11/21 - Child abuse Flashcards
what to report
- suspected incidents of physical abuse, sexual abuse, neglect and emotional cruetly
- instances in which the child is deprived of adequate nurturing, health, education, and safety
- a few states also require reporting of newborn infants who suffer from fetal alcohol syndrome or other fetal drug syndromes
general - reporting requirements
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
basis for having these child abuse laws - mandating it
because death can occur
definition of child abuse
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
neglect covers
NOT having these things: medical care dental safety physical
treated differently than abuse
location of abuse more
orofacial region is commonly invlved
- craniofacial, head, face, and neck injuries occur in OVER 50% of the cases of child abuse
preventing abuse
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)
use what type od questions wth the kids
open ended
primary indicators recognizable during routine physical exam
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
patient gives evasice unsatisfactory responses
brief explanation of your concerns may elicit additional information
talk with parent?
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.”
abuser profile
40-60% were abused children
isolate, young, single parents
substance abuse
seldom touches/ looks at child
overly critical of child
abused profile
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
“frozen watchfulness”
characterstic of someone being abused
- no eye contact but always scanning and no spontaneous smiles
involvement of staff
be observing the interactions and the way child carries themselves
signs of malnutrition
small stature for age postural fatigue with rounded shoulder flat chest protruberant abdomen thinning hair
face - pale , muddy, lacks luster
injuries
if does not math given history
bruising of soft tissue not overlying bony prominences - armpits, inner thigh
injury more recent color
red-blue more vivid
older - brown / green - yellow more faded
bruised frenum suspect?
abuse
most commonly affecteed site
laceration or abrasion of the LIPS – 54%
then buccal mucosa, palate (soft/ hard) gingiva, alveolar mucosa, frenum, tongue
fractured luxated avulsed non vital anteriorteeth
get history
- sign of potential abuse
describe bite mark
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
animal or dog bites tend to
tear flesh
- human bites compress flesh and rarely tear tissue
an intercanine distance over 3cm is suspicious of an adult human bite!!
T/F DNA from epithelial cells from the mouth may be deposited in bites
true
can document bites through aerican board of forensic odontology
documenting bites
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
sexual abuse
pathognomonic for sexual abuse?
visible oral injuries or infections are rare even though oral cavity is a frequent site
periorial gonorrhea in prepubertalchildren is PATHOGNOMNIC FOR SEXUAL ABUSE
evidence of forced oral sex
petachiae of palate – particulary the junction of hard and soft palate
how to check for injury to ribs
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
role of dental assistant
be present in room and aware of the suspicion of abuse
should verify and record findings as dentist examines child
only areas that are not deemed withi the purview of the dentist
genetalia and buttocks
exception is “different child” being treated in OR setting
after head and neck exam
body surfaces normally covered can be examines
pants, shorts, shirts, blouses, dresses should be lifted to the limit they allow
dental neglect
untreated, rampant caies easily detected by lay person
untreated pain, infection, bleeding, trauma affecting the orofaial region
when is it neglect
if caregiver has adequate knowledge of neds and demonstrates willful failure to seek care
when is it not neglect
if caregiver does NOT have the knowlege nor the awareness of their child’s need for dental care
obligation for neglec
point them in the right direction and tell them what they need to do
when to consider a parent is neglecting
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
if barriers exist between patient needing tx? your role
should assist the family in finding financial aid, transportation, or public facilities for needed services
failure to report supsected abuse?
deentist can be liable for child injury
reporters protected?
yes - protected from civil/ criminal liablity if the report is made in good faith
if make mistake but did report -
abusing parents can be helped?
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
examine the child when
without parent and with staff and ask anout injury in childs terms
then solicit history of injury from parents
- may contact MD to confirm
describe ijury by __ when reporting
type color size stage characteristics location
what to incclude in report
take rx’s if needed
photographs with different views
treat injury and refer if needed
so important to document injusries because?
may take several days before a rep and a pediatrician see the child
can contact service agency and not report
yes! - to help council
dentist obligated to inform parent they will report?
when to notify the parent
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
PANDA
prevent abuse and neglect through dental awareness coalition
- can reach out to this
populations that rely on caregivers
children
elderly
disabled
