Neglect Toolkit

• All health needs met
• Fully compliant with all treatment plans and use of specialist equipment
• Compassion for the child’s needs 

• Missed and cancelled appointments but parent/ carer rearranges and attends rearranged appointments
• Any lack of compliance is due to legitimate reasons
• Compassion for the child’s needs

• Consistent missed/cancelled appointments but did not phone to cancel/rearrange or did not attend the rearranged appointment
• Compliance frequently lacking
• Shows limited compassion for unborn / child’s needs and the reasons for needing to attend appointments and services
• Parents not returning completed core screening consent to school health service

• Chronic missed appointments that are significantly detrimental to the unborn /child’s health
• Health needs unmet
• Shows no compassion for the child’s needs and the reasons for needing to attend appointments and services
• Difficulty in recognising and prioritising needs of the child
• Serious compliance failure (medication not given for no reason, specialist equipment not used, treatment plan not followed)
• Inexplicable deterioration in the child’s normal functioning behaviour

• The child is of optimum health
• All health needs met
• Good relationship with parents/carers
• The child is reaching full potential for their medical condition

• Detection of treatable conditions in the Unborn child/child at increased risk of becoming delayed
• The child has health needs met within an appropriate timeframe
• The child likely to reach full potential 
• Good relationship with parent/carer

• The child is not meeting their full health potential which will impact on health/wellbeing
• Increasing need for support due to not accessing relevant health services and appointments
• May not have the necessary equipment/services involved to meet their health needs and therefore impact on their growth, intellectual development and mental health
• Detection of treatable conditions in the Unborn child/child delayed
• A child suffering from preventable chronic ill health

• Risk of child’s health and developmental needs not being met
• Risk of child/ young person not reaching their full potential and intellectual development, and therefore impact on emotional health which may lead to depression, anxiety, self-harm
• Missed appointments in children may be critical due to the potential acute nature of their condition – could lead to hospitalisation or death
• Unborn child’s / child’s health needs undetected and therefore increased the likeliness of the child being born with health implications/child having health implications
• Invisibility of the child due to increased isolation
• Risk of severe or life-threatening harm

• Child is clean
• The child is treated for usual minor ailments
• The child has necessary self-care skills

• Child on occasion looks unwashed, hair uncombed, occasional body odour
• An occasional episode of head lice / nappy rash treated appropriately
• There have been low-level concerns raised from others, the parent is aware and agrees with the concerns and is engaging or willing to engage to address the issues
• Occasionally needs reminding of self-care needs

• The child is dirty, food spilt on clothes, dirty feet, dirty nails, nappy sodden, has body odour
• Head lice / nappy rash treatment only used if prompted
• Head often shaved or cut very short in severe style as head lice treatment
• There have been concerns raised by others that are significant on one or more occasion
• School often providing facilities for child / young person to wash
• Poor self- care skills for level of ability due to the impact of parenting

• The child is very dirty, has an offensive odour
• Hair matted and unwashed
• Repeated head lice infestation, untreated and may be showing signs of infection, head shaved or cut short due to infestation
• Severe nappy rash, untreated and may be showing signs of infection
• Ingrained dirt under finger and toenails
• Dirty clothes, clothes have an odour
• Invasive treatment unclean i.e. ng tubes, peg feeds, dialysis equipment
• There are on-going significant concerns raised by others and/or referrals to agencies in the past
• Inadequate self – care skills for level of ability due to the impact of parenting

Impact on child

• All hygiene needs met
• The child can thrive, remain safe and enjoy and achieve 

• May be at risk of gastrointestinal infections, threadworm
• Chid at increased risk of pain, soreness, itching and discomfort
• Irritability in babies

• The child at increased risk of being bullied and isolated - impact on emotional health therefore possible emergence of depression, anxiety and low self-esteem, poor friendships and reduced education attainment
• Increased risk of infections, fungal infection, threadworm – causing illness, pain and suffering for the child and increased stress levels

• The child at risk of severe infection/septicaemia – illness, pain and suffering for the child
• The child is isolated, lonely and at increased risk of bullying – increased risk of mental health issues, difficulty with forming and maintaining relationships, reduced educational attainment and at increasing risk of self-harm, severe anxiety, suicide
• Children may be uncomfortable, itchy, sore - which may impact on their sleep and daily functioning
• The child develops poor self-care skills

