Skip to main content

Advertising Disclaimer »

Main menu

  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors/Reviewers
    • Submit Manuscript
    • Author Guidelines
    • Reviewer Guidelines
    • Open Access
    • Editorial Policies
  • Content
    • Current Issue
    • Online First
    • Archive
    • Blogs
    • Topic/Program Collections
    • AAP Meeting Abstracts
  • Pediatric Collections
    • COVID-19
    • Racism and Its Effects on Pediatric Health
    • More Collections...
  • AAP Policy
  • Supplements
  • Multimedia
    • Video Abstracts
    • Pediatrics On Call Podcast
  • Subscribe
  • Alerts
  • Careers
  • Other Publications
    • American Academy of Pediatrics

User menu

  • Log in
  • My Cart

Search

  • Advanced search
American Academy of Pediatrics

AAP Gateway

Advanced Search

AAP Logo

  • Log in
  • My Cart
  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors/Reviewers
    • Submit Manuscript
    • Author Guidelines
    • Reviewer Guidelines
    • Open Access
    • Editorial Policies
  • Content
    • Current Issue
    • Online First
    • Archive
    • Blogs
    • Topic/Program Collections
    • AAP Meeting Abstracts
  • Pediatric Collections
    • COVID-19
    • Racism and Its Effects on Pediatric Health
    • More Collections...
  • AAP Policy
  • Supplements
  • Multimedia
    • Video Abstracts
    • Pediatrics On Call Podcast
  • Subscribe
  • Alerts
  • Careers

Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
FROM THE AMERICAN ACADEMY OF PEDIATRICS

When Is Lack of Supervision Neglect?

Kent P. Hymel and Committee on Child Abuse and Neglect
Pediatrics September 2006, 118 (3) 1296-1298; DOI: https://doi.org/10.1542/peds.2006-1780
Kent P. Hymel
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • Comments
Loading
Download PDF

Abstract

Occasionally, pediatricians become aware of children who are inadequately supervised. More frequently, pediatricians treat children for traumatic injuries or ingestions that they suspect could have been prevented with better supervision. This clinical report contains guidance for pediatricians considering a referral to a child protective services agency on the basis of suspicion of supervisory neglect.

  • child supervision
  • childhood injury
  • child neglect

BACKGROUND

Laws in all 50 states mandate that pediatricians report any suspicion of child abuse or neglect to the appropriate child protective services agency. Barriers to physician reporting include lack of knowledge and training, previous negative experiences with a child protective services agency, fear of damaging the relationship with the child's family, and fear of courtroom testimony.1 There are no guidelines specifically designed to help pediatricians decide when to report suspected supervisory neglect.

In our society, parents, guardians, baby-sitters, and other designated caregivers* are expected to protect children from harmful people or situations. Nevertheless, epidemiologic studies confirm that many young children are injured in their own homes,2,3 and inadequate supervision is cited frequently as a contributing cause.4 The extent to which adequate supervision protects children from injury or inadequate supervision increases injury risk remains largely undefined.5–11 Furthermore, there are no established standards that define adequate (or inadequate) parental supervision across a wide variety of cultures and specific circumstances.12,13

Under what circumstances should a pediatrician report a suspicion of supervisory neglect? Are parents neglectful only when an inadequately supervised child suffers harm? Or, can a parent be considered neglectful before actual harm occurs? There are no easy answers to these questions. Many pediatric injuries occur while a child is being supervised, and many poorly supervised children do not get injured. Injury risks in young children are related to their developmental capabilities.14 Certainly, the attention, proximity, and/or continuity of adult supervision necessary to protect an active toddler is vastly different from that required to safely monitor a responsible 10-year-old.5

The American Academy of Pediatrics believes that supervisory neglect occurs whenever a caregiver's supervisory decisions or behaviors place a child in his or her care at significant ongoing risk for physical, emotional, or psychological harm.

ADVICE FOR PEDIATRICIANS

  1. In some jurisdictions, child protective services agencies promote or enforce age-specific guidelines for the supervision of children. Become aware of these guidelines (if any) in the local community and consider educating parents about them. Jurisdictional laws or guidelines may not reflect best practices for prevention of injuries.

