An Introduction to Child Protection and Dental Neglect Flashcards
Define child abuse
The physical, sexual, or emotional mistreatment or neglect of a child
A child
Person under the age of 18 years
What does the GDC expect?
Be aware of procedures to raise concern
Have knowledge of who to contact
How to refer to the appropriate authority
Child protection is…
Everyone’s responsibility
A shared responsibility
Responsibility of every member of the dental team
What is the current NI leglislation regarding child care?
The Children (NI) Order 1995
Addressing Bullying in Schools Act (NI) 2016
Children’s Services Co-operation Act (NI) 2015
Safeguarding Board Act (NI) 2011
Safeguarding Vulnerable Groups (NI) Order
2007
Criminal Law Act (NI) 1967
Legislation about criminal offences of abuse and
neglect
POCVA (NI) 2003
What does the ‘child protection and the dental team’ documentation do
Responsibility
Recognising
Responding
Reorganising
Resources
Children and the young people’s charter?
The right to respect
The right to information about yourself
The right to be protected from harm
The right to have a say in your life
The right to have a good start in life
The right to be and feel secure
Victoria Adjo Climbie
Died 25/02/2000
Jan 2003
8 years old
Suffered months of appalling ill treatment from her Great aunt and John Manning, who received life sentences
Victoria Adjo Climbie
Died 25/02/2000
Jan 2003
Publication of Lamming Report containing 108 recommendation s covering accountability and good practice
What was the outcome of the Lamming report?
Do the simple things better-
Professionals should have
A responsibility to work together
Should never do nothing
Confidentiality doesn’t apply
Training and education if contact with children is a regular feature of work
Who abuses?
Families
Institutions and community settings
People known to them
Or rarely by strangers
Who are more vulnerable to abuse
Younger children
- under 5
- Infants under 1
- Pre-term babies
Children with disabilities/learning difficulties
A ‘difficult’ or ‘demanding’ baby
Children living away from home
Children who are/were on the child register
Other vulnerable groups include
Homeless families
Travelling families
Refugees and asylum seekers
Children of parents with chronic health or mental health needs
Types of abuse
Physical injury
Emotional abuse
Sexual abuse
Physical neglect
Combination
Physical injury accidental
Head, forehead, nose, chin, elbows, palm, knees and shins
Physical injury non accidental
Ears, triangle of safety, inner aspects of arms, side of trunk (esp over boney spine)
Sides of feet, inner aspect of thighs, groin or genital
Chest, abdomen, forearms (when raised to protect)
Intra-oral
Soft tissues of cheeks
Black eyes, especially if bilaterally
What to remember with accidental injuries
Involve boney premices
Match the history
Are in keeping with the development of the child
What to remember with non-accidental injuries
Injuries to both sides of the body
Injuries to soft tissue
Injuries with particular patterns
An injury that doesn’t fit the explanation
Delays in presentation
Untreated injuries
3 signs of abuse to the face that the dentist could pick up on
Slap marks
Torn frenum
Bruising to both sides of the ear
What is the definition of physical abuse
May involve hitting, shaking, throwing,
poisoning, burning or
scalding, drowning,
suffocation or otherwise causing physical harm to the child
Also includes fabricated or induced illnesses
How to recognise physical abuse
Bruising, abrasions, lacerations, burns, bite
marks, eye injuries, bone
fractures, intra-oral injuries
site, size, patterns
delay in presentation
does not fit the explanation given
Prevalence of abuse in NI
Physical
N. Ireland DHSSPS, June 2017
Number of children on child protection register in NI
And percentage of total
694
33.7 percent
Emotional?
182
8.8 percent
Sexual?
132
6.4 percent
Neglect
583
28.3
Multiple
470
22.8
Total
2061
47.3 in 10,000
100 percent
Definition of emotional abuse?
Persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development
How to recognise it
Poor growth
developmental delay
educational failure
social immaturity
lack of social responsiveness, aggression or indiscriminate friendliness
challenging behaviour
attention difficulties
concerning parent-child interaction
What does emotional abuse include?
Conveying to a child that they are worthless or unloved/inadequate
Imposition of inappropriate expectations on a
child
Causing children to feel frightened or in
danger, or exploiting or corrupting children
What is the definition fo sexual abuse
forcing or enticing a child or young person to take part in sexual activities, including prostitution, whether or not the child is aware of what is happening
How to recognise it?
direct allegation (disclosure)
sexually transmitted infection
pregnancy
trauma
Emotional and behavioural signs eg. Delayed development, anxiety and depression, self harm, drug, solvent or alcohol abuse
In what way is neglect multi factorial?
Inadequate food, shelter, medical care, clothing, protection from harm/danger, emotional support.
What phrase is associated with neglect?
Non organic failure to thrive
What is the definition of neglect?
Persistent failure to meet a child’s basic needs, likely to result in the serious impairment of the child’s health or development
Includes failing to ensure appropriate medical care or treatment
How to recognise it?
failure to thrive
short stature
inappropriate clothing
frequent injuries
ingrained dirt
developmental delay
withdrawn or attention seeking behaviour
failure to respond to a known significant dental problem
In practice what do you need to remember about neglect?
That you’re not responsible for diagnosing it but you should share concern
You don’t have to deal with it on your own
Signs of neglect?
Failed to reach normal weight/growth or developmental milestones
Physical and genetic reasons have been medically eliminated
What are the long term effects of neglect?
Serious childhood illnesses and reduction in stature
In young children this is life threatening within a short period of time
What is dental neglect?
the persistent failure to meet a child’s basic oral health
needs, likely to result in the serious impairment of a child’s oral or general health or development
May occur in isolation or be part of wider picture of
neglect or abuse
To reach optimal oral health a child needs
A diet limited in amount and frequency of sugar intakes
A regular source of fluoride
Daily oral hygiene
Access to regular dental care
Children are reliant on parents or careers to meet these needs
Dental neglect is a common indicator of
Overall child neglect
Abused children and untreated decayed teeth?
Abused children are 8 times more likely to have untreated decayed teeth
What are the signs of dental neglect?
Poor dental maintenance and caries despite efforts made regarding dental hygiene instruction and dietary advice
Carer appears to have ignored dental pain in child
Repeated failure to engage with dental services
Children who fail to attend appointments on a regular bases
Identifying dental neglect … through assessment of dental and non dental factors
Evaluation of dental diseases,
Caries, oral pain, infection, trauma, and oral pathology
Asking children about their symptoms.
Symptoms reported by parents and carers should also be recorded.
Consider consulting others e.g. nursery staff or teachers.
Severe dental caries in children should be a healthcare priority.
Severe untreated disease may occur due to lack of parental awareness
This could include
Lack of knowledge
Failure to implement recommended preventive
advice
Neglect to seek dental care.
Fear
Family stress or poverty.
Lack of dental healthcare traditions,
or trust in the dental healthcare system
What to do if you have concerns that a child is at risk of abuse or neglect
Follow local policies and procedures,
Understanding the Needs of Children in Northern
Ireland, 2011. UNOCINI Guidance.
N. Ireland DHSSPS, Child protection June 2016
Additional guidance?
Child protection and dental team hosted by the BDA 2016
NICE accredited
Child maltreatment: When to suspect maltment in under 18s. NICE Clinical guideline [CG89] Published date: July 2009. Updated 2014, renamed 2016,review date 2017.Hosted by the British
Steps in the child referral process regional policy
See the flowchart
Time scale- regional policy
- Confirm a phone referral in writing within 24 hourschild to be seen by social services
within 24 hours.] - Social services should acknowledge within 5 working days (follow up if don’t hear in 7 days)
- After a formal referral the child is to be seen by social services within 24 hours
Ivestigation, initial assessment and initial case
conference within 15 working days.
Core group meeting within 10 working days of case
conference.
Review case conference at no more than 3 months then
6 monthly.
What can you use for referral as a guide in practice
Child protection and dental team flowchart
What to do if you have concerns?
- Assess the child
take a history
examine carefully
talk to the child
discuss with an
appropriate
colleague
decide if you still have concerns
If you still have concerns
Provide urgent dental care
talk to the child and parents
explain your concerns
inform of your intention to refer
seek consent to sharing information
keep full clinical records
refer to social services
confirm referral has been acted on
If you no longer have concerns
provide necessary
dental care
keep full clinical records
provide information
about local support
services for children and
families
arrange dental follow-up
The aim of intervention is …
is not to blame the
family, but to ensure that children receive
the support needed to safeguard their welfare
Responding to dental neglect occurs in 3 stages according to the level of concern …
i) Preventive dental team management
(ii) Preventive multi-agency management
(iii) Child protection referral
Responsibility of the dental team
Observe
Record
Communicate
Refer for assessment
NOT expected to diagnose
Tips for best practice when safeguarding children in the dental practice
- Identify a staff member to lead on child protection
- Adopt a child protection policy
- Follow best practice in record keeping
- Undertake regular team training
- Practice safe staff recruitment
- Follow-up children who have dental disease & DNA
What’s important when looking at child protection?
Accident?
Does explanation fit the age and clinical findings?
Delay in seeking advice and if so why?
Demeanor of child
Nature of relationship between guardian and child?
Child’s reaction to others and reaction to receiving medical/dental examination?
Comments about the child that raise concern?
Index of suspicion for child abuse
Delay in seeking help
Story vague, lacking
in detail, vary with
each telling and
person to person
Account not
compatible with
injury
Parents mood
abnormal. Preoccupied.
Parent/guardian behaviour gives cause for concern
Child’s appearance and interaction with parents is abnormal
Child may say something contradictory
History of previous injury