• Good parental awareness of oral health
• The child is registered with a dentist
• Cleans teeth twice daily with toothpaste
• Age appropriate cup used for drinks
• Child given vitamin supplements to aid the absorption of calcium

• The child over 6 months not registered with a dentist
• Giving inappropriate drinks
• Using a baby bottle for a child over 1 year
• No evidence of decay
• Parents not engaged in prevention but open to advice
• Cleans teeth twice daily with children’s toothpaste
• Inappropriate use of dummy over the age of 1 year, parent/carer open to supporting to cease use

• The child not registered with a dentist
• Cleans teeth usually once per day with toothpaste
• Given inappropriate drinks in a baby bottle over 2 years
• Evidence of discolouration of teeth and decay – may be lacking in vitamin D
• Parents not accepting advice or engage in prevention
• The young person does not own a toothbrush or toothpaste
• Inappropriate use of dummy over the age of 2 years and/or parents reluctant to advise to cease use

• The child not registered with a dentist
• Does not clean teeth
• Has frequent sugary snacks/drinks
• Has obvious decay / or recurrent abscesses
• Using a baby bottle for drinks over 3 years
• Parents not taken on any previous advice
• The child frequently complaining of toothache and absent from school as a consequence
• Child given dummy over the age of 3 years and parents not open to advice
• The child is attending for dental extractions of baby teeth  and or adult teeth due to decay

• The child has good oral health, free from pain and discomfort

• The child has good dental health but is at risk of developing decay
• Increased risk of developing speech and language delay

• Some evidence of damage to teeth
• At risk of pain, discomfort, decay and associated infections
• Increased risk of reduced nutritional intake and communication – impacting on relationships
• Increased risk of being bullied – impacting on emotional health needs which may lead on to the emergence of depression, anxiety and self-harm
• Increasing risk of speech and language delay
• Increased risk of disturbed sleep patterns, crying and irritability

• The child has significant decay and dental caries
• Increased risk of reduced nutritional intake and effective communication
• At risk from sepsis, unclear speech, extreme pain and discomfort, disturbed sleep, low self-esteem due to appearance, frequent abscesses, halitosis, impact on diet and nutritional needs
• Increasing risk of isolation from peers, bullying and therefore increasing impact emotional health and well-being which can lead to depression, anxiety and self-harm
• At high risk of speech and language delay

• Child is thriving
• BMI within normal limits and/or no concerns regarding centile chart information
• Special food supplement always available and parents fully accomplished in use and care of alternative feeding methods
• Parents always following the advice given by professionals

• Weight is proportional to height and within normal BMI, however, may appear large or small in stature and/or centile charts proportional to the stature
• (Consider parents build)
• Not having vitamin supplements
• Age appropriate diet and exercise is being considered but not always achieved
• Diet and exercise is appropriately monitored
• Special food supplements usually available and manage to provide adequate care in using specialised equipment

• The child is outside of normal BMI and/or data on centile charts, not in proportion
• Child’s weight increasing significantly
• The child is not putting on weight, looks thin and pale
• The child not engaging in healthy lifestyle activity, exercise, P.E
• A poor diet of poor nutritional value
• Not having vitamin supplements
• Attending appointments with paediatricians/weight management/dieticians
• Often does not have child’s food supplement and poor skills demonstrated in the use and care of specialised equipment
• Inconsistently following advice from professionals
• Parents not consenting to core/obesity screening in school, therefore, weight unable to be reviewed
• Parents not promoting the development of varied diet
• The child not encouraged in independency in eating

• Parents not engaging with some or all advice is given
• The child has BMI above or below the normal range and/or weight and height above or below centile charts normal range
• Has not attended Paediatric/Weight Management/ dietician appointment.
• Very unhealthy diet
• No vitamin supplements
• Breathless on exertion
• Engaging in unhealthy lifestyle choices such as playing video games/watch TV for long periods
• No priority is given to the provision of food supplement and feeding equipment not maintained or used
• Not following advice from professionals
• Parents not appropriately responsive to behavioural difficulties around meal time

• The child can remain healthy, enjoy and achieve
• Nutritional needs fully met

• The child is at emerging risk of being deficient of vitamins and nutritional elements – impacting upon energy levels and lethargy
• The child may not be as active as is optimum and therefore impacting upon the child’s physical health and development