  2. Consider every allegation or suspicion of supervisory neglect individually.

  3. If the information is available, carefully consider:

    1. whether the child has previously demonstrated an ongoing ability to execute appropriate judgments regarding his or her own behaviors;

    2. whether the child has any physical, developmental, genetic, behavioral, emotional, cognitive, or psychiatric disabilities;

    3. the length of time and the time of day that the child was inadequately supervised;

    4. the caregiver's reasoning and understanding of the situation;

    5. the inherent danger(s) of the child's unsupervised environment (eg, a young child left home alone, unattended in a car or bathtub, or with unrestricted access to a swimming pool);

    6. the child's level of discomfort regarding his or her unsupervised situation;

    7. the specific nature of the child's activities while he or she was left unsupervised (eg, age-appropriate play activities versus accessing pornography on the Internet, vandalism, or shoplifting);

    8. the child's knowledge of emergency telephone numbers†and procedures;

    9. the child's knowledge and use of protocols for safely answering the telephone and/or door when he or she has been left unsupervised;

    10. the child's accessibility to his or her parent or to another, specific, informed individual designated to be his or her caregiver;

    11. past allegation(s) of supervisory neglect or abuse involving the child and/or the child's caregiver;

    12. the physical, emotional, and mental capabilities of the designated caregiver (eg, a young baby-sitter or an elderly grandmother asked to care for too many children simultaneously);

    13. the number, ages, and maturity of the other children under the caregiver's supervision; and

    14. the age-appropriateness of the responsibilities given to the child.

  4. Remember that some child injury risks are unpredictable or unavoidable; caregivers may underestimate the supervisory requirements for some children, and even the most careful caregiver may experience a brief lapse of supervisory attention, proximity, and/or continuity that leads to childhood injury. In these circumstances, counseling regarding child supervision may be an appropriate initial intervention.

  5. Be mindful of the emotional burden a caregiver endures when a child in his or her care suffers a preventable injury.

  6. When a reasonable suspicion exists that a pattern of caregiver decisions or behaviors have placed a child at significant ongoing risk for physical, emotional, or psychological harm, report the incident to the appropriate child protective services agency.

COMMITTEE ON CHILD ABUSE AND NEGLECT, 2005–2006

Robert W. Block, MD, Chairperson

Roberta Ann Hibbard, MD

Carole Jenny, MD, MBA

Nancy D. Kellogg, MD

Betty S. Spivak, MD

John Stirling, Jr, MD

LIAISONS

David L. Corwin, MD

American Academy of Child and Adolescent Psychiatry

STAFF

Tammy Piazza Hurley

Footnotes

  • All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

  • The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

  • ↵* For the purposes of this report, a caregiver is defined as a parent, guardian, or other designated individual who is responsible for the supervision of the children under his or her care.

  • ↵† Emergency telephone numbers include the telephone numbers for the police, fire department, emergency medical services, and the parent (or another designated, responsible individual) to be called in the event of an emergency.

REFERENCES

  1. ↵
    Flaherty EG, Sege R. Barriers to physician identification and reporting of child abuse. Pediatr Ann.2005;34 :349– 356
    OpenUrlCrossRefPubMed
  2. ↵
    Baker SP, O'Neil B, Ginsburg MJ, Li G. The Injury Fact Book. 2nd ed. New York, NY: Oxford University Press; 1992
  3. ↵
    Shannon A, Bashaw B, Lewis J, Feldman W. Nonfatal childhood injuries: a survey of the Children's Hospital of Eastern Ontario. CMAJ.1992;146 :361– 365
    OpenUrlAbstract
  4. ↵
    Garbarino J. Preventing childhood injury: developmental and mental health issues. Am J Orthopsychiatry.1988;58 :25– 45
    OpenUrlCrossRefPubMed
  5. ↵
    Saluja G, Brenner R, Morrongiello BA, Haynie D, Rivera M, Cheng TL. The role of supervision in child injury risk: definition, conceptual and measurement issues. Inj Control Saf Promot.2004;11 :17– 22
    OpenUrlCrossRefPubMed
  6. Morrongiello BA, Ondejko MA, Littlejohn A. Understanding toddlers' in-home injuries: I. Context, correlates, and determinants. J Pediatr Psychol.2004;29 :415– 431
    OpenUrlAbstract/FREE Full Text
  7. Morrongiello BA, Ondejko MA, Littlejohn A. Understanding toddlers' in-home injuries: II. Examining parental strategies, and their efficacy, for managing child injury risk. J Pediatr Psychol.2004;29 :433– 446
    OpenUrlAbstract/FREE Full Text
  8. Cataldo MF, Finney JW, Richman GS, et al. Behavior of injured and uninjured children and their parents in a simulated hazardous setting. J Pediatr Psychol.1992;17 :73– 80
    OpenUrlAbstract/FREE Full Text
  9. Garling A, Garling T. Mothers' supervision and perception of young children's risk of unintentional injury in the home. J Pediatr Psychol.1993;18 :105– 114
    OpenUrlAbstract/FREE Full Text
  10. Morrongiello BA, House K. Measuring parent attributes and supervision behaviors relevant to child injury risk: examining the usefulness of questionnaire measures. Inj Prev.2004;10 :114– 118
    OpenUrlAbstract/FREE Full Text
  11. ↵
    Morrongiello BA, Kiriakou S. Mothers' home-safety practices for preventing six types of childhood injuries: what do they do and why? J Pediatr Psychol.2004;29 :285– 297
    OpenUrlAbstract/FREE Full Text
  12. ↵
    Peterson L, Ewigman B, Kivlahan C. Judgements regarding appropriate child supervision to prevent injury: the role of environmental risk and age. Child Dev.1993;64 :934– 950
    OpenUrlCrossRefPubMed
  13. ↵
    Peterson L, Stern BL. Family processes and child risk for injury. Behav Res Ther.1997;35 :179– 190
    OpenUrlCrossRefPubMed
  14. ↵
    Agran PF, Anderson C, Winn D, Trent R, Walton-Haynes L, Thayer S. Rates of pediatric injuries by 3-month intervals for children 0 to 3 years of age. Pediatrics.2003;111(6) . Available at: www.pediatrics.org/cgi/content/full/111/6/e683
  • Copyright © 2006 by the American Academy of Pediatrics
PreviousNext
Back to top

