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Child Abuse and Neglect --A Dentist’s Perspective--

Child Abuse and Neglect --A Dentist’s Perspective--. Dr. Jeff Johnson University of Kentucky College of Dentistry Department of Oral Health Science Division of Pediatric Dentistry. Learning Objectives. The student dentist should be able to: Define child abuse and neglect.

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Child Abuse and Neglect --A Dentist’s Perspective--

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  1. Child Abuse and Neglect--A Dentist’s Perspective-- Dr. Jeff Johnson University of Kentucky College of Dentistry Department of Oral Health Science Division of Pediatric Dentistry

  2. 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.

  3. Child Abuse and Neglect--A Dentist’s Perspective-- Child abuse is defined as any act (non-accidental or trauma) that endangers or impairs a child’s 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, Children’s Hospital, Boston and Clinical Professor of Pediatric Dentistry, Harvard School of Dental Medicine

  4. Child Abuse and Neglect--A Dentist’s 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

  5. Child Abuse and Neglect--A Dentist’s 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)

  6. 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. Child Abuse and Neglect--A Dentist’s Perspective--

  7. Child Abuse and Neglect--A Dentist’s 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.

  8. Child Abuse and Neglect--A Dentist’s 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.

  9. Child Abuse and Neglect--A Dentist’s 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.

  10. Child Abuse and Neglect--A Dentist’s 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.

  11. Child Abuse and Neglect--A Dentist’s 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.

  12. 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. Child Abuse and Neglect--A Dentist’s Perspective--

  13. Child Abuse and Neglect--A Dentist’s Perspective-- • Child fatalities are the most tragic consequence of maltreatment. • Approximately 1,200 children died of abuse or neglect in the year 2000—a 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.

  14. Child Abuse and Neglect--A Dentist’s 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).

  15. Child Abuse and Neglect--A Dentist’s 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 public’s health.

  16. Child Abuse and Neglect--A Dentist’s 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.

  17. Child Abuse and Neglect--A Dentist’s 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.

  18. Child Abuse and Neglect--A Dentist’s 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.

  19. Child Abuse and Neglect--A Dentist’s 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.

  20. Child Abuse and Neglect--A Dentist’s 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!!!

  21. Child Abuse and Neglect--A Dentist’s 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.

  22. Child Abuse and Neglect--A Dentist’s 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 child’s misbehavior.

  23. Child Abuse and Neglect--A Dentist’s Perspective-- Remember. . .children with special needs are especially vulnerable to abuse.

  24. Child Abuse and Neglect--A Dentist’s 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

  25. Child Abuse and Neglect--A Dentist’s Perspective-- • In three large studies cited in the Dentists C.A.R.E. Conference, contusions and bruises totaled 37% of of all injuries.

  26. Child Abuse and Neglect--A Dentist’s Perspective-- • Bony fractures were the next highest and composed 15% of all injuries in the studies.

  27. Child Abuse and Neglect--A Dentist’s Perspective-- • Abrasions and lacerations made up another significant amount of types of injuries.

  28. Child Abuse and Neglect--A Dentist’s Perspective-- So. . .What about Kentucky??? “Childhood is a time for storytelling and sharing surprises with friends. It’s not a time for abuse.” --Kentucky First Lady Judi Patton (2000)

  29. Child Abuse and Neglect--A Dentist’s 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.

  30. Child Abuse and Neglect--A Dentist’s 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.

  31. Child Abuse and Neglect--A Dentist’s 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.

  32. Child Abuse and Neglect--A Dentist’s 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 Commonwealth’s Attorney, or the County Attorney.

  33. Child Abuse and Neglect--A Dentist’s Perspective-- • Anyone acting upon reasonable cause in the making of a report in good faith shall have immunity from any civil or criminal liability.

  34. Child Abuse and Neglect--A Dentist’s Perspective-- • Child/Adult Abuse Hotline 1-800-752-6200 • Parent Help line 1-800-432-9251

  35. Child Abuse and Neglect--A Dentist’s Perspective-- • For more information. . . www.cfc.state.ky.us/help/child_abuse.asp • Prevent Child Abuse Kentucky www.pcaky.org

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