LAUSR

Background Neglect of medical needs in childhood is a complex and multifactorial form of child maltreatment with potentially life-threatening consequences. However, there is a knowledge gap surrounding this issue and the extent of the problem remains unknown in the UK. Aims This project aimed to quantify the extent of neglect of medical needs, with a particular focus on the neglect of chronic illness, at a busy district general hospital. It further aimed to identify the challenges professionals face in the management of this issue. Methods A mixed methods approach was used to address this research question. A review of all of the paediatric safeguarding referrals between 1 January 2013 and 11 April 2018 was conducted, providing a range of quantitative data which was statistically analysed to outline the extent of this issue. In-depth interviews with healthcare professionals and social workers were then conducted and thematically analysed in order to provide qualitative data which explored the views of healthcare professionals and social workers. Results 184 cases of medical neglect were identified from a database of 3933 cases, representing 4.7% of the total number of safeguarding referrals over five years. Of those, 90 referrals were related to the neglect of chronic illnesses. The types of medical conditions these concerned were far-ranging and 33 different conditions or combinations of conditions were present in the referrals. Diversity was also seen amongst the demographic variables recorded and the outcomes of the referrals. Thematic analysis identified four over-arching themes; these were: ‘a lack of understanding’, ‘the perceived role of selves and others’, ‘the variability within this issue’ and ‘the gap between the scale of the problem and solutions available’. Conclusion Neglect of medical needs in childhood is poorly understood, under-recognised and inconsistently managed. It is a diverse and ubiquitous form of child maltreatment, yet professionals receive a lack of training and guidance on this topic. Therefore, more research needs to be dedicated to this issue in order to strengthen the evidence base and to provide a greater understanding amongst professionals. Furthermore, a practicable and cohesive multi-agency strategy needs to be developed to effectively address its management.