Child Abuse and Neglect --A Dentist

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Child Abuse and Neglect--A Dentists
Perspective--

• Dr. Jeff Johnson
• University of Kentucky College of Dentistry
• Department of Oral Health Science
• Division of Pediatric Dentistry

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Learning Objectives

• The student dentist should be able to
• Define child abuse and neglect.
• Discuss indicators of abuse.
• List typical abuse patterns.
• Describe Kentucky statute as it relates to the
  reporting of suspected abuse.
• Discuss potential behaviors that may indicate an
  abusive situation.

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Child Abuse and Neglect--A Dentists
Perspective--

• Child abuse is defined as any act (non-accidental
  or trauma) that endangers or impairs a childs
  physical or emotional health or development.
• Child neglect is defined as the failure to
  provide adequate support, supervision, nutrition,
  medical or surgical care.
• Dr. Howard Needleman
• Associate Dentist-in Chief, Childrens
  Hospital, Boston and Clinical Professor of
  Pediatric Dentistry, Harvard School of Dental
  Medicine

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Child Abuse and Neglect--A Dentists
Perspective--

• Types of child abuse
• 1. Physical abuse
• 2. Emotional abuse and neglect
• 3. Health care neglect (medical and dental)
• 4. Physical neglect
• 5. Sexual abuse
• 6. Failure to thrive
• 7. Safety neglect
• 8. Intentional poisoning
• 9. Munchausen Syndrome by proxy

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Child Abuse and Neglect--A Dentists
Perspective--

• Factors contributing to abuse
• 1. Dire poverty
• 2. Stress
• 3. Lack of support network
• 4. Substance/alcohol abuse
• 5. Learned behavior
• 6. Other forms of violence in the home (spousal
  or elderly abuse)

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Child Abuse and Neglect--A Dentists
Perspective--

• In 2000, three million referrals concerning the
  welfare of approximately five million children
  were made to CPS agencies throughout the United
  States.
• Professionals including teachers, law enforcement
  officers, social service workers, and physicians,
  made 56 of the reports.

• Family members, neighbors, and other members of
  the community made the remaining (44) referrals.
• Almost one-third of investigations resulted in
  finding that the child was maltreated or at risk
  of maltreatment.

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Child Abuse and Neglect--A Dentists
Perspective--

• National statistics for the year 2000
• 63 of child victims suffered neglect
• 19 were physically abused
• 10 were sexually abused
• 08 were psychologically maltreated
• Approximately 12.2 per 1000 children were victims
  of abuse in the year 2000.

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Child Abuse and Neglect--A Dentists
Perspective--

• More than half of all victims were Caucasian
  roughly a quarter were African American 15
  percent were Hispanic American Indian/Alaska
  Natives/Asian and Pacific Islanders accounted for
  3 percent of victims.

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Child Abuse and Neglect--A Dentists
Perspective--

• Victimization rates decline as age increases.
• The rate of victimization for children in the age
  group of birth to 3 years old was 15.7 victims
  per 1,000 children of the same age.
• The rate of victimization for children ages 16
  and 17 was 5.7 victims per 1,000 children of the
  same age in the population.

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Child Abuse and Neglect--A Dentists
Perspective--

• Excluding sexual abuse, victimization rates were
  similar for male and female victims (11.2 and
  12.8 per 1,000 children respectively).
• The rate for sexual abuse was 1.7 victims per
  1,000 female children compared to 0.4 victims per
  1,000 male children.

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Child Abuse and Neglect--A Dentists
Perspective--

• Most states define perpetrators of child abuse or
  neglect as parents and other caretakers, such as
  relatives, babysitters, and foster parents, who
  have maltreated a child.
• Sixty percent of perpetrators were females and 40
  percent were males.
• The median age of female perpetrators was 31
  years the median age of male perpetrators was 34
  years.

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Child Abuse and Neglect--A Dentists
Perspective--

• More than 80 percent of victims were abused by a
  parent or parents.
• Mothers acting alone were responsible for 47
  percent of neglect victims and 32 percent of
  physical abuse victims

• Non-relatives, fathers acting alone, and other
  relatives were responsible for 29 percent, 22
  percent and 19 percent, respectively, of sexual
  abuse victims.

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Child Abuse and Neglect--A Dentists
Perspective--

• Child fatalities are the most tragic consequence
  of maltreatment.
• Approximately 1,200 children died of abuse or
  neglect in the year 2000a rate of 1.71 per
  100,000 children in the population.
• Youngest children were the most vulnerable.
  Children younger than one year old accounted for
  44 percent of child fatalities and 85 percent of
  child fatalities were younger than 6 years of age.

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Child Abuse and Neglect--A Dentists
Perspective--

• What is the role of the dental professional in
  detecting child abuse??
• To answer the aforementioned question, the ADA
  sponsored a conference in 1998 called Dentists
  C.A.R.E. (Child Abuse Recognition and Education
  Conference).

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Child Abuse and Neglect--A Dentists
Perspective--

• In approximately 65 of all cases of physical
  abuse, injuries occur in the head, neck, and face
  areas.
• Knowing that dentists are in a good position to
  detect such injuries, the dental profession has
  stepped up professional education efforts to
  improve the publics health.

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Child Abuse and Neglect--A Dentists
Perspective--

• In a recent study by da Fonseca, Feigal, and
  Bensel, it was concluded that of the 1248 cases
  used in the project, 37.5 included injuries to
  the head, face, mouth or neck. Interestingly,
  dentists did not examine or refer any children in
  the study.

