Safeguarding Children

Question 0

What are the four main areas of abuse?

Answer 0

Physical
Sexual
Emotional( includes the child witnessing domestic violence)
Neglect

Question 1

What are the basic human rights for children

Answer 1

Right to survive
To develope to their fullest
To protect form harmful influences, abuse and exploitation
To participate fully in family, cultural and social life

Question 2

Infra oral signs of sexual abuse?

Answer 2

Erythema
Ulceration and vesicle formation arising from gonorrhoea and STI’s
Erythema and petechiae at the junction of the hard and soft palate which may indicate oral sex

Question 3

What are the emotional and behaviour signs of abuse?

Answer 3

Delayed development 
Anxiety and depression
Psychosomatic indicators 
Self harm
Soiling or wetting the bed
Inappropriate sexual behaviour or language 
Running away
Drug abuse

Question 4

Dental neglect

Answer 4

May occur in isolation or an indicator of wider abuse. There is no threshold level of decay beyond which the diagnosis of dental neglect can be made

Question 5

How does the dental team respond to dental neglect?

Answer 5

Preventative team management- raise concerns with parents, offer support, set targets and monitor

Preventative multi agency management- liaise with other professionals such as school nurse, doctor, social worker and check the child protection register. Agree a joint plan of action and review at agreed intervals.

Refer to social services

Question 6

What to do if you are worried about a child?

Answer 6

First duty is to the child so address their pain.

Then assess the child

• details from the child and the carer about PC
• past dental history
• past medical history
• family and social circumstance

Full exam
Dental, oral or facial injuries note the site and any patterns
General appearance of the child, hygiene, thriving well.
Their demeanour and interaction with their parents. Look for frozen watchfulness where the child as to take in everything going on but in a detached wary and fearful manner.

Question 7

Features of concern about a child?

Answer 7

Delay in presentation
Discrepancy between history and findings
Developmental inappropriate findings
Previous concern over siblings or the child

Question 8

What questions to ask yourself if you are concerned?

Answer 8

Has there been a delay in seeking advise?
Does the history change over time or not explain the illness?
Do they have unexplained injuries
Are you concerned with the child’s behaviour and interaction Keith parent/ carer.

If you answer YES to any of these questions discuss with a. Senior colleague and follow child protection procedure.

Question 9

How to make a referral?

Answer 9

Referrals should be made by telephone so you can directly discuss your concerns and should be followed up in river ting within 48 hours .
The letter should clearly document the facts of the case and include and explicit statement of why you are concerned.

The telephone discussion should be Clearly recorded documenting what was said and what decisions were made and an unambiguous plan.

In letter document precisely what was said and your concerns

Question 10

Should you inform the parents that you are making a referral?

Answer 10

Good practise to explain your concerns and ask for consent .

Exceptions to this are

• if the discussion may but the child at further risk
• Discussion would impede a police investigation or a social work enquiry
• where sexual abuse by a family member is suspected or organised or multiple abuse is suspected
• where fabricated or. Induced illness is suspected
• if parents or carers are being violent and would place you at risk
• if it is not possible to contact the parents without causing undue delay in making the referral

Question 11

If asked to give witness in court

Answer 11

Can either be in the civil court ( child protection) or the criminal courts you should give an accurate unbiased account of your findings, your opinion based on those findings and any action you took as a consequence. In court you should NEVER venture beyond your level of expertise or provide opinions that you are unable to back up.

Question 12

Info sharing . When should you and what are the restriction?

Answer 12

Amount of shared info should be proportional to your level of concern
Most situations ask parents
The restrictions on info sharing

• the common law duty of confidence
• Human right act 1998
• Data protection act 1998

Question 13

Diagrams and clinical photographs

Answer 13

Notes should be clearly labelled with child’s identity
Marked with date and time
The diagram should be referred to in the notes
Annotated with descriptions and measurements

Not the dentists responsibility to take photographs off forensic quality