Comment in Nature Mental Health: Julia Ditzer and Jana Ray talk about the need to rethink physical neglect in children

Physical neglect is a common but often overlooked form of child maltreatment that has profound consequences for the development, mental well-being and health of those affected. To date, physical neglect has received little scientific and public attention, although it occurs more frequently and is equally as harmful as other forms of maltreatment.
Julia Ditzer and Jana Ray, doctoral students at the Chair of Clinical Child and Adolescent Psychology led by Professor Anna-Lena Zietlow, with colleagues from the Chair of Psychopathology and Clinical Intervention at the University of Zurich (led by Professor Andreas Maercker), have published a commentary in Nature Mental Health in which they highlight the relevance and challenges of physical neglect and while making recommendations for research and practice. ‘Physical neglect of children is rarely recorded in research. We call this ‘the neglected neglect’ - and we no longer wanted to accept this. Because research shows that neglect can be just as harmful as other forms of child maltreatment - but receives much less attention. We therefore wondered: ‘Why is physical neglect so rarely measured in a valid way? And what does it take to change this?’ If we want to protect children effectively, we can no longer accept physical neglect as a blind spot in research and practice. We hope that our comment will provide an impetus for this,’ says Julia Ditzer.

Inadequate measurement methods and lack of definition
The assessment of physical neglect is particularly challenging, as it can affect a variety of unmet basic needs, including inadequate nutrition, inadequate clothing or a lack of medical care. What constitutes neglect varies greatly depending on culture and historical circumstances. What was considered normal in a particular country or at a particular time may be considered neglect today. This makes it difficult to clearly identify physical neglect.
Overall, there is a lack of a standardized, cross-cultural definition, which makes it difficult to clearly distinguish physical neglect from other forms of maltreatment. While previous proposed definitions agree that physical neglect deprives children of certain physical needs, there is disagreement as to which specific needs - e.g. care, medical care or education - should be included. The exact circumstances and possible causes of neglect also play a significant role. Whether a child does not have enough to eat due to poverty or due to the neglect of their parents or caregivers makes a difference. Both circumstances can affect a child's well-being in a similar way. For targeted intervention, however, it is important to distinguish between physical neglect caused by willful neglect on the part of caregivers and neglect caused by economic pressures (e.g. poverty), parental limitations (e.g. education, disability) or political conditions (e.g. war, displacement).

Recommendations for research and practice
Based on the complexity of causes and manifestations described above, the authors suggest developing different definitions of physical neglect for the respective actors involved. ‘For professionals such as educators or social workers, the definition should be as broad as possible to be able to identify children at risk at an early stage - but without unnecessarily burdening or stigmatising families affected by poverty with limited resources. For practical support services to be effective, it is essential to understand the background to physical neglect - for example, whether parents need support or economic hardship is the trigger. Targeted help therefore requires closer interdisciplinary cooperation between social, medical and educational institutions and reliable funding - as well as better material support for affected families,’ explains Anna-Lena Zietlow. In research, on the other hand, physical neglect should be described as differentiated as possible - considering cultural differences and with the aim of conducting more studies in non-Western cultures.
Jana Ray summarises: ‘Physical neglect is a complex phenomenon that requires close and continuous collaboration between professionals from different disciplines and those affected - to better understand the topic, clarify definitions and develop effective measures’.

Original publication:
Julia Ditzer*, Jana Ray*, Myriam V. Thoma, Rahel Bachem, Andreas Maercker, Anna-Lena Zietlow.^.Rethinking the measurement of physical neglect in research and practice. Nature Mental Health. DOI: 10.1038/s44220-025-00425-3

Contact:
Julia Ditzer
Chair of Clinical Child and Adolescent Psychology
Email:
Tel. +49 351463 40313

Jana Ray
Chair of Clinical Child and Adolescent Psychology
Email:
Tel. +49 351463 40313

Prof. Dr. Anna-Lena Zietlow
Chair of Clinical Child and Adolescent Psychology
E-Mail:
Tel. +49 351463 40313