Patient Presentation
An 11-year-old male came to clinic for a health supervision visit. He had no health, developmental, behavioral or social concerns. The diagnosis of a healthy pre-teen was made. When the resident was staffing the patient, he noted that the patient was being left alone for short periods of time after being dropped off from sports practice until the parents came home from work. This occurred twice per week for about 20 minutes. The resident felt the child was mature enough to be left alone but asked what the laws were in the state regarding the issue. He and the staff did a brief Internet search and found the state’s Department of Human Services website which stated that the state did not have an absolute age, but did have guidelines regarding issues to consider to help determine if a child was being neglected.
Discussion
There is no one right answer to the difficult decision of when can a child be left home alone safely. Parents need to consider the individual child and circumstances. The majority of states also do not have legal definitions of when a child can stay home alone and it not be considered neglectful, but may have guidelines. The Child Welfare Clearinghouse from U.S. Government has a list of state agencies that can be contacted by Internet or phone for more information (see To Learn More below). Generally children around 11-13 years can be ready to stay home alone. However, children even older may not be ready if they cannot show the maturity to handle the responsibility.
Learning Point
- Child’s General Readiness
- Is the child physically and mentally able to care for himself?
- Does the child obey rules and make good decisions?
- Does the child feel comfortable or is fearful about being home alone?
- Does the child have a sense of security and confidence in himself?
- Does the child have the skills to handle boredom and fear?
- How does the child handle unexpected situations? Can the child recognize danger or a dangerous situation?
- Does the child handle personal responsibility such as homework, household chores? Does the child understand and follow rules? Does the child make good judgments or is he prone to taking risks?
- Does the child understand expectations?
- Will the child seek help from an adult if needed?
- Does the child know and physically can perform safety measures?
- Safety
- Not only is it important to ask the child about these situations, it is important to have the child physically show that he can do what would be expected. For example, a child might know to go to the door and go outside if there is a fire, but may not be able to actually unlock the deadbolt lock. What would the child do then?
- Does the child know what to do if:
- They or someone gets cut or hurt
- A stranger comes to the door
- The telephone rings or someone calls for a parent who isn’t home
- There is a severe weather alarm such as tornado
- There is a power outage
- A smoke alarm goes off
- There is a small fire
- Home alarm system goes off accidentally
- What will the child do, when he doesn’t know what to do
- Is the child physically able to demonstrate:
- Opening doors, windows and locks
- Operate the telephone or cellular telephone
- Turn lights on and off
- Operate food preparation equipment such as knifes, refrigerators, microwave oven, stoves, oven
- Operate a home alarm system and what to do
- Know when and how to call 911
- Knows name, address, phone number, parents names and where the parent contact information is
- Find and use the home first aid kit
- Home Situation
- How long will the child be alone for?
- How often will this occur?
- What time of day and/or night?
- Is the child expected to care for siblings or animals?
- Is the child expected to prepare a snack or meal?
- Is the home safe?
- Is the neighborhood safe?
- Who or what would be the child’s resources to help solve a problem if they can’t contact the parent or until the parent could return to help?
- Before the Child Stays Home Alone
- Role play different scenarios and problems with the child
- Establish rules including if and where the child may leave, TV/Computer/Internet use, doing homework and other household chores, when the child should call the parent.
- Have a regular plan to check in with the child.
- Review and talk about how the child is feeling and physically coping with staying home.
- Have an emergency contact sheet readily available for the child.
- Practice staying home for shorter time periods.
- Review and talk about how the child is feeling and physically coping with staying home.
- Reconsider if the child is still ready to stay home alone
Questions for Further Discussion
1. When is a child able to babysit/supervise other children?
2. What is the definition of child neglect in your state?
Related Cases
- Disease: Child Safety
- Symptom/Presentation: Behavior Problems | Child Abuse and Neglect and Sexual Abuse | Health Maintenance and Disease Prevention
- Specialty: Child Abuse and Neglect | General Pediatrics | Psychiatry and Psychology | Social Services
- Age: School Ager
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for this topic: Child Safety
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
Child Welfare Information Gateway. Leaving Your Child Home Alone. Available from the Internet at http://www.childwelfare.gov/pubs/factsheets/homealone.pdf (rev. 7/2007, cited 9/8/10).
Child Welfare Information Gateway. Child Abuse Reporting Numbers. Available from the Internet at http://www.childwelfare.gov/pubs/reslist/rl_dsp.cfm?rs_id=5&rate_chno=11-11172 (rev. 9/8/10, cited 9/8/10).
Green N. Leaving Your Child Home Alone.KidsHealth.Available from the Internet at http://kidshealth.org/parent/firstaid_safe/home/home_alone.html# (rev. October 2010, cited 9/8/10).
4C for Children. blogParents. Is My Child Ready? Available from the Internet at: http://blogparents.4cforchildren.org/ (rev. 07/21/2010, cited 9/8/10).
ACGME Competencies Highlighted by Case
1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients’ is gathered.
6. Information technology to support patient care decisions and patient education is used.
8. Health care services aimed at preventing health problems or maintaining health are provided.
12. Evidence from scientific studies related to the patients’ health problems is located, appraised and assimilated.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
15. Information technology to manage information, access on-line medical information and support the healthcare professional’s own education is used.
16. Learning of students and other health care professionals is facilitated.
19. The health professional works effectively with others as a member or leader of a health care team or other professional group.
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital