Neglect and serious case reviews (PDF, 735KB) - nspcc

In reading the set of serious case reviews where malnutrition was a feature, a number of
issues arose. Given the small number of malnutrition cases in total, it is likely that some
of the issues below may have pertained to only one or two children’s cases:
• Withholding of food as a form of punishment – limiting food being used as a way of
establishing adult authority;
• A relationship between the child and caregiver that is so poor that for the adult the
child had ceased to exist;
• Restricted diet resulting from faith/lifestyle choices; diets which are appropriate for
adults may be deficient in certain nutrients for small children, and can increase the
possibility of diet-related conditions such as rickets (insufficient calcium in the diet);
• Mother’s eating disorder impacting on her ability to feed her children nutritiously;
• For the small number of older children, an additional feature of their lives was the
virtual imprisonment in which they were held.
themeS aNd learNiNg poiNtS
emotional development and faltering weight gain in babies and young children
While cases of life threatening malnutrition were rare, a number of other serious case
review reports addressed concerns about faltering weight gain. These cases revealed
complex and differing reasons as to why parents or carers appeared not to be nurturing
their child. There was also a pattern of professionals failing to recognise that a key part
of the baby or child’s faltering growth could lie in a problematic relationship between
the child and his or her caregiver, which hindered the child’s emotional development.
What happens during feeding provides powerful clues to the parents’ reactions to their
child, and to the child’s responses to his or her caregivers. In addition to their physical
needs to be properly fed, these babies had an emotional need to feel connected with
their mothers, which was not being met. More detail about feeding is found in our recent
study of child development in serious case reviews (Brandon et al 2011).
Neglect in children given a low priority
3. A thematic analysis of neglect
On occasions this had prevented emergency action. In one instance a community
paediatrician had to convince a colleague in hospital to admit a child with life threatening
malnutrition – the colleague’s view initially had been that ‘neglect is not a medical
emergency’. A number of more recent serious case reviews have provided evidence
of more positive practice and, in the set of SCRs we analysed here, speedy hospital
admission saved at least two children’s lives.
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