facility" means:

A "hospital" as defined in Iowa Code section 135B.1, including a facility providing medical or health services that is open twenty-four hours per day, seven days per week and is a hospital emergency room, or

A "health care facility" as defined in Iowa Code section 135C.1 means a residential care facility, a nursing facility, an intermediate care facility for persons with mental illness, or an intermediate care facility for persons with an intellectual disability.

According to the law, “first responder” means an emergency medical care provider, a registered nurse staffing an authorized service program under section 147A.12, a physician assistant staffing an authorized service program under section 147A.13, a fire fighter, or a peace officer as defined in section 801.4. https://dhs.iowa.gov/safe-haven

KENTUCKY

Kentucky’s Safe Haven Law allows parents to leave newborn infants less than 30 days old with an officer at a police station, a firefighter at a fire station or an emergency medical services provider (EMT) or hospital emergency room staff person.

The law states a parent will not be criminally prosecuted for abandoning a baby, 3 days old or younger, if the baby is taken to a safe place and has not been physically abused or neglected after birth.
https://www.chfs.ky.gov/agencies/dcbs/dpp/cpb/Documents/Safeinfantsafeplace210.pdf

Monica Kelsey developed Safe Haven Baby Boxes, which don’t require mothers to surrender a child face-to-face with someone else. These boxes are available in the Louisville, Kentucky area. https://spectrumnews1.com/ky/louisville/news/2022/02/11/baby-boxes-in-kentucky

NEW YORK STATE

In New York, since 2000, the Abandoned Infant Protection Act (AIPA), amended in 2010 states the following:

Under the AIPA, amended in 2010, a parent will not be charged if the following criteria are met:

1. The abandoned infant can be no more than 30 days old.
2. The person abandoning the infant must have intended the child be safe and well cared for. He or she cannot have intended the child any harm.
3. The infant must be left in a suitable location, such as a fire department, hospital, or police station with staff present. An appropriate person must be notified immediately of the child’s location, so the child can be taken into custody and cared for.

Mandated reporters, such as nurses, are obligated to report abandoned infants even if the parents are unknown (NY OCFS, 2012b). https://ocfs.ny.gov/programs/safe/

PENNSYLVANIA

Safe Haven of Pennsylvania, also known as the Newborn Protection Act, was enacted in 2003 and amended in 2014, and it states that any parent may leave a newborn baby in the care of a hospital or with a police officer at a police station without being criminally liable as long as the baby is no older than 28 days and is not harmed. Pregnant adolescents or adult women need to know their baby can be kept healthy and safe anonymously.

Under Pennsylvania Constitutional Statute section 2511, if a parent leaves her child in someone else’s care or custody and refuses or fails to acknowledge her responsibilities as parent for six continuous months, she or he has abandoned the child. In Pennsylvania, the child’s guardian or another state agency can petition the court to terminate that parent’s parental rights.
https://pafamiliesinc.org/understanding-systems/office-of-children-youth-and-families/what-is-the-safe-haven-law-in-pennsylvania

 These safe haven locations, rules and regulations can change. It is imperative nurses stay up to date with their state’s regulations.

Leaving infants and toddlers unattended in vehicles

While there is no federal law covering at what age and for how long it is alright to leave a child alone in a car, there are currently 19 states that have laws making it a crime to leave infants and children unattended in a vehicle. Additional states are planning similar legislation. In Colorado, there is immunity for anyone who breaks into a car to rescue a child or animal at risk of harm. Even without state laws, some cities and municipalities have laws prohibiting children be left alone in a car. Without specific laws about leaving a child in cars, general child welfare laws concerning neglect under the provision to provide supervision and/or a general endangerment law could apply.

Anyone who sees a child at risk can report the incident and trigger a child welfare investigation. Children left alone in a vehicle can be at risk for heatstroke, kidnapping, strangulation with power windows, and accidents from putting a car in gear. Check the following link for information on specific states.
https://www.kidsandcars.org/resources/state-laws/

Older children and Neglect and inadequate supervision

Only three states give a set age at which a child can safely be left alone. Illinois law requires children to be 14 years old before being left alone; Maryland, 8 years old; Oregon, 10 years old before being left home alone. Other states state parents need to determine when their children are physically and mentally able to care for themselves and safely can be home alone. It is important parents realize the child protection act requires parents to provide adequate supervision of a child even if the state or municipality does not specifically define what that is. It is considered neglect when a child under 18 is left without supervision in an inappropriate circumstance. Many malls, for example, do not allow unsupervised children under 16 to be there. Some city parks will state an age under which children need to be supervised. If not followed and an injury occurs, or the incidence is reported, parents may be visited by someone from the police department and/or child protective service agency.

It is important for nurses to know the reporting requirements in their state and city for situations when children are at risk. Neglect signs and symptoms include the following:

• Poor growth or weight gain or being overweight
• Poor hygiene
• Lack of clothing or supplies to meet physical needs
• Taking food or money without permission
• Hiding food for later
• Poor record of school attendance
• Lack of appropriate attention for medical, dental or psychological problems or lack of necessary follow-up care.  https://www.ncbi.nlm.nih.gov/books/NBK57157/

Factor associated with abandonment

The following is a list of factors that have been commonly found in cases of child abandonment. Teenage pregnancy is one factor that increases the likelihood of other factors such as poverty and depression:

• Poverty
• Homelessness
• Age under 18
• Unmarried
• Physical disability
• Mental illness
• Substance abuse
• Infant is ill or has health complications
• Not the sex the parents wanted
• Parent is going to prison or being deported
• Postpartum depression
  https://www.childwelfare.gov/pubPDFs/riskprotectivefactors.pdf

Reference

Guttenmacher Institute (2019) State Laws and Policies, Sex and HIV Education. Retrieved 4/13/2019 https://www.guttmacher.org/state-policy/explore/sex-and-hiv-education

Hoffman, S.D. (2008). Kids having kids: Economic costs and social consequences of teen pregnancy. Washington, DC: The Urban Institute Press.

Hoft, M. & Haddad, L. (2017). Screening Children for Abuse and Neglect: A Review of the Literature. J Forensic Nurs.13(1):26-34.

Horner, G. (2014). Child Neglect: Assessment and Intervention. Journal of Pediatric health Care. 28(2),286-192.

Hornor, G. & Zeno, R. (2018). Child Sexual Abuse Perpetrators: What Forensic Nurses Need to Know. J. Forensic Nurs. 14(4), 206-213.

Penman-Aguilar, A., Carter, M., Snead, M.C. & Kourtis, A.P. (2013). Socioeconomic disadvantage as a social determinant of teen childbearing in the U.S. Public Health Rep. 128(suppl 1), 5-22.

Perper, K., Peterson, K. & Manlove, J. (2010). Diploma Attainment Among Teen Mothers. Child Trends, Fact Sheet Publication #2010-01: Washington, DC: Child Trends

U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2018). Child maltreatment 2016. Available from https://www.acf.hhs.gov/cb/research-data-technology/statistics-research/child-maltreatment.