• The child is at risk of becoming obese or anorexic
• Less active and able to join in physical activities with peers
• The child at risk of failure to thrive, anaemia, poor brain growth, malnutrition, electrolyte imbalance, poor vitamin absorption
• Impact on self- esteem – can lead to eating disorders, depression, anxiety and self-harm
• Increased risk of being bullied and associated impact on emotional health

• The child is at increased risk of diabetes, asthma, heart disease
• The child is undernourished and therefore at increased risk of health issues, growth problems, retardation and socio-emotional deficits, severe malnutrition
• The child is tired and having unnecessary investigations
• At high risk of developing an eating disorder and being bullied, impacting on emotional health and increased risk of depression, anxiety and self-harm

• The child is always dressed in clean and appropriate clothes
• The child is wearing clothes appropriate to their age, level of maturity and occasion whilst promoting independence
• Parents and/or child are following advice from professionals

• The child is dressed appropriately but clothes appear unwashed
• Does not have many clothes
• Child occasionally seen wearing few or too many clothes for temperature, but plausible reasons are given by a carer
• Parents happy to accept charity referral

• The child is often dressed in unsuitable clothes for the environment/weather
• Clothes are too small/too large
• Shoes are too small/too big
• Holes in clothes/shoes
• The child frequently presents in school without school uniform even though school have previously provided one
• School frequently washing child’s clothing in school
• Clothing frequently unwashed, looks dirty, has an odour

• The child is always dressed in clothes not appropriate to the environment/weather
• Clothes are too big/small
• Clothes have an offensive odour
• Shoes too big/small and may have an offensive odour
• Parents do not see an issue
• The child is not wearing clothes appropriate to their age, level of maturity and occasion whilst promoting independence
• Parent and/or child is not following advice from professionals

• Confident and good self-esteem
• Appropriate body temperature

• Maybe self-conscious due to clothing and therefore impact on self-esteem
• May be too warm or too cold impacting on the ability to enjoy and achieve in activities

• Impact on emotional health due to poor self-esteem and increased risk of being bullied and isolation which can lead on to depression, anxiety, self- harm
• Increased risk of infections
• Issues with forming and maintaining relationships
• Impact on educational attainment

• The child is affected socially and emotionally, therefore, increased risks of depression, anxiety, self–harm and suicide
• Issues with forming and maintaining relationships
• Feet may be damaged which could lead on to issues with gross motor development, carrying out exercise and activities and play
• Increasing risk of infection - leading on to poor health
• Poor self-esteem and confidence – may negatively impact on educational attainment, peer relationships and emotional health

• Child accesses health services promptly and appropriately
• Optimal age appropriate supervision of children
• Appropriate safety equipment in place and used
• Appropriate road safety
• Medication and alcohol stored safely

• The child attends A & E for minor illnesses instead of GP
• Occasional minor accident
• Attends A&E in a timely manner
• Lack of safety equipment in the home
• Parents are willing to accept advice and have knowledge of child developmental needs
• Occasionally child not supervised age appropriately
• The child not registered with a G.P
• There have been low level concerns raised by others, the parent is aware and agrees with the concerns and is engaging or willing to engage to address the issues
• Storage of medication/alcohol inadequate

• The child has had 2 or more accidents which could be due to lack of supervision within age appropriate time frame
• Frequent A&E attendances for minor illnesses due to a poor home environment/ poor diet /anxious parents
• Inappropriate use of A&E
• Medical attention is not sought in a timely manner
• Safety equipment is not in place
• Parents reluctant to accept advice
• Poor supervision of children
• Poor road safety measures are taken and/or child has limited road safety awareness
• There have been concerns raised by others that are significant on one or more occasion

• The child attends A& E frequently for illness and accidents due to poor supervision
• The child is not taken promptly to GP/ A&E when injured and/or ill
• The home environment presents danger/risk of accidents to the child
• Child is unsupervised
• Parents do not accept advice
• Reduced school attendance due to injuries, attendance at A + E
• No road safety measures and/or have no awareness of road safety
• There are on-going significant concerns raised by others and/or referrals to agencies in the past

• The child has all health needs met
• Is safe and supervised

• At risk of injuries
• At risk of delay of seeking appropriate medical advice and neglecting basic health needs

