The focus of this three-part study was on the recognition of, and service response to, families in which negative or rejecting behaviour is shown towards one of the children, whereas the siblings are accepted. Part 1 was an interview-based survey of health visitors’ views. They were able to identify families with such problems but were seldom in a position to intervene constructively and referrals to specialist services were not easily achieved. Part 2 was a case file study based on referrals of alleged emotional abuse to social services offices. The nature of the risk-assessment process undertaken by social workers was explored and it was shown that, beyond the initial stage of seeing the families, a lack of capacity was evident to provide structured assessments of the child, formal assessment of parenting and observation of the parent-child relationship. One-third of the emotional abuse cases were subject to child protection registration but only a minority received substantial social work intervention. Although it was found that singly rather than jointly referred children were given less priority and had less-thorough assessments, this could have been related to other characteristics of these children. Part 3 explored how child mental health professionals conceptualized the families’ difficulties, devised therapeutic interventions, considered obstacles to engaging the families and assessed the benefit of psychological help. It was acknowledged that some of these families can present a considerable challenge to any child welfare system because of denial of the problem or difficulties in engaging with existing services. More attention needs to be paid in these cases to maternal mental health problems, especially depression. Recommendations are made for developing more accessible preventive services while ensuring the protection and effective treatment of the singled-out child.