Neglect in Children

Dear Dr. Cason,

Child Protective Services has just placed my Cousin-in-law's son with me after years of abuse and neglect. He is 4 years old and has epilepsy, but has not been to his neurologist in a year. He is very skinny, you can feel every bone in his body and his spine and shoulder blade are very pronounced. You can see all of his ribs, and his stomach sticks out. His head is very large for his body. I am trying to get him in to a specialist since his neurologist has retired, but his medical records have become trapped somewhere in the CPS system. Do you have any advice or recommendations until I can get him in? He eats so much; I don't know if he was underfed or if there is some underlying problem.

Thanks, Anonymous

Dear Anonymous,

I’m happy to see that Child Protective Services has placed this little boy with you. You obviously care about his well being and are looking into his various medical issues. If he is actively having seizures, then he needs a medical exam now- even if that means taking him into your local Emergency Room. If he is not actively seizing and appears thin but well then you can take him to your local pediatrician or family practitioner. Child Protective Services can point you in the right direction if you can't find one. Don't worry about not having his medical records right now just take him for the exam. As a general pediatrician I have often seen children within the foster care system. The majority didn’t have their medical records and I did the best I could to reconstruct their medical history and start the appropriate treatment.

Without a physical exam and a detailed medical history, it’s hard to say exactly whether the child’s thin appearance is due to an underlying medical issue or is simply related to neglect. His large head size could be related to his seizure disorder or could appear large in relation to his small stature. When the brain is actively growing in size – up until two years of age - the calories will specifically be used first for head growth then stature and lastly weight.

Neglect, even treated, can have significant ramifications. The National Academies Press, in the online book titled: (1993) Commission on Behavioral and Social Sciences and Education, states that Even after diagnosis and treatment, the psychological consequences of emotional neglect persist. Some studies suggest that certain signs of severe neglect (such as when a child experiences dehydration, diarrhea, or malnutrition without eceiving appropriate care) may lead to developmental delays, attention deficits, poorer social skills, and less emotional stability.

So we will have to wait to see what his future holds for him. In the meantime he is lucky to be in a stable home and receiving the specific care he needs. To help increase your foster child's weight, please see my article labeled Tips on Mealtime and your Underweight Child for some specific recommendations. I wish you and your family well. No doubt that it will be a difficult time for everyone. Please let me know if I can answer any other questions.

Sheila Cason MD