child protection and dental neglect Flashcards

1
Q

what is child abuse?

A

> the physical, sexual or emotional mistreatment or neglect of a child

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2
Q

what is a child?

A

> a child is defined as a person under the age of 18 years

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3
Q

what does the GDC expect registration to do in the case of child protection?

A

> 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

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4
Q

who’s responsibility is child protection?

A

> Everyone’s responsibility.

> A shared responsibility.

> The responsibility of every member of the dental team

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5
Q

what are the current Northern Ireland legislations involved with child protection?

A

> 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

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6
Q

what are the 5 Rs outlined in the child protection and dental team?

A

> Responsibility

> Recognising

> Responding

> Reorganising

> Resources

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7
Q

based of the children and young peaples charter…what do they have the right to?

A

> 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

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8
Q

what was the outcome of the laming report for professionals?

A

> ‘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

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9
Q

who abuses ?

A

abuse can occur in/ or by =

> Families

> Institutions or community settings

> People known to them

> Or more rarely by strangers

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10
Q

who is vulnerable to abuse?

A

> 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

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11
Q

what groups of people are vulnerable?

A

> homeless families,

> travelling families,

> refugees and asylum seekers

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12
Q

what are the types of abuse?

A
  1. physical neglect
  2. emotional abuse
  3. physical abuse
  4. sexual absue

> combination

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13
Q

what is the definition of physical abuse?

A

> 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

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14
Q

how do you recognise physical abuse?

A

> 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)

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15
Q

what is the definition of emotional abuse?

A

> persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development

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16
Q

how do you recognise emotional abuse?

A

> poor growth

> developmental delay

> educational failure

> social immaturity

> lack of social responsiveness, aggression or
indiscriminate friendliness

> challenging behaviour

> attention difficulties

> Concerning parent-child interaction

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17
Q

emotional abuse is persistent emotional neglect or ill treatment…how does the abuser do this?

A

> 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

18
Q

what is sexual abuse?

A

> 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

19
Q

how do you recognise sexual abuse?

A

> 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

20
Q

what are multifactorial examples of neglect?

A

Multifactorial:
> Inadequate = food, shelter, medical care, clothing, protection from harm/danger, emotional support.

> ‘Non-organic failure to thrive’

21
Q

what are the signs of neglect?

A

> Failed to reach normal weight/growth or developmental milestones

> physical and genetic reasons have been medically eliminated

22
Q

what are the long term effects of neglect ?

A

> serious childhood illnesses and reduction in stature

> in young children this is life threatening within a short period of time

23
Q

what is the definition of neglect?

A

> 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

24
Q

how do you recognise neglect?

A

> 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

25
Q

what is the most important thing to remember when you are faced with a child who may have been abused ?

A

> 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

26
Q

what is dental neglect? (BSPD 2009)

A

> 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)

27
Q

what does a child need to reach/ have optimal oral health?

A

> 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

28
Q

what are he signs of dental neglect?

A

> 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)

29
Q

how does the clinician identify dental neglect through assessment of dental and non dental factors?

A

> 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.

30
Q

what aspects parental awareness/ behaviour can cause the presence of severe untreated disease?

A

> 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

31
Q

what to do if you have concerns that a child is at risk from abuse or neglect?

A

> Follow local policies and procedures,

  • Understanding the Needs of Children in Northern Ireland, 2011. UNOCINI Guidance.
  • N. Ireland DHSSPS, Child Protection, June 2016
32
Q

at all stages of the regional policy of the child protection process what must you do?

A
  1. assess
  2. plan
  3. intervene (if necessary)
  4. review
33
Q

based of the regional policy for child protection what are the time scales?

A

> 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.

34
Q

what do you do if you have concerns about a Childs welfare?

A

> assess the child

> take a history

> examine carefully

> talk to the child

> discuss with an appropriate colleague

> decide if you still have concerns

35
Q

after discussion with a colleague, what do you do if you still have concerns?

A

> 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

36
Q

what if you no longer have concerns about a Childs welfare?

A

> provide necessary dental care

> keep full clinical records

> provide information about local support services for children and families

> arrange dental follow-up

37
Q

what is the aim of intervention??

A

> The aim of intervention is not to blame the family, but to ensure that children receive the support needed to safeguard their welfare

38
Q

what are the 3 stages of response to dental neglect according to level of concern?

A
  1. Preventive dental team management - (Treatment)
  2. Preventive multi-agency management - (Seek parental consent to consult other professionals)
  3. 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)
39
Q

what responsibility lies on the dental team when it comes to concern of child welfare?

A
  1. Observe
  2. Record
  3. Communicate
  4. Refer for assessment

*NOT expected to diagnose

40
Q

what are the tips for best practice in safeguarding children in the dental practice?

A
  1. Identify a staff member to lead on child protection
  2. Adopt a child protection policy
  3. Follow best practice in record keeping
  4. Undertake regular team training
  5. Practice safe staff recruitment
  6. Follow-up children who have dental disease & DNA
41
Q

what is a good checklist to have if you are concerned/ suspicious for a Childs welfare?

A

> 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

42
Q

what is the index of suspicion for child abuse?

A

> 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