Prevevtive Sheet #4 By Aseel Al-badaineh

Out line



1-defination

2-type of child abuse

3-risk factors

4-prevalance

5-type of injury you can see

6-diagnose and management of the child





Definition: is considered to be abused if he or she
is treated in way that is un acceptable in given culture at given time.”Neadow
1993”

So we identify that the type of treatment is not acceptable
emotionally or physically and some thing that affect the child in along time
according to culture differences .





Why to prevent??

-preventing death .physical and mental handicap, suffering .

-35_50%of child suffer injury

-50%will die if they return home without treatment

Sooo this is very important if you see it ,make sure to
manage it.



Victoria
climbic

She is an example of a child from Colombia, Victoria mam sent victoria with her ante to get better
life in UKand the ante boy friend harm
victoria ,she has many treatment and sent many time to the hospital
,once she had burns on her face, again burns in all her body so the hospital identify
that there is problem but again return her to the home ,at the end she spend all the winter in bath
room and only covered by plastic thin
sheet at cold ,so she sent to the
hospital with hypothermia ,malnutrition and when they did different examination
they look on her body and found 128 injuries in different part .

Sooo again we can prevent suffering of child.



Prevalence of child abuse


Its very difficult because of

-abuse and neglect are under reported and under recorded

-about 50,000children in the UK
are at risk of abuse (on child protection registrater)”nspcc,uk(2012).

Soo all children that are at high risk of abuse register at
NSPCC



Child abuse in Jordan

-reporting cases are rising ,so more identification and more
interesting

-661 in 2002

-1,423 in 2004(more than double)

Again there could be some cases under estimated



Dar al-Aman center ,Amman
“جزء من جمعية
حماية الاسرة المسؤؤلة عن حماية الاطفال,وهي وسيلة لمعالجة العنف ضد الطفل "



the child are taken
and the parent are guided and counseling about the ways of child management

Type of child abuse


1-physical ‘when anon
accidental act cause injury to the body of the child ‘it’s the most common, it
could be minimal or fetal

Child abuse could non
accidental, so you have to differentiate between the injuries that happen
accidentally and non accidentally

2- Sexual’ cover broad
range of sexual act that not suitable to the child age or development

3-emotional ‘the most
difficult to diagnose ‘,behavior which endanger the child mental health and
emotion wellbeing

4-neglet ,some thing
seen a lot “negligent treatment of a child so their health ,welfare or safety
are harmed and give the basic need (no food ,no clothes ,not seeing doctors,
not going to school);we see it in the clinic when the child has all his teeth
with caries and not taken to the doctors, suffering of pain and infection .



Risk factors

We are taken about higher risk that happen in a situation of
etiology

1-personallity trait of abuser :usually they are a young and
or single parent which increase the stresses in dealing child.

Alcohol and or drug abuse that can’t take care of child /abused as a
child themselves (20 time to abuse children )/psychiatric history or
personality disorder make them unable to deal with child ) /marital instability(problem
btw mother and father J) / it may be apparent. relative cohabitant not
relative to child.



2- characteristic of child that make him more abuse :add
stress and provokes anger (continuous crying ,soiling their clothes, maybe un
wanted child or pregnancy ,handicapped need
special care .



3-ennviromental factors
:occur in all social classes /unemployment /economic hard ship /single
parent or young may have problem in dealing with child .



So why as dentist we talk about child abuse

It because 50%of physical abuse result in facial and head
injury ,and this area we usual examine so its very good position to pick up any
kind of abuse injuries, and also 25%of abuse injury occur in and around mouth .

Type of abuse injuries

Bruises

Fractures

Bites

Burn

Laceration …………………………………………

Dental trauma (it not just by falling,theres too many thing
that may result in dental trauma )





Most common extra oral injuries are bruising, cut and
laceration ,fracture ,abrasion ,fracture
(least common)



Most common intraoral injuries are bruising ,cut and
dental trauma



Bruises

Basically 90% of child abuse “most common type “

-accidental bruises is rare in young immobile children ,as
if we have infant with bruises its non accidental because he doesn’t set or
walk

.especially in soft area of the cheek

-even if the child fall the bruises will not be prominent





“You have to keep in mind how to differentiate
between accidental and non accidental”

Usually accidental injury occur over bony
prominent; chin ,knee, elbow ,

But its not common to have bruise in soft area
where’s no bone as cheek,scalp,ear, nose, neck

In non accidental bruises you can see different
ages of bruises and more than one episode of bruises ,bruises in different
stages and different color

Theres also some features for non accidental
bruises you may see finger tips imprint (slap gripping/arcade ),some time you could see object imprint.



