CHILD STARVATION AND NEGLECT

Of the possible forms of child maltreatment, neglect is the most uncommon in industrialized countries. Neglect is associated with deprivation of necessities or caregiver’s inability to provide for child’s basic needs and/or failure to provide adequate supervision according to the child’s developmental age. Starvation is an extreme form of nutrient deficiency which can be unintentional or deliberate, depending on the motivation of perpetrators. Lethal neglect resulting from dehydration and failure to supply food and provide child medical care, remains a relatively uncommon and not well-identifiable cause of death in industrialized countries. When child neglect and starvation are suspected, forensic pathologists must perform a comprehensive assessment of all circumstantial data and medical records keeping in mind that many natural diseases can mimic abuse. In lethal cases, complete information about the child and their family life, crime scene investigation, and forensic autopsy coupled with laboratory findings orient the diagnosis and rule out other causes of death. Starvation can be acute or chronic. Assessing the duration of starvation is of paramount importance but it can rarely be done reliably. The reason for determining duration of fasting is to understand whether and how long prior to death any signs should have been recognizable by caregivers or health care workers, to enable the victim to receive medical care. In suspected child neglect and starvation a skeptical approach is fundamental. A neglected child can die in various ways, and neglected children may not show any signs of physical abuse.