11/21 - Child abuse

Question 1

what to report

Answer 1

1. suspected incidents of physical abuse, sexual abuse, neglect and emotional cruetly
2. instances in which the child is deprived of adequate nurturing, health, education, and safety
3. a few states also require reporting of newborn infants who suffer from fetal alcohol syndrome or other fetal drug syndromes

Question 2

general - reporting requirements

Answer 2

all statutes include

• definitions of child abuse and neglect
• description of reporting procedures
• grants of immunity from liability for mandatory reporters who make reports in good faith

Question 3

basis for having these child abuse laws - mandating it

Answer 3

because death can occur

Question 4

definition of child abuse

Answer 4

those acts or omissions of care that deprive a child of the opportunity to fully develop his or her unique potential as a person either physically, socially, or emotionally

Question 5

neglect covers

Answer 5

NOT having these things:
medical care
dental
safety
physical 

treated differently than abuse

Question 6

location of abuse more

Answer 6

orofacial region is commonly invlved

- craniofacial, head, face, and neck injuries occur in OVER 50% of the cases of child abuse

Question 7

preventing abuse

Answer 7

recognize and report

dental professionals are in a good position to recognize and report

• see the child parent interact over a perios of time
• orofacial involvment (over 50% of cases here)

Question 8

use what type od questions wth the kids

Answer 8

open ended

Question 9

primary indicators recognizable during routine physical exam

Answer 9

uncleanliness

cigaretter or other burns, bute marks, grab marks, belt lashes

marks on neck from strangling

external ears traumitized

abrasions. / lacerations

unusual skin raashed which defy dermatologic diagnosis

Question 10

patient gives evasice unsatisfactory responses

Answer 10

brief explanation of your concerns may elicit additional information

Question 11

talk with parent?

Answer 11

one on one and express concerns in private

• objective and avoid accusations

simply “i feel some concern about jack’s bump on his head and want to check these concerns with you.”

Question 12

abuser profile

Answer 12

40-60% were abused children

isolate, young, single parents

substance abuse

seldom touches/ looks at child

overly critical of child

Question 13

abused profile

Answer 13

more in handicapped, hyperactive

shy around adults

fearful of parent

inapporopriate sexual remarks (sexual)

preoccupaion with body (sexual)

poor overall care/ appearance

overreacts to parents
responses

30-50% invovle head and neck

Question 14

“frozen watchfulness”

Answer 14

characterstic of someone being abused

- no eye contact but always scanning and no spontaneous smiles

Question 15

involvement of staff

Answer 15

be observing the interactions and the way child carries themselves

Question 16

signs of malnutrition

Answer 16

small stature for age 
postural fatigue with rounded shoulder
flat chest
protruberant abdomen 
thinning hair 

face - pale , muddy, lacks luster

Question 17

injuries

Answer 17

if does not math given history

bruising of soft tissue not overlying bony prominences - armpits, inner thigh

Question 18

injury more recent color

Answer 18

red-blue more vivid

older - brown / green - yellow more faded

Question 19

bruised frenum suspect?

Answer 19

abuse

Question 20

most commonly affecteed site

Answer 20

laceration or abrasion of the LIPS – 54%

then buccal mucosa, palate (soft/ hard) gingiva, alveolar mucosa, frenum, tongue

Question 21

fractured luxated avulsed non vital anteriorteeth

Answer 21

get history

- sign of potential abuse

Question 22

describe bite mark

Answer 22

bruises, abrasion, lacerations found in ELLIPTICAL OR OVOD PATTERN

CENTRAL AREA OF ECCHYMOSES caused by eithe

• positive pressure from closing the teeth with disruption of bloos vessels
• negative pressure from sunction and tongue thrusting

Question 23

animal or dog bites tend to

Answer 23

tear flesh
- human bites compress flesh and rarely tear tissue

an intercanine distance over 3cm is suspicious of an adult human bite!!

Question 24

T/F DNA from epithelial cells from the mouth may be deposited in bites

Answer 24

true

can document bites through aerican board of forensic odontology

Question 25

documenting bites

Answer 25

written observations and photos should be taken every day for 3 days forensic odontologists may be able to match models of a suspected abusers teeth with impressions or photos of the bite mark

Question 26

sexual abuse pathognomonic for sexual abuse?

Answer 26

visible oral injuries or infections are rare even though oral cavity is a frequent site periorial gonorrhea in prepubertalchildren is PATHOGNOMNIC FOR SEXUAL ABUSE

Question 27

evidence of forced oral sex

Answer 27

petachiae of palate -- particulary the junction of hard and soft palate

Question 28

how to check for injury to ribs

Answer 28

move the child up towards the headrest while he/ she is in a supine position if the lifting motion results in pain, there may have been trauma to the child's ribs or clavicles

Question 29

role of dental assistant

Answer 29

be present in room and aware of the suspicion of abuse should verify and record findings as dentist examines child

Question 30

only areas that are not deemed withi the purview of the dentist

Answer 30

genetalia and buttocks exception is "different child" being treated in OR setting

Question 31

after head and neck exam

Answer 31

body surfaces normally covered can be examines | pants, shorts, shirts, blouses, dresses should be lifted to the limit they allow

Question 32

dental neglect

Answer 32

untreated, rampant caies easily detected by lay person untreated pain, infection, bleeding, trauma affecting the orofaial region

Question 33

when is it neglect

Answer 33

if caregiver has adequate knowledge of neds and demonstrates willful failure to seek care

Question 34

when is it not neglect

Answer 34

if caregiver does NOT have the knowlege nor the awareness of their child's need for dental care

Question 35

obligation for neglec

Answer 35

point them in the right direction and tell them what they need to do

Question 36

when to consider a parent is neglecting

Answer 36

AFTER the parent has been properly notified about the condition, the tx needed, and how to get the treatment if despite all these services (like helping through barriers too) then case should be reported

Question 37

if barriers exist between patient needing tx? your role

Answer 37

should assist the family in finding financial aid, transportation, or public facilities for needed services

Question 38

failure to report supsected abuse?

Answer 38

deentist can be liable for child injury

Question 39

reporters protected?

Answer 39

yes - protected from civil/ criminal liablity if the report is made in good faith if make mistake but did report -

Question 40

abusing parents can be helped?

Answer 40

yes -- estimated that 80-90% of abusing parents can be helped, bu many have no idea they need help or know where to find help

Question 41

examine the child when

Answer 41

without parent and with staff and ask anout injury in childs terms then solicit history of injury from parents - may contact MD to confirm

Question 42

describe ijury by __ when reporting

Answer 42

``` type color size stage characteristics location ```

Question 43

what to incclude in report

Answer 43

take rx's if needed photographs with different views treat injury and refer if needed

Question 44

so important to document injusries because?

Answer 44

may take several days before a rep and a pediatrician see the child

Question 45

can contact service agency and not report

Answer 45

yes! - to help council

Question 46

dentist obligated to inform parent they will report?

Answer 46

NO -- no legal obligation to inform parents that abuse is suspected or will be reported -

Question 47

when to notify the parent

Answer 47

AFTER you have reported to child protective agency | - ensures that any subsequent conversation with the parents will not result in the dentist changing that decision

Question 48

PANDA

Answer 48

prevent abuse and neglect through dental awareness coalition - can reach out to this

Question 49

populations that rely on caregivers

Answer 49

children elderly disabled