Early years neglect: systematic review

Child Protection Evidence is a resource for clinicians across the UK and internationally to inform clinical practice, child protection procedures and professional and expert opinion in the legal system.


Neglect has varying definitions across agencies and countries.  However, evidence clearly shows that neglect of infants and young children has far-reaching consequences. For the purposes of this review, we have focused on neglect and emotional abuse in children aged 0 – 6 years using the World Health Organization definitions.  Practitioners often lack confidence in identifying the emotionally neglected / abused infant or toddler and thus there is delay in implementing appropriate interventions.

This systematic review evaluates the scientific literature on early years neglect in children published up until June 2021 and reflects the findings of eligible studies. The review aims to answer one clinical question:

    • What are the emotional, behavioural and developmental (EBD) features in the child indicative of any type of neglect / emotional abuse?

Key findings:

  • In infants aged 0-20 months, neglect was associated with avoidant and insecure attachment and passive or withdrawn behaviour. There are also signs that neglected children had developmental delays
  • In the 20–30-month age group, children showed less positive social interaction and more internalising behaviours
  • Children aged 3-4 years were delayed in language development, both receptive and expressive
  • The older children, 4-6 years, included in this review had lower self-esteem and displayed reduced executive functioning, cognitive skills and language skills. In addition, they had lower levels of social interaction compared to control or abused children, disruptive behaviour, and attachment issues
  • Important attachment disorders are recognised in young infants and toddlers and warrant formal evaluation by professionals trained in infant mental health. Many features described in neglected / emotionally abused children overlap with those found in children suffering from autistic spectrum disorder or attention deficit hyperactivity disorder
  • There are clearly identifiable features in the pre-school child who is being neglected and / or emotionally abused, thus it is incumbent upon all health practitioners working with these children to be aware of the indicators that they may identify
Disclaimer: This is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

Original reviews and content © Cardiff University, funded by NSPCC

Updates and new material by RCPCH March 2022

While the format of each review has been revised to fit the style of the College and amalgamated into a comprehensive document, the content remains unchanged until reviewed and new evidence is identified and added to the evidence-base. Updated content will be indicated on individual review pages.

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