CHILD ABUSE AND NEGLECT

Definitions

  • Child abuse and neglect affects children across all socio-economic groups, ethnicities, and cultures.

    • Physical Abuse: Nonaccidental physical injury caused by a parent, caregiver, or responsible individual.

      • 50-75% of cases exhibit orofacial trauma.

      • Battered child syndrome: Injuries do not match the explanation given.

      • Common injuries include bruises, welts, fractures, burns, and lacerations.

    • Sexual Abuse: Any sexual behavior or activity with a minor by an adult for the adult's sexual pleasure.

      • Oral findings include trauma to the oral cavity or sexually transmitted diseases in the oral cavity.

    • Neglect: Failure to provide basic needs for proper development, causing pain or suffering.

      • Can be physical, medical, educational, or emotional.

Additional Definitions

  • Emotional or Psychological Abuse: A behavior pattern that hinders a child’s development and self-esteem through constant criticism or lack of love and guidance.

  • Medical Child Abuse: Perpetrator fabricates/exaggerates signs or symptoms of illnesses in a child, leading to unnecessary and harmful tests or treatments. The medical community may unknowingly participate in this abuse.

Overview of Child Abuse in the United States

  • Abuse occurs across ages, races, genders, and socioeconomic levels.

  • In 2012, Child Protective Services received 3.4 million referrals involving 6.3 million children:

    • 78% for child neglect

    • 18% physical abuse

    • 10% sexual abuse

  • Most cases occur within families; factors include:

    • Economic pressure

    • Violent adult relationships

    • Substance abuse

    • Illness

  • Suspicious scenarios should be scrutinized.

Physical Indicators of Abuse

  • Unexplained injuries: bruises, fractures, burns, lacerations, and abrasions.

    • Normal injuries (bruises on shins and foreheads) vs. abnormal injuries (neck, upper arms, abdomen).

    • Bruising in infants not walking raises questions.

    • Unusual bruising patterns (shapes of objects) and various healing stages may indicate abuse.

    • Mouth injuries inconsistent with explanations and fractures at growth centers are also warning signs.

  • Other signs: cigarette burns, untreated injuries, poor hygiene, distended abdomen.

Behavioral Indicators of Abuse

  • Withdrawal, depression, and poor school performance.

  • Clinginess or social distance in children.

  • Fear of home or parents; may avoid eye contact.

  • Reports of caregiver-inflicted injury must be taken seriously.

  • Red flags in caregivers include indifference to the child’s injury or over-concern.

  • Changing narratives by parents can indicate deception.

History-Taking (for suspected abuse)

  • Complete medical and dental history gathering.

  • Details on trauma should be collected privately and thoroughly.

  • Use open-ended questions (who, what, when, where, why, how).

  • Parents altering their stories may signal issues.

  • Focus on documenting observations rather than investigating.

Physical Examination

  • Evaluate the head, neck, and skin carefully, considering the child’s age and development level.

  • Look for signs: long sleeves in summer, hair pulling (alopecia), unequal pupils, nasal fractures, bruising behind ears.

  • Traumatic injuries may manifest as labial/lingual frenum tears, malocclusion, and fresh oral trauma.

  • Note painful reactions when moving the child and document adult bite marks (3 cm. distance).

  • Take photographs with an ID tag and scale marker for evidence.

Management of Suspected Cases

  • Provide appropriate treatment for injuries/dental neglect and refer to specialists as needed.

  • Document observations meticulously, including statements, timelines, and injury descriptions with visual evidence.

  • Report suspicions to law enforcement and child protection services, regardless of further referrals.

  • Child abuse remains underreported due to healthcare provider concerns, beliefs, attitudes, and training inadequacies.

    • Dentists, physicians, teachers, and clergy are mandated reporters; some states also require hygienists to report.

Parental Concerns

  • Consult with parents respectfully about concerns regarding potential abuse.

  • Avoid accusations; emphasize the child's health and welfare.

  • In cases of obvious injury/abuse, contact law enforcement/CPS for protective custody.

  • Note that there is no legal obligation to inform parents of abuse suspicions or reports.