Neglect and starvation

Finding

Neglect means failing to give a child, an older person or a dependant the food, hygiene or care they need; it can cause death.

Updated Nov 13, 2026

What it is

Neglect is maltreatment by omission: the person responsible for a dependant (a child, an older person, a person with disability) fails to provide food, water, hygiene, warmth or medical care. In its severe form it causes malnutrition, dehydration, pressure ulcers and infections, and it can cause or contribute to death. The forensic doctor must establish whether malnutrition and neglect existed, how long they lasted and whether a disease explains them. The autopsy looks for signs of severe weight loss, dehydration, poor hygiene and associated injuries, and compares them with the medical record and the care received.

How to tell it apart

A wasting disease (cancer, tuberculosis, HIV, malabsorption, anorexia nervosa) explains cachexia, but not poor hygiene or lack of care.
In an older person, dementia or refusal to eat does not excuse the carer from seeking medical care.
Pressure ulcers also occur in seriously ill patients who are well cared for: their number, depth and the care received matter.
Larvae in wounds or on the skin of a living person show neglect lasting days; entomology helps work out its minimum duration.

How to recognise it

Marked loss of subcutaneous fat and muscle mass, prominent ribs and pelvic bones, sunken eyes.
Signs of dehydration: dry skin in which a pinched fold persists, and a dry tongue.
Pressure ulcers, sometimes deep, and skin infections.
Skin soiled with excrement, long uncut nails, matted hair, clothes or nappy not changed.
In children: weight and height well below what is expected for age, missed check-ups and vaccines.
Empty stomach and small bowel, with hard, dry stool in the colon.

How it forms

Prolonged lack of energy uses up fat first and then muscle (marasmus); lack of protein can cause oedema (kwashiorkor).
Immobility without changes of position causes pressure ulcers, which become infected.
Death may be due to the malnutrition itself or to complications such as infection, dehydration or hypothermia.

Next step: what to do and document

Weigh and measure the person and calculate body mass index; in children, plot growth charts and record the centiles.
Describe and measure pressure ulcers, hygiene and clothing, and the state of the home if you visited it.
Collect insects or larvae in labelled jars for entomology, plus samples for toxicology and vitreous humour to assess dehydration.
If the person is alive, treat them, admit them if needed and activate protection: the ICBF for minors and the competent authority for adults.
If the person dies, do not certify a natural death: inform the Fiscalía; for minors with suspected abandonment the medico-legal autopsy is mandatory (Decree 786 of 1990, art. 7(d)).
Official text checked on 2026-11-13 at funcionpublica.gov.co.

Common mistakes

Attributing cachexia to old age or disease without reviewing the medical record and the care received.
Not weighing or measuring the body, or not photographing ulcers and hygiene.
Forgetting to look for associated injuries: fractures, bruises or burns.
Removing larvae or dirt without first collecting and documenting them.

Test yourself

Think of the answer, then tap the question to see it.

Which autopsy findings suggest death from neglect in a dependent older person?

Malnutrition and dehydration, pressure ulcers, skin infections, soiling with excrement and uncut nails, with no disease that explains everything.

What does entomology add in a neglect case?

It can show that larvae were on the person before death and estimate the minimum duration of that infestation, that is, of the neglect.

What is the difference between marasmus and kwashiorkor?

Marasmus is loss of fat and muscle from lack of energy; kwashiorkor is malnutrition from lack of protein, with oedema.

Which Colombian rule singles out the medico-legal autopsy of a minor whose death is suspected to be due to abandonment?

Decree 786 of 1990, article 7, literal d.

Add to my cards (4)

Elsewhere in DurgiPedia

Connections

← All of forensic medicine

Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.

Sources: How to prove neglect in the context of the post-mortem examination (Forensic Science, Medicine and Pathology (PMC), 2024); An interdisciplinary forensic approach in a mummified child with evidence of abuse and neglect (Forensic Sciences Research (PMC), 2024); Decreto 786 de 1990: autopsias clínicas y médico-legales y viscerotomías (compilado en el Decreto 780 de 2016) (Función Pública, Gestor Normativo, 1990).

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Representative model, for educational purposes only.