Advertising Disclaimer »

In this issue

Pediatrics
Vol. 118, Issue 3
September 2006
  • Table of Contents
  • Index by author
View this article with LENS
PreviousNext
Email Article

Thank you for your interest in spreading the word on American Academy of Pediatrics.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
When Is Lack of Supervision Neglect?
(Your Name) has sent you a message from American Academy of Pediatrics
(Your Name) thought you would like to see the American Academy of Pediatrics web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Request Permissions
Article Alerts
Log in
You will be redirected to aap.org to login or to create your account.
Or Sign In to Email Alerts with your Email Address
Citation Tools
When Is Lack of Supervision Neglect?
Kent P. Hymel, Committee on Child Abuse and Neglect
Pediatrics Sep 2006, 118 (3) 1296-1298; DOI: 10.1542/peds.2006-1780

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
When Is Lack of Supervision Neglect?
Kent P. Hymel, Committee on Child Abuse and Neglect
Pediatrics Sep 2006, 118 (3) 1296-1298; DOI: 10.1542/peds.2006-1780
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
Print
Download PDF
Insight Alerts
  • Table of Contents

Jump to section

  • Article
    • Abstract
    • BACKGROUND
    • ADVICE FOR PEDIATRICIANS
    • COMMITTEE ON CHILD ABUSE AND NEGLECT, 2005–2006
    • LIAISONS
    • STAFF
    • Footnotes
    • REFERENCES
  • Info & Metrics
  • Comments

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • The Evaluation of Suspected Child Physical Abuse
  • Preliminary Development of a Rapid Assessment of Supervision Scale for Young Children
  • Evaluation of Suspected Child Physical Abuse
  • Google Scholar

More in this TOC Section

  • Ethical Considerations in Pediatricians’ Use of Social Media
  • 2021 Recommendations for Preventive Pediatric Health Care
  • Recommended Childhood and Adolescent Immunization Schedule: United States, 2021
Show more From the American Academy of Pediatrics

Similar Articles

Subjects

  • Home Health
    • Home Health
  • Advocacy
    • Advocacy
  • Journal Info
  • Editorial Board
  • Editorial Policies
  • Overview
  • Licensing Information
  • Authors/Reviewers
  • Author Guidelines
  • Submit My Manuscript
  • Open Access
  • Reviewer Guidelines
  • Librarians
  • Institutional Subscriptions
  • Usage Stats
  • Support
  • Contact Us
  • Subscribe
  • Resources
  • Media Kit
  • About
  • International Access
  • Terms of Use
  • Privacy Statement
  • FAQ
  • AAP.org
  • shopAAP
  • Follow American Academy of Pediatrics on Instagram
  • Visit American Academy of Pediatrics on Facebook
  • Follow American Academy of Pediatrics on Twitter
  • Follow American Academy of Pediatrics on Youtube
  • RSS
American Academy of Pediatrics

© 2021 American Academy of Pediatrics