About bruise on the ear ,what is ?it looks like cigarette but its not, its bruise “picture”



{differential diagnosis of bruising are }

1-paint or ink on the skin .

2-bleeding disorders (thrombocytopenia, hemophilia) are more
likely to a bruise so even with accidental ,they will get bruise in the soft
area .

3-birth mark, the child could born with this bruise .



Laceration /cut

Burns

Cigarette burns are something people use actually to harm child,
and usually characteristic by .5-1cm in width, as Victoria that get injury in whole her body
with cigarette burns” so a person who dose this is sick”.

It could be some thing else conform to hot object ,conform
object shape.

Scald

Its wet burns ‘hot liquid”.

Again you have to differentiate between accidental and non
accidental .if it accidental you can see splash mark ,but if it non accidental
as dipping the child in something hot ,you would see a clear demarcated .rarely
seen on the face

Bites

Again you can see the imprint of the teeth and tissue damage
,you can see direct pressure of the teeth and mostly the most prominent tooth
is the canine with bruise in the center and
V notch .

When they take a photo of any kind of injury they put a ruler
and measure it ,so in adult bite form
they measuring it ,is about 3 cm
or more ,because a child may bite each other rather than adult.

So you have to differentiate between a child or adult bite
not from teeth but by using a ruler and
taking a photo

- usually you can see double arcade ;the upper lower teeth
,canine prominent ,central bruise .

Fractures

In sever cases , skull fractures with multiple and complex
configuration and intra cranial hemorrhage.

You can see fractures in other bone
(rib,metaphyseal,scapular )

You can see fractures at different stages which mean many episodes of abuse .

-bilateral fractures, and any other signs of abuse



What we can see in
the mouth ?



Intra orally: why the
mouth is get targeted ?

Because the child may be screaming and crying the parents
direct there action to this area to keep them quit ,so if the hitting is done by upward motion
we would bruise upper lip and turn the frenum .

-torn labial frenum not necessary be pathognamic “not definitely
child abuse ,it could due to forced
feeding if the parents forced the spoon toward frenum”and it could by pulling the
frenum down .

History ,examination and
good investigation






*..You have to be aware of certain thing in the history .

-detailed history of pain/injury” why ,what cause the injury,
exactly what happen.

Make sure in the clinic to ask where, when ,why in case of dental trauma ,

-record the parents and child explanation ,and its better to
listen from suffered child and see if there’s a match .

-when and where incident took place

-what time, its important to see the delay in seeking the
treatment ang ask why the child not get the help.

-witnesses

-after how much time medical help sought.

*..You have to ask about the medical history

-bleeding disorders may cause bruises

-osteogenesis imperfecta
may cause fractures

*…you have to ask about family and social history .

-record of previous accidents

-may the brothers and sisters are of same injury .




Start with general examination, when the child walk in the
surgery ,what wear ,are they clean ,about dresses ,as if the child wear in
winter short clothes L,facial expression are they afraid
;characteristically children who are abuse have facial expression called لبيسشس

-you do your extra
oral examination ,you look to head-scalp,eyes,face,neck,ears and throat.

-after general
examination do oral examination to lips,
oral mucosa ,teeth ,fractures,luxation
and then you do some investigation as radiograph.





Key
indication of non accidental injury

1-unexplained delay in
seeking help

2-vague history or history
that varies ,no detail or parent change history every time you ask them.

3-ahistory that is in
compatible with the injury seen

4-abnormal behavior by
parents; highly defensive aggressive ,angry.

5-child appearance
,especially facial expression .

6-parent_child
relation ship .

7-history or signs of
previous injury .

8-other signs of
abuse-neglect or deprivation .

9- if the child tell
you that some one hit me ,make sure to respect this and take it in your
consideration .



Dentist
role



1-well documented
detailed history

2-record,draw diagram
for the injury, take photograph

3- check the history
several time at the beginning ,middle and at the end for consistency

4-provide an emergency treatment ,there’s reason for child coming so don’t ignore it

5-Report your suspicious





Reporting non
accidental injury in Jordan
not known so the doctors will give us an articles.

When looking
to dentist knowledge about child abused ,unfortunately in Jordan not doing very well.

We are
suspicious .

Don’t accuse
the parents .

Consultation
with specialist pediatric dentist .

Contact
protection agency.

Be prepared
to report suspicious cases