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Child Abuse and Neglect--A Dentists
Perspective--

• Common peri- and intra-oral indicators of abuse
• 1. Bite marks (on tongue).
• 2. Torn frenum.
• 3. Palatal bruising.
• 4. Avulsed teeth.
• 5. Black eyes.
• 6. Damage to the ears.
• 7. Intra- and extra-oral burn marks.

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Child Abuse and Neglect--A Dentists
Perspective--

• To detect abuse, there must be a clinical
  protocol including behavioral assessment of the
  child and parent/guardian, patient history,
  general physical assessment, oral examination,
  injury documentation, and consultation with state
  social service department to discuss suspicions.

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Child Abuse and Neglect--A Dentists
Perspective--

• Behavioral indicators of abuse
• 1. Child does not make eye contact.
• 2. Child is wary of patients.
• 3. Child demonstrates fear of touch.
• 4. Child displays dramatic mood changes.
• 5. Child seems either withdrawn or aggressive.
• 6. Child has history of attempts of suicide and
  running away.

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Child Abuse and Neglect--A Dentists
Perspective--

• Patient history indicators of abuse
• 1. Patient has unexplained injuries or injuries
  that are inconsistent with the explanation.
• 2. There is a delay in seeking care.
• 3. The adult who was present at the time of the
  injury is absent at the examination.
• 4. The child makes a specific accusation.
• If a child accuses someone, take that as the
  truth!!!

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Child Abuse and Neglect--A Dentists
Perspective--

• Specific caregiver indicators strongly suggestive
  of abuse
• 1. Caregiver gives an explanation of the injury
  that is not believable.
• 2. The explanation is inconsistent or changes.
• 3. The child has been previously abused.
• 4. The caregiver understates the seriousness of
  the condition or projects blame to a third
  party.
• 5. The caregiver delays seeking attention,
  cannot be located, functions poorly, or has a
  history of substance abuse.

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Child Abuse and Neglect--A Dentists
Perspective--

• Non-specific caregiver indicators of abuse
• 1. Caregiver displays hostile and aggressive
  attitude.
• 2. The caregiver appears compulsive, inflexible,
  unreasonable, cold, passive, and dependent.
• 3. Caregiver avoids certain hospitals because
  they know signs of abuse are noticed so they
  shop hospitals.
• 4. Caregiver has unrealistic expectations of the
  child or he/she overreacts to the childs
  misbehavior.

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Child Abuse and Neglect--A Dentists
Perspective--

• Remember. . .children with special needs are
  especially vulnerable to abuse.

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Child Abuse and Neglect--A Dentists
Perspective--

• Physical indicators of abuse include
• 1. Bruises
• 2. Welts
• 3. Bite marks
• 4. Burns
• 5. Fractures
• 6. Injuries to the head
• 7. Dental/medical neglect

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Child Abuse and Neglect--A Dentists
Perspective--

• In three large studies cited in the Dentists
  C.A.R.E. Conference, contusions and bruises
  totaled 37 of of all injuries.

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Child Abuse and Neglect--A Dentists
Perspective--

• Bony fractures were the next highest and composed
  15 of all injuries in the studies.

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Child Abuse and Neglect--A Dentists
Perspective--

• Abrasions and lacerations made up another
  significant amount of types of injuries.

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Child Abuse and Neglect--A Dentists
Perspective--

• So. . .What about Kentucky???
• Childhood is a time for storytelling and sharing
  surprises with friends. Its not a time for
  abuse.
• --Kentucky First Lady Judi Patton (2000)

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Child Abuse and Neglect--A Dentists
Perspective--

• 62.9 Kentucky children per 1,000 were reported as
  being abused or neglected.
• 28.2 Kentucky children per 1,000 were confirmed
  victims.
• 65 were neglected, 27 were physically abused,
  and 8 were sexually abused.

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Child Abuse and Neglect--A Dentists
Perspective--

• Kentucky statute (KRS 620.020) defines the abused
  or neglected child as an individual whose health
  or welfare is harmed or threatened with harm when
  his/her parent, guardian, or other person
  exercising custodial control or supervision of
  the child
• 1. Inflicts or allows to be inflicted upon the
  child physical or emotional injury by other
  accidental means
• 2. Creates or allows to be created a risk of
  physical or emotional injury to the child by
  other than accidental means
• 3. Commits or allows to be committed an act of
  sexual abuse, sexual exploitation, or
  prostitution upon the child
• 4. Abandons or exploits such child.

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Child Abuse and Neglect--A Dentists
Perspective--

• Kentucky statute also states that a child is
  considered abused or neglected when he/she is not
  provided with adequate care, supervision, food,
  clothing, shelter and education, or medical care
  necessary for his/her well being.

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Child Abuse and Neglect--A Dentists
Perspective--

• In Kentucky, who shall report? According to KRS
  620.030, any person who knows or has reasonable
  cause to believe that a child is dependent,
  neglected, or abused shall immediately cause an
  oral or written report to be made to a local law
  enforcement agency or the Kentucky State Police,
  the Department for Social Services, the
  Commonwealths Attorney, or the County Attorney.

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Child Abuse and Neglect--A Dentists
Perspective--

• Anyone acting upon reasonable cause in the making
  of a report in good faith shall have immunity
  from any civil or criminal liability.

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Child Abuse and Neglect--A Dentists
Perspective--

• Child/Adult Abuse Hotline
• 1-800-752-6200
• Parent Help line
• 1-800-432-9251

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Child Abuse and Neglect--A Dentists
Perspective--

• For more information. . .
• www.cfc.state.ky.us/help/child_abuse.asp
• Prevent Child Abuse Kentucky
• www.pcaky.org