Child abuse and neglect is a major health problem all over the world. In most of the cases the perpetrator is someone whom the child or the parent knows. April has been designated Child Abuse Prevention Month in the United States since 1983. U.S. President Barack Obama continued that tradition by declaring April 2009 Child Abuse Prevention Month.

1. CHILD
ABUSE
AND
NEGLECT
By
Priyanka
Pant

2. INTRODUCTION
Child abuse is a major public health problem
all over the world. There are four major types
of abuse: physical abuse, sexual abuse,
emotional abuse and neglect. Although the
injuries of child abuse are many and varied,
several types of injuries are common to
abuse. Many of these injuries are within the
scope of dentistry or easily observed by the
dental professional in the course of routine
dental treatment.

3. According to Selwyn et al. child abuse is
defined as “the non-accidental physical
injury, minimal or fatal, inflicted upon
children by persons caring for them.”

4. According to Journal of Child Abuse and
Neglect, child abuse is "any recent act or
failure to act on the part of a parent or
caretaker which results in death, serious
physical or emotional harm, sexual abuse or
exploitation, an act or failure to act which
presents an imminent risk of serious harm."

5. TYPES OF CHILD ABUSE
Physical abuse 31.8%
Educational abuse 26.3%
Emotional abuse 23.3%
Sexual abuse 6.8%
Failure to thrive 4.0%
International drugging or
poisoning
Not specified
Munchausen syndrome
by proxy
Not specified

6. TYPES OF CHILD NEGLECT
Emotional neglect 27.8%
Health care neglect
including dental neglect
8.7%
Physical neglect 7.8%

7. PROBABLE FACTORS
RESPONSIBLE IN CHILD ABUSE
Stresses Ego Weaknesses Vectors
Youthful parenthood Character disorders Stresses created
Unplanned parenthood Impulsive-aggressive Psychodynamics
Low SES Rigid-exacting Collusion by partner
Social isolation Immaturity Cultural discipline
Long parenthood Passive dependency Absence of other needs
Partner discord Psychic disorders Facilitation by partner
Altered physical status Low self esteem
Frustration Inability to empathize
Child (infantile colic) Inability to trust

8. INJURIES FREQUENTLY ENCOUNTERED IN
ABUSED CHILDREN

9. The indicators that may be noticeable to the dental
professional include trauma to the teeth and
injuries to the mouth, lips, tongue or cheeks that
are not consistent with an accident. Other common
signs of child abuse include fractures of the maxilla
and mandible and oral burns. Injuries to the upper
lip and maxillary labial frenulum may be a
characteristic in severely abused young children.

11. EXAMINING CHILD
ABUSE/NEGLECT
The dentist and his staff should be educated to get
a visual impression of the child as he enters the
reception room.

12. COMMON SITES TO BE OBSERVED AND
EXAMINED
(General Physical Findings)
Many abused or neglected children due to fear may
appear overly vigilant or display a frozen watchfulness
staring constantly. There are no spontaneous smiles
and almost no eye contact
The dentist should observe the child for lack of
cleanliness, for small stature with respect to age and
for evidence of malnutrition. Typical signs of
malnutrition include a posture of fatigue with rounded
shoulders.

13. Overdressed children should also be noted, long
sleeves or high necked shirts during summer may
be worn to cover signs of physical abuse.
Face, neck should be examined for peri-orbital
ecchymosis, sclera hemorrhage, ptosis, deviated
nasal septum, cigarette burn marks and hand slap
marks

14. Corners of the mouth are reported with binding
marks from a gag tied in place for hours to force
the feed.
Sometimes, a spoon or fork applied with enough
force or determination, which may result in
fracture anterior teeth or torn frenulum.

15. While moving child up in the dental chair in a supine
position if child complains of pain, trauma is suspected. Belt
marks, electric cord marks, bite marks, bruises or fracture
of ribs or clavicles should be suspected and dentist should
confirm by checking them which can be performed in short
time.

16. FINDINGS ON A DENTAL
EXAMINATION
Examination of dental injuries includes
thorough visual observation, radiographic
studies, manipulation of the jaws, pulp
vitality tests, and percussion. Trans-illumination
may also be helpful.

17. TEARING OF THE LABIAL AND
LINGUAL FRENULUM
These injuries may result from blunt force trauma.
For example, the labial frenulum may be torn when
a hand or other blunt object is forcibly applied to
the upper lip to silence the child . Injuries of this
type may also occur in forced feeding, as a result of
the bottle being forced into the mouth.

18. Loosened, fractured, or avulsed
teeth
Severe trauma to the lower face may loosen teeth,
completely displace them from their alveolar sockets,
and/or cause dental
fractures. It is not uncommon for root fractures to occur,
but this finding may be missed unless the radiographs are
examined carefully. These injuries, as well as most other
traumatic injuries, may be accidental rather than abusive.
Therefore, one must always determine whether the injury is
compatible with the explanation given. If the dental injuries
resulted from a fall, for example, one would expect to also
find bruised or abraded knees, hands, or elbows. When
these additional injuries are not present, further inquiry is
required.

