This document discusses child abuse and neglect. It defines the different types according to WHO and US law, including physical abuse, sexual abuse, emotional abuse, and neglect. It describes common signs of abuse seen in dental examinations such as fractures, injuries to the mouth. It outlines the various forms of neglect including nutritional, healthcare, dental, safety, emotional and physical neglect. The document emphasizes the importance of dental professionals screening children for signs of abuse and neglect.

1. CHILD ABUSE & NEGLECT
PRESENTED BY: DR.KRITIKA SINGH
JR – II
PEADIATRIC &PREVENTIVE DENTISTRY
KGMU LUCKNOW

2. CHILD ABUSE
Abuse can mean
different things
to different
children, and can
happen once or
many times.

3. CHILD ABUSE

Child abuse can
rob kids of the joy
of growing up and
affect them
negatively for years
to come.

5. DEFINITIONS
The World Health Organization ((WHO)
defines child abuse and child maltreatment as "all
forms of physical and/or emotional ill-treatment,
sexual abuse, neglect or negligent treatment or
commercial or other exploitation, resulting in
actual or potential harm to the child's health,
survival, development or dignity in the context
of a relationship of responsibility, trust or
power’’.

6. DEFINITIONS
The United States federal Child Abuse
Prevention and Treatment Act defines child
abuse and neglect as, at minimum, "any recent
"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" and/or "an act or failure
to act which presents an imminent risk of
serious harm’’.

7. WHO IS ABUSED?
 Children from all
walks of life may be
victims of child abuse
or neglect.
 No age, race, gender,
or socioeconomic
level is spared.

8. STATISTICS
National statistics state that about 53%
children are abused. The highest number of
cases were reported in Uttar Pradesh, Delhi,
Assam, Andhra Pradesh and Bihar.

9. TYPES OF CHILD MALTREATMENT
The World Health Organization
distinguishes four types of child
maltreatment:
 Physical Abuse
 Sexual Abuse
 Emotional/Psychological Abuse
 Neglect

10. EXAMINETION OF ABUSED
CHILD IN DENTAL CLINIC
Screening OR Examination

11. The examination for CA should be incorporated
with the routine dental examination :
1. Dentist and staff should be educated to get a visual impression
of the child as he enters the reception room.
2.They should note the child and guardian have appropriate
interaction or not.
3. Many abused and neglected children are fearful for further
abuse and display several reactions.They may appear overly
vigilant, or display a "frozen watchfulness," staring constantly.
4.Their eyes constantly scan the environment for
danger, while at the same time their faces are
immobile.
There are no spontaneous smiles and almost no eye
contact.It is as , they think that by not looking
someone in the eye, they make themselves invisible
and therefore safe from attack.

12. 5. The dentist and staff should observe the child ;
Lack of cleanliness small stature with respect to age
Evidence of malnutrition- Typical signs of
include a posture of fatigue with rounded shoulder
,flat chest, the face is pale, muddy and lacks luster.
child’s clothing, which should be appropriate for the
climactic conditions.
Failure to provide adequate clothing for protection from
rain, cold, or snow may constitute child neglect.
Overdressed children also should be noted; long
sleeves and highnecked shirts or blouses during hot
summer months may be worn to cover the signs of
physical abuse.
Be observant for physical problems, such as a limp,
difficulty climbing into the dental chair, poor
or abnormal positioning of the limbs.

13. Oral examination :
 A variety of orofacial injuries occurs in 50% or more of
abused children,these are ;
 Fractured, missing, displaced, or discolored teeth;
 Scars of the lips and mucosa
 Slap marks
 Torn or scarred maxillary midline, or sublingual
frenaum, deviated, or scarred tongue.
 These injuries may result from a parent’s attempt to
silence a child with a gag, hand slap, or punch ,Or a
spoon or fork applied with enough force .

14. CA may be initiated at any
age, a notation should be
recorded on the chart at
every recall to indicate that a
CA screening was done, and
that the findings were
negative. If the screening
examination leads to
questionable or suspicious
findings, a more thorough
examination is warranted.

16. PHYSICAL ABUSE
 Physical abuse is the
injury by other than
accidental means of a
child under 18 years of
age which is the result
of actions by a parent,
guardian, or other
designated (temporary
or permanent)
caretaker.

17. PHYSICAL ABUSE
• The injuries inflicted are
intentional and not
accidental.
• Some result from
punishment that is
inappropriate for the child’s
age ,condition, or level of
development.
• Some result from a parent’s
frustration and lack of
control in acting out anger.

18. BATTERED CHILD SYNDROME
• A severe form of physical abuse.
• First described by Kempe in 1962.
• Battered child syndrome is the
collection of injuries sustained by a
child as a result of repeated
mistreatment or beating.

19. BATTERED CHILD SYNDROME
• Bruises, lacerations , burns and fractures
are commonly inflicted injuries.
• The major trait of the caretakers is either
a lack of an explanation for critical injuries
or explanations that does not account for
the severity of injuries.

20. MUNCHAUSEN SYNDROME
 MUNCHAUSEN SYNDROME is a
psychological disorder in which the
person fabricates the symptoms or injury
in order to undergo medical tests,
hospitalization or even medical or surgical
treatment , when she/he is not really sick.
 Described by Dr. Richard Asher in 1951.

21. MUNCHAUSEN SYNDROME
BY PROXY
 In cases of Munchausen
syndrome by proxy , a parent or
caretaker attempts to bring
medical attention to
themselves by injuring or
inducing illness in their
children.
 It describes children who are
victims of parentally fabricated
or induced illness.
 The term was coined by Dr.
Roy Meadow.

22. MUNCHAUSEN SYNDROME
BY PROXY
• It is the most difficult
form of child
maltreatment to
identify and treat.

23. SHAKEN BABY SYNDROME
• First reported by
Guthkelch in 1971.
• Seen primarily in children
18 months of age or
younger.
• The infant’s head is shaken
vigorously forward and
backward hitting the chest
and shoulders.

24. SHAKEN BABY SYNDROME
• Symptoms are:
Retinal haemorrhage
o Subdural or subarachnoid
hematomas
o Breathing difficulties
o Seizures/Unconsciousness

25. SEXUAL ABUSE

26. CHILD SEXUAL ABUSE
 Sexual abuse is the misuse of a
child for sexual pleasure or
gratification.
 It is of two types.
1) Out -of-house abuse
2) In-house abuse(Incest)
 Sexual abuse has the potential
to interfere