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An Introduction to Child Protection and Dental Neglect Flashcards

1
Q

Define child abuse

A

The physical, sexual, or emotional mistreatment or neglect of a child

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2
Q

A child

A

Person under the age of 18 years

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3
Q

What does the GDC expect?

A

Be aware of procedures to raise concern
Have knowledge of who to contact
How to refer to the appropriate authority

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4
Q

Child protection is…

A

Everyone’s responsibility
A shared responsibility
Responsibility of every member of the dental team

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5
Q

What is the current NI leglislation regarding child care?

A

The Children (NI) Order 1995
Addressing Bullying in Schools Act (NI) 2016
Children’s Services Co-operation Act (NI) 2015
Safeguarding Board Act (NI) 2011
Safeguarding Vulnerable Groups (NI) Order
2007
Criminal Law Act (NI) 1967
Legislation about criminal offences of abuse and
neglect
POCVA (NI) 2003

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6
Q

What does the ‘child protection and the dental team’ documentation do

A

Responsibility
Recognising
Responding
Reorganising
Resources

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7
Q

Children and the young people’s charter?

A

The right to respect
The right to information about yourself
The right to be protected from harm
The right to have a say in your life
The right to have a good start in life
The right to be and feel secure

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8
Q

Victoria Adjo Climbie
Died 25/02/2000
Jan 2003

A

8 years old
Suffered months of appalling ill treatment from her Great aunt and John Manning, who received life sentences

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9
Q

Victoria Adjo Climbie
Died 25/02/2000
Jan 2003

A

Publication of Lamming Report containing 108 recommendation s covering accountability and good practice

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10
Q

What was the outcome of the Lamming report?

A

Do the simple things better-
Professionals should have
A responsibility to work together
Should never do nothing
Confidentiality doesn’t apply

Training and education if contact with children is a regular feature of work

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11
Q

Who abuses?

A

Families
Institutions and community settings
People known to them
Or rarely by strangers

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12
Q

Who are more vulnerable to abuse

A

Younger children
- under 5
- Infants under 1
- Pre-term babies
Children with disabilities/learning difficulties
A ‘difficult’ or ‘demanding’ baby
Children living away from home
Children who are/were on the child register

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13
Q

Other vulnerable groups include

A

Homeless families
Travelling families
Refugees and asylum seekers
Children of parents with chronic health or mental health needs

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14
Q

Types of abuse

A

Physical injury
Emotional abuse
Sexual abuse
Physical neglect
Combination

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15
Q

Physical injury accidental

A

Head, forehead, nose, chin, elbows, palm, knees and shins

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16
Q

Physical injury non accidental

A

Ears, triangle of safety, inner aspects of arms, side of trunk (esp over boney spine)
Sides of feet, inner aspect of thighs, groin or genital
Chest, abdomen, forearms (when raised to protect)
Intra-oral
Soft tissues of cheeks
Black eyes, especially if bilaterally

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17
Q

What to remember with accidental injuries

A

Involve boney premices
Match the history
Are in keeping with the development of the child

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18
Q

What to remember with non-accidental injuries

A

Injuries to both sides of the body
Injuries to soft tissue
Injuries with particular patterns
An injury that doesn’t fit the explanation
Delays in presentation
Untreated injuries

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19
Q

3 signs of abuse to the face that the dentist could pick up on

A

Slap marks
Torn frenum
Bruising to both sides of the ear

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20
Q

What is the definition of physical abuse

A

May involve hitting, shaking, throwing,
poisoning, burning or
scalding, drowning,
suffocation or otherwise causing physical harm to the child

Also includes fabricated or induced illnesses

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21
Q

How to recognise physical abuse

A

Bruising, abrasions, lacerations, burns, bite
marks, eye injuries, bone
fractures, intra-oral injuries
 site, size, patterns
 delay in presentation
 does not fit the explanation given

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22
Q

Prevalence of abuse in NI
Physical
N. Ireland DHSSPS, June 2017
Number of children on child protection register in NI
And percentage of total

A

694
33.7 percent

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23
Q

Emotional?

A

182
8.8 percent

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24
Q

Sexual?