19. PREVIOUSLY MISSING TEETH
In examining a child who has experienced recent
trauma, it may be noted that one or more teeth
has been lost prior to the present incident. The
etiology of this earlier tooth loss should be
investigated. If it was due to ―an accident‖, a
pattern of repeated trauma has been established.
This pattern needs to be evaluated, and child abuse
is one of the possibilities to be considered.

20. TRAUMA TO THE LIP
It is not uncommon to find contusions, lacerations, burns,
or scars on the lips of abused children. Bruises to the lip
may result from forced feeding. Burns on the lip, as well as
burns on the face or tongue, may be signs of physical
punishment. Bruises at the angles of the mouth may result
from efforts to gag or silence a child.

21. TRAUMA TO THE TONGUE
The tongue of an abused child may exhibit
abnormal anatomy or function due to scarring. This
may result from a burn or other trauma.

22. Other soft tissue injuries
Trauma to the mouth may also cause ulceration of
the palate or uvula. Additionally, lacerations are
sometimes found in the floor of the mouth, which
may be caused by forced bottle feeding.

23. Fractures of jaws and associated
structures
The examination for maxillofacial fractures is performed within
the concept of overall patient care, including airway
maintenance, control of hemorrhage, and neurologic
examination.
In a significant number of jaw fractures there is also damage to
associated structures, including the cribriform plate, nasal, and
zygomatic bones. Intracranial lesions and skull fractures may
also be present. The clinical examination includes both extraoral
and intraoral palpation. Bilateral palpation is helpful to detect
asymmetry. Swelling or ecchymosis in the lower
face is suggestive of fractures of the mandible

24. THE LAW PROTECTING CHILDREN
The role of the legal system in attempts to ensure the
protection of children has attracted considerable attention
of late. It should be borne in mind, at the outset, that the
law alone cannot ensure adequate protection. Any
approach to the problem must be multi-disciplinary,
involving various other professions and community as a
whole. What the legal system can do is to provide a
framework- defining standards of protection, mechanisms
by which they might be achieved and the roles of the
parties involved.

25. THE PROTECTION OF CHILDREN FROM
SEXUAL OFFENCES ACT, 2012
An Act to protect children from offences of sexual
assault, sexual harassment and pornography and
provide for establishment of Special Courts for
trial of such offences and for matters connected
therewith or incidental there to.

26. Goa Children's Act, 2003, was the only specific piece of child
abuse legislation before the 2012 Act. Child sexual abuse
was prosecuted under the following sections of
Indian Penal Code:
I.P.C. (1860) 375- Rape
I.P.C. (1860) 354- Outraging the modesty of a woman
I.P.C. (1860) 377- Unnatural offences
I.P.C. (1860) 511- Attempt

27. In England, the National Society for the Prevention
of Cruelty to Children, founded in 1884 and, in
Scotland, the Royal Scottish Society for the
prevention of Cruelty to Children, founded in 1889,
are organizations whose sole aim is the protection
of children

28. In the United States by 1967, all 50 states and the
District of Columbia had child abuse reporting statutes,
codifying a medical diagnosis into a legal framework
which in many states defined official functions for the
courts. Not until 1972, did a court decide that parents’
right to care, custody and control over their children
was no longer absolute.
April has been designated Child Abuse Prevention
Month in the United States since 1983. U.S. President
Barack Obama continued that tradition by declaring
April 2009 Child Abuse Prevention Month

29. Conclusion
As most of the abuse injuries occur in the head and
neck, dentists can easily diagnose them and as a
oral care professional it is our duty to detect such
abuses at an early stage to prevent further harm to
the child and counseling of abusive caretaker
Reported cases of child abuse and corporal
punishment, both new and under management and
treatment, require continual monitoring.

30. The involvement of dentists in child protection
teams would be beneficial in two ways:
Dentists would become aware of their role and
would assist in the training of physicians and other
professionals.
In turn, non-dental practitioners would benefit
from consultations with dentists in the evaluation
of physical and sexual abuse or neglect, especially
those dentists who have experience or expertise
with children.

31. REFERENCES
1. Shobha Tandon, (2001) -Textbook of Pedodontics.
Hyderabad: Paras Publishing
2. Child abuse and its detection in the Dental Office - J Indian
Acad Forensic Med. October- December 2011, Vol. 33, No. 4
3. Barness, E.G. & Debich-Spicer, D.E. (2005) Handbook of
Pediatric Autopsy Pathology.
New Jersey: Humana Press
4. Mason, J.K. (1989)- Paediatric forensic Medicine and
Pathology.
New York: Chapman and Hall Medical

32. THANK YOU