The Tragedy Of Child Neglect

Parents Need Society's Help

The March 15 editorial "Cruelty to Children; Maryland needs to update its abuse law" focused on a mother who left her five young sons unattended in a squalid basement apartment in Prince George's County. It suggested tougher penalties for child neglect. No one should condone such circumstances. But, in urging punishment of neglectful parents, the editorial reflected a limited understanding of neglect and of what children truly need.

Child neglect is a serious problem. It does not evoke the strong reaction that abuse does. But it should.

Neglect accounts for two-thirds of the 3 million reports made to child protective services annually in the United States. That's the tip of the iceberg. There are severe short- and long-term harms of neglect. Neglect occurs in half the 1,500 child deaths attributed to maltreatment annually. Neglected children suffer many mental and physical health problems, such as depression and heart disease, decades later. Neglect contributes to juvenile delinquency and adult criminality. The fiscal costs are enormous. We are paying dearly.

Our response to neglect should be guided by an understanding of what contributes to this problem.

After 25 years as a pediatrician and researcher in this field, I still believe that most parents care about their children. Most do not intentionally neglect them. Instead, there are usually several problems that compromise parents' abilities to care for their children. Some reside within parents, such as depression. Some relate to the child, such as severe disabilities. Others pertain to the family, such as domestic violence. Some are within the community, such as the burdens of poverty. A study found neglect to be 44 times more frequent in families earning less than $15,000 a year than among those earning more than $30,000.

Pediatricians get upset when children are not brought in for medical care, but what if the family lacks health insurance? More than 9 million American children have none. This does not let parents off the hook; they are primarily responsible for ensuring that their children's needs are met. But neglect is not simply a result of parents who don't care.

What's our current response? Sometimes neglect is reported to child protective services. About half of those cases get investigated, perhaps leading to helpful interventions. Too often, little happens. Caseworkers are often undertrained and overwhelmed, struggling in "a poor system for poor people." Child protective services, mandated by law to protect children, often lack the funds to provide what children and families need. Still, repeatedly, there's media and public outrage when disaster strikes on such agencies' watch.

Another response is to conveniently wag a finger at the responsible parent and seek punishment. Indeed, some circumstances warrant a punitive approach. But in most instances, support and services are what children and families need. About 20 states are modifying their approach to neglect, replacing forensic investigations with evaluations of what's needed. Their success hinges on community resources, such as affordable day care, accessible medical and mental health care, and low-income housing.

Those who favor prosecuting neglectful parents need to consider who will care for the children of parents in prison. We don't have good alternatives. Foster homes are in short supply. Separating children from parents is traumatic; it should be the last resort. Most neglect situations are less egregious than those making horrible headlines. Most neglected children appropriately remain in their parents' care. We need ways to improve their lot while monitoring their safety and well-being.

There are policies and programs that provide families valuable support and services. We know much about what works and what's needed. Tackling poverty is critical; expanding the earned-income tax credit program and raising the minimum wage would help. Prosecuting parents is not a solution to this complex problem. We need to muster public support and the political will to develop the decent, child-friendly and compassionate society to which we aspire. If not, with all our resources, are we not being neglectful ourselves?

-- Howard Dubowitz

Bethesda

The writer is a professor of pediatrics at the University of Maryland School of Medicine. His e-mail address ishdubowitz@peds.umaryland.edu.