Neglect

Neglect is a complex issue that is often not straightforward from either a medical or legal perspective. When concerns arise regarding a child’s health and growth, a comprehensive review of medical records by a forensic medical expert can help identify underlying medical conditions or contributing factors that may be affecting the child’s overall health status. In many cases involving suspected physical neglect, experts are consulted to determine whether conditions such as faltering weight or other medical disorders may be contributing to the child’s wasting syndrome and the concerns that prompted a criminal investigation.

Growth faltering, previously referred to as failure to thrive, is generally defined as a child growing more slowly than expected for their age due to inadequate nutrition or malnutrition (Cleveland Clinic, 2024). Historically, diagnosis relied heavily on standardized growth charts, particularly those developed by the World Health Organization. However, diagnostic criteria continue to evolve and may now include indicators such as a mid-upper arm circumference of less than 12.5 cm in children under five years of age, slower-than-expected growth patterns, or weight measurements below the third or fifth percentile for age (Han B. Kersten et al., 2026).

There are many potential causes of weight loss and faltering growth in children, including medical, nutritional, developmental, behavioral, and psychosocial factors (Kristi L. King, 2026). Common contributors may include dehydration, infection, malnutrition, feeding difficulties, and, less commonly, child neglect (Derya Caglar, 2026). Because the causes are often multifactorial, a thorough diagnostic evaluation is essential before conclusions are reached. This evaluation may include laboratory testing to assess electrolyte imbalances, urinalysis to evaluate kidney function, and specialized testing for conditions such as malabsorption disorders, inflammatory bowel disease, gastroesophageal reflux disease (GERD), cystic fibrosis, or endocrine disorders.

Equally important is assessing the caregiver-child feeding relationship and overall environment. Clinicians may evaluate whether the child is feeding in a distracting environment, whether hunger and fullness cues are recognized appropriately, and whether oral motor or swallowing difficulties are present. These assessments can provide important insight into whether inadequate intake may be related to developmental or behavioral challenges rather than intentional neglect (Kristi L. King, 2026).

Faltering weight is relatively common among pediatric patients (Kristi L. King, 2026). Studies estimate that approximately 20–40% of hospitalized children with chronic illnesses meet criteria for undernutrition or faltering weight (Kristi L. King, 2026). While child neglect is generally considered an uncommon cause within this population, it remains an important consideration when there is evidence of intentional withholding of food or persistent resistance to medically recommended interventions despite a supportive and multidisciplinary treatment approach (Kristi L. King, 2026).

Understanding the broad range of medical and psychosocial factors that can contribute to faltering weight is essential for healthcare providers, legal professionals, and investigators alike. Careful, evidence-based evaluation helps ensure that children receive appropriate medical care while avoiding premature conclusions regarding the cause of a child’s condition.