Transcript Child abuse and neglect

Child abuse and neglect
• Acts of commission or omission on the part of a
responsible caretaker.
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Child maltreatment is usually divided into :
Physical
Sexual
Emotional or psychological
neglect
• No one individual is responsible for deciding
what is abuse and neglect
• Identification
• Treatment
• intervention
• Maltreatment is not always willful
• Emotion expressed activety or passivity
against the child is often unplaned ,but
nontheless can result in significant harm or
death
Physical abuse
• Is often the most often the most easily
recognized form of child maltraetment.
• The injuries are inflicted and not
accidental;some result from punishment that
• Is inapporoprait for child s age,condition,or
level of development
• Result:parents frustration,lack control in
acting out anger
• Physical abuse is usually recognized by the
pattern of injury and ,or its inconsistency with
the history related.
• Bruises,welts,fractures,burns,and lacerations
are commonly inflicted physical injuries
• 50%:face and head
• 25%:aruond the mouth
Sexual abuse
• Sexual abuse and sexual misuse are frequently
interchanged terms that denote any sexually
stimulating activity that is inappropriate for the
child age,level of cognitive development,or role
within the family.
• Child sex play ,sexual experimentation , and
parent –child physical-sexual contact , it may be
difficult to distinguish normal behavior from
lustful intrusion
Sexual abuse
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Exhibition or kissing to fondling
Intercourse
Pornography
Rape
Trauma to the mouth may result from sexual
contact
neglect
• Inaattention to the basic needs of a child, such as
food,clothing,shelter,medical care,education,and
supervision.
• Depends on the child `age and levelopmen
• AAPD:willful failure of parent or guardian to seek
and follow through with treatment necessary to
ensure alevel of oral health essential for
adequate functionand freedom from pain and
infection.
• Culture and religious,poverty,community
requirements and standards
Emotional or psychological abuse
• Different definition
• Continuous
isolation,rejection,degradation,terrorization,
• corruption,exploitation,or denial of affection
Child abuse in medical setting
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Factitious disorder
Munchausen syndrome by proxy
Usually mother— illnesssigns or symptoms—
Fabricates illnesses—extensive medical
evaluation testing and prolongd
hospitalization
• Present with persistent and recurrent illness
that cannot be explained,with sign and
symptoms that do not make sense clinically
• Bizarre nature of many of these cases makes
them almost unbelievable to professionals
involved
Legal requirments
• report
Who is abuse
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No age ,race ,gender,or socioeconomic
65%neglect
16%physical
9%sexual
7%emotional
sociodemographic
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Average age: 7.4 y
48% male
49%white
23%black
18% hispanic
Sexual abuse :female
Infant to 2 y:neglect
12-17: sexual and emotionality
Family
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Low sc
Spousal abuse
Drug and alchol abuse
Health or economic stresses
Physical indicator
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History:mechanism of the injury
Time injury
developmentalevel
Unwitnessed
Bruises or welt in places not routinely
Bruises Different area at various stagesof healing
Multifracture in varying stages of healing
Fracture youger than 2 y
Intentional cigarette
Behavioral indicator
Withdrawal,dep,poor school performance,regression in
developmentally appropriate behavior,acting
out,clinginess, somatic complaints ,young children
wary and distant social interaction,afraid to go home
Caretaker-lack of concern or inappropriatehigh levels of
concern
Defensive or hostile
Refuse hospitalization and testing
change history
• Poor jujment,jealllousy or extrem protective
• Child abandonment,violent behavior,erratic
behavior(drug or alcholor psyhiatry)
neglect
• Delay in seeking medical care for a child
`obious injury ,doctor or or emergency
department shopping or excessive use of
medical care
evaluation
• Truma to the orofacial structures is frequent
manifestationof child abuse
• 50% physic al abuse
• Dental practitioner may be the first person
• History
• Detail
• Separatly(p-child)
• Open-ended question (what happened?)
• Witness
• (who- where-how)
Communication with the patient
• Suggest
• investigative
physicalexamination
• Examination:expose
• clothing,inappropiate dress
• Lackof spontaneous smiling –avoidance of eye
contact
• Parent:vigilance watchful
• Examinaqtion at the top:hair and scalpa
• Alopecia(medical-malnutritionor hair pulling
• Nose –septum
• Periorbital ecchymosis,ptosis,deviated or unequal
pupils
Hind the ears
• Bruises inside and behind ears
• Neurological assessment
• Any brusie in the shape of an object, such as a
belt,loop cord,hand print,or hanger
• Varing color of bruises---several stages of
resolution
• Examination neck
• Rope burns or bruises---strangulation
• Severe shaking –large bruises on the back of the
neck –brain damage
• Chest or ribs---lifting motion
• Bite marks---photographed
• Any missing teeth or previously truma tized
• Teeth(avulsions,luxation,intrusions,or fracture)
• Or soft tissue
• Mandible—deviation ,trismus,occlusion at
rest
• Maxilla—any mobility—facial fracture
• Bleeding under the tongue---fracture
mandible
• Maxilla labile frenum and the lower lingual
frenum
• Torn ligual frenum ---sexual abuseor forced
feeding
• Brusing or petechia of the soft and hard palat
---sexual abuse
• Infection and ulceration---speciments---STD
• Gonorrhea.syphilis,venereal wart
• Compelet history and physical exam—basic for
• suspicion
Manangement
ducumentation and peporting
• Medical and dental mangement
• Documentation(includingphotographs)
• And report
treatment
• the y medical or dental treatment that is
indicated by the child condition should be
• Provided,
• A referral for a complete pediatric history and
physical examination will assist in identifying
• And treating other possibly associated
conditions(e.g,FTT,anemia)
• Medical evaluationh should include
assessment for medical conditions that can
mimic or be confused . with child abuse.
• Differential diagnosis and any additional
medical evaluation necessary.
• Referral to a physician does not eliminate the
dentist `s obligation to make a report to
authorities if maltreatment is suspected.
ducumentation
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Medical history and physical examination
Positive and negative finding
Actual comments and negativefinding
Photography
Name –date photpgraphy
Method report ( telephone-written report)
reporting