A

132
6.4 percent

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25
Neglect
583 28.3
26
Multiple
470 22.8
27
Total
2061 47.3 in 10,000 100 percent
28
Definition of emotional abuse?
Persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development
29
How to recognise it
Poor growth  developmental delay  educational failure  social immaturity  lack of social responsiveness, aggression or indiscriminate friendliness  challenging behaviour  attention difficulties  concerning parent-child interaction
30
What does emotional abuse include?
Conveying to a child that they are worthless or unloved/inadequate Imposition of inappropriate expectations on a child Causing children to feel frightened or in danger, or exploiting or corrupting children
31
What is the definition fo sexual abuse
 forcing or enticing a child or young person to take part in sexual activities, including prostitution, whether or not the child is aware of what is happening
32
How to recognise it?
 direct allegation (disclosure)  sexually transmitted infection  pregnancy  trauma Emotional and behavioural signs eg. Delayed development, anxiety and depression, self harm, drug, solvent or alcohol abuse
33
In what way is neglect multi factorial?
Inadequate food, shelter, medical care, clothing, protection from harm/danger, emotional support.
34
What phrase is associated with neglect?
Non organic failure to thrive
35
What is the definition of neglect?
Persistent failure to meet a child’s basic needs, likely to result in the serious impairment of the child’s health or development Includes failing to ensure appropriate medical care or treatment
36
How to recognise it?
 failure to thrive  short stature  inappropriate clothing  frequent injuries  ingrained dirt  developmental delay  withdrawn or attention seeking behaviour  failure to respond to a known significant dental problem
37
In practice what do you need to remember about neglect?
That you’re not responsible for diagnosing it but you should share concern You don’t have to deal with it on your own
38
Signs of neglect?
Failed to reach normal weight/growth or developmental milestones Physical and genetic reasons have been medically eliminated
39
What are the long term effects of neglect?
Serious childhood illnesses and reduction in stature In young children this is life threatening within a short period of time
40
What is dental neglect?
the persistent failure to meet a child’s basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development May occur in isolation or be part of wider picture of neglect or abuse
41
To reach optimal oral health a child needs
A diet limited in amount and frequency of sugar intakes A regular source of fluoride Daily oral hygiene Access to regular dental care Children are reliant on parents or careers to meet these needs
42
Dental neglect is a common indicator of
Overall child neglect
43
Abused children and untreated decayed teeth?
Abused children are 8 times more likely to have untreated decayed teeth
44
What are the signs of dental neglect?
Poor dental maintenance and caries despite efforts made regarding dental hygiene instruction and dietary advice Carer appears to have ignored dental pain in child Repeated failure to engage with dental services Children who fail to attend appointments on a regular bases
45
Identifying dental neglect ... through assessment of dental and non dental factors
 Evaluation of dental diseases, Caries, oral pain, infection, trauma, and oral pathology  Asking children about their symptoms.  Symptoms reported by parents and carers should also be recorded.  Consider consulting others e.g. nursery staff or teachers. Severe dental caries in children should be a healthcare priority.
46
Severe untreated disease may occur due to lack of parental awareness This could include
 Lack of knowledge  Failure to implement recommended preventive advice  Neglect to seek dental care.  Fear  Family stress or poverty.  Lack of dental healthcare traditions,  or trust in the dental healthcare system
47
What to do if you have concerns that a child is at risk of abuse or neglect
Follow local policies and procedures,  Understanding the Needs of Children in Northern Ireland, 2011. UNOCINI Guidance.  N. Ireland DHSSPS, Child protection June 2016
48
Additional guidance?
Child protection and dental team hosted by the BDA 2016 NICE accredited Child maltreatment: When to suspect maltment in under 18s. NICE Clinical guideline [CG89] Published date: July 2009. Updated 2014, renamed 2016,review date 2017.Hosted by the British
49
Steps in the child referral process regional policy
See the flowchart
50
Time scale- regional policy
- Confirm a phone referral in writing within 24 hourschild to be seen by social services within 24 hours.] - Social services should acknowledge within 5 working days (follow up if don’t hear in 7 days) - After a formal referral the child is to be seen by social services within 24 hours  Ivestigation, initial assessment and initial case conference within 15 working days.  Core group meeting within 10 working days of case conference.  Review case conference at no more than 3 months then 6 monthly.
51
What can you use for referral as a guide in practice
Child protection and dental team flowchart
52
What to do if you have concerns?
- Assess the child  take a history  examine carefully  talk to the child  discuss with an appropriate colleague  decide if you still have concerns
53
If you still have concerns
Provide urgent dental care  talk to the child and parents  explain your concerns  inform of your intention to refer  seek consent to sharing information  keep full clinical records  refer to social services  confirm referral has been acted on
54
If you no longer have concerns
 provide necessary dental care  keep full clinical records  provide information about local support services for children and families  arrange dental follow-up
55
The aim of intervention is ...
is not to blame the family, but to ensure that children receive the support needed to safeguard their welfare
56
Responding to dental neglect occurs in 3 stages according to the level of concern ...
i) Preventive dental team management (ii) Preventive multi-agency management (iii) Child protection referral
57
Responsibility of the dental team
Observe Record Communicate Refer for assessment NOT expected to diagnose
58
Tips for best practice when safeguarding children in the dental practice
1. Identify a staff member to lead on child protection 2. Adopt a child protection policy 3. Follow best practice in record keeping 5. Undertake regular team training 6. Practice safe staff recruitment 7. Follow-up children who have dental disease & DNA
59
What’s important when looking at child protection?
Accident? Does explanation fit the age and clinical findings? Delay in seeking advice and if so why? Demeanor of child Nature of relationship between guardian and child? Child’s reaction to others and reaction to receiving medical/dental examination? Comments about the child that raise concern?
60
Index of suspicion for child abuse
Delay in seeking help Story vague, lacking in detail, vary with each telling and person to person Account not compatible with injury Parents mood abnormal. Preoccupied.  Parent/guardian behaviour gives cause for concern  Child’s appearance and interaction with parents is abnormal  Child may say something contradictory  History of previous injury

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