• The child is at increased risk of injuries
• The child unable to enjoy and achieve for periods of time 
• May be out of education, therefore, impact on attainment – child becoming more invisible to professionals
• At risk of more severe health issues and consequences of illness and injuries

• At risk of serious illness, severe injuries and death
• The child unable to enjoy and achieve for significant periods of time – impact on peer relationships
• Educational attainment impacted upon due to non-attendance at school
• Increased risk of depression, anxiety and self-harm

• The child is thriving and gaining weight
• Development within expected limits
• Having vitamin and folic acid supplements
• Attending all follow-up appointments and baby clinic
• Increased risk of sudden infant death being managed appropriately
• Attending for immunisations

• The child following adjusted growth centiles
• Occasionally not attending a baby clinic for weight review but with a plausible explanation
• Having vitamins and folic acid
• Missed/could not attend the occasional appointment
• Adhering to safe sleeping guidelines

• The child frequently not attending a baby clinic for weight review
• Has missed 2 or more follow-up appointments with no explanation
• Evidence of developmental delay occurring
• Not up-to-date with immunisations
• Safe sleeping guidelines only being adhered to when reminded
• The young person presents in school as failure to thrive
• Frequent absence from school due to frequent illnesses

• The child has been discharged from hospital follow-up due to non-attendance
• Not having vitamin supplements
• Not attending a baby clinic for weight review
• Not accessing services
• No evidence of toys/play and stimulation
• Childs development clearly below what is expected
• Outstanding immunisations
• Not adhering to safe sleeping guidelines
• Not attending school due to health needs

• The child is having all health needs met
• Thriving and well stimulated
• No lasting effects of prematurity

• Potential issues with weight gain and development
• Emerging risk of effects of prematurity becoming prolonged

• The child not achieving full developmental and educational potential
• Increased risks of prolonged effects of prematurity
• At risk of failure to thrive
• At risk of rickets
• At risk of communicable disease
• Increased risk of sudden death

• The child at risk of death
• Significant risk of severe developmental delay
• Significant risk of failure to thrive, rickets and other health issues
• Significant risk of communicable disease
• Significant risk of sudden death
• Significantly at risk of prolonged effects of prematurity

• The child is meeting all developmental milestones
• Observed playing with age appropriate toys
• Parent adapts the stimulation/leisure activities that meet the child’s level of need;
• This includes the use of readily available outside agencies and this is overseen carefully
• Specialised equipment and advice is fully implemented.

• Child occasionally seen strapped in buggy/car seat in the home
• Child occasionally seen sat in a highchair in the home when not meal times
• Attends occasional Stay and Play Sessions
• Occasionally age appropriate stimulation and play needs of the child not achieved
• Parents open to advice
• There have been low level concerns raised by others, the parent is aware and agrees with the concerns and is engaging or willing to engage to address the issues
• Occasionally specialist equipment not used when needed

• The child often seen strapped in buggy/Highchair
• No toys in reach
• Frequent use of television as stimulation
• Only attending local groups if required to by professional
• Some developmental/speech delay evident
• Parent reluctant to accept advice
• The parent uses inappropriate stimulation/leisure activities for the child’s level of need
• Referrals needed to community paediatrician due to concerns of developmental delay
• The young person not allowed to engage in school activities, activities after school or access to peers as parental permission is not given
• There have been concerns raised by others that are significant on one or more occasion
• Limited use of specialist equipment

• The child is always seen in highchair/buggy
• No toys observed in the home
• Missed appointment with Community Paediatrician
• Not attending any groups
• Parents not engaging with services and not receptive to advice
• No overseeing of support or outside agency involvement to ensure if they are appropriate
• No stimulation or leisure activities for the child
• There are on-going significant concerns raised by others and/or referrals to agencies in the past
• No use of specialist equipment

• Child is thriving
• The child is reaching their full potential
• Able to enjoy and achieve
• The child is healthy and safe

• Child occasionally unable to enjoy and achieve for periods of time
• Emerging risk of delay of gross and fine motor development

• Delayed gross motor and fine motor skills
• Delayed Speech and Language
• Evidence of some behaviour issues
• Isolation from peers causing an impact on self – esteem and social development which may lead on to depression, anxiety, self-harm

• Marked developmental delay in all areas and significant behaviour problems
• The child is unable to communicate needs
• Socially isolated – leading on to depression, anxiety, self-harm and suicide
• Risk of developing asthma, heart disease, obesity