child protection and dental neglect Flashcards
what is child abuse?
> the physical, sexual or emotional mistreatment or neglect of a child
what is a child?
> a child is defined as a person under the age of 18 years
what does the GDC expect registration to do in the case of child protection?
> expects registrants to be aware of procedures to raise concern
> have knowledge of who to contact
> have knowledge of how to refer to appropriate authority
who’s responsibility is child protection?
> Everyone’s responsibility.
> A shared responsibility.
> The responsibility of every member of the dental team
what are the current Northern Ireland legislations involved with child protection?
> 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 are the 5 Rs outlined in the child protection and dental team?
> Responsibility
> Recognising
> Responding
> Reorganising
> Resources
based of the children and young peaples charter…what do they have the right to?
> 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 a good start in life
> The right to be and feel secure
what was the outcome of the laming report for professionals?
> ‘do the simple things better’
> 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 ?
abuse can occur in/ or by =
> Families
> Institutions or community settings
> People known to them
> Or more rarely by strangers
who is vulnerable to abuse?
> Younger children
- Under 5 years
- Infants under 1 year
- Pre-term babies.
> Children with disabilities/learning difficulties
> A “difficult” or “demanding baby”
> Children living away from home
> Children who are/were on a Child Protection Register
> children of parents with chronic health or mental health needs
what groups of people are vulnerable?
> homeless families,
> travelling families,
> refugees and asylum seekers
what are the types of abuse?
- physical neglect
- emotional abuse
- physical abuse
- sexual absue
> combination
what is the definition of physical abuse?
> may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocation or otherwise causing physical harm to a child
> also includes fabricated and induced illness
how do you 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
(torn frenum, bruising behind both side of the ear)
what is the 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 do you recognise emotional abuse?
> poor growth
> developmental delay
> educational failure
> social immaturity
> lack of social responsiveness, aggression or
indiscriminate friendliness
> challenging behaviour
> attention difficulties
> Concerning parent-child interaction
emotional abuse is persistent emotional neglect or ill treatment…how does the abuser do this?
> 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 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 do you recognise sexual abuse?
> direct allegation (disclosure)
> sexually transmitted infection
> pregnancy
> trauma
> emotional and behavioural signs e.g. delayed development, anxiety and depression, self-harm, drug, solvent or alcohol abuse
what are multifactorial examples of neglect?
Multifactorial:
> Inadequate = food, shelter, medical care, clothing, protection from harm/danger, emotional support.
> ‘Non-organic failure to thrive’
what are the 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 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 do you recognise neglect?
> 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
what is the most important thing to remember when you are faced with a child who may have been abused ?
> you do not need to manage this on your own
> Members of the dental team are not responsible for making a diagnosis of child abuse or neglect, just for sharing concerns appropriately
what is dental neglect? (BSPD 2009)
> 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 a wider picture of neglect or abuse
> often a common indicator for overall child neglect
> Abused children 8 x more likely to have untreated decayed teeth. (Green at al. Paed Dent 1994)
what does a child need to reach/ have optimal oral health?
> 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 dependant on parents or carers to meet these needs
what are he signs of dental neglect?
> Poor dental maintenance and caries despite efforts made regarding oral 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 basis
> poor maintenance of orthodontic appliance, Pain (from wire sticking out)
how does the clinician identify 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.
what aspects parental awareness/ behaviour can cause the presence of severe untreated disease?
> 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 from 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
at all stages of the regional policy of the child protection process what must you do?
- assess
- plan
- intervene (if necessary)
- review
based of the regional policy for child protection what are the time scales?
> Confirm a phone referral in writing within 24 hours.
> Social services should acknowledge within 5 working days (follow up if don’t hear in 7 days).
> After a formal referral child to be seen by social services within 24 hours.
> Investigation, 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 do you do if you have concerns about a Childs welfare?
> assess the child
> take a history
> examine carefully
> talk to the child
> discuss with an appropriate colleague
> decide if you still have concerns
after discussion with a colleague, what do you do 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 upon
what if you no longer have concerns about a Childs welfare?
> provide necessary dental care
> keep full clinical records
> provide information about local support services for children and families
> arrange dental follow-up
what is the aim of intervention??
> The aim of intervention is not to blame the family, but to ensure that children receive the support needed to safeguard their welfare
what are the 3 stages of response to dental neglect according to level of concern?
- Preventive dental team management - (Treatment)
- Preventive multi-agency management - (Seek parental consent to consult other professionals)
- Child protection referral.- (If concerned that the child is suffering significant harm, a child protection referral should be made. Follow local child protection procedures.) (Belfast Health & Social Care Trust)
what responsibility lies on the dental team when it comes to concern of child welfare?
- Observe
- Record
- Communicate
- Refer for assessment
*NOT expected to diagnose
what are the tips for best practice in 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 is a good checklist to have if you are concerned/ suspicious for a Childs welfare?
> Could the injury have been caused accidentally and if so how?
> Does the explanation for the injury fit the age and the clinical findings?
> If the explanation is consistent with the injury, is this itself within normally acceptable limits of behaviour?
> If there has been delay in seeking advice, are there good reasons for this?
> The general demeanour of the child
> The nature of the relationship between guardian and child
> The child’s reactions to other people
> The reaction of the child to any medical or dental examination
> Any comments by the child and or guardian that give concern about the child’s upbringing or lifestyle
what is the 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
> History of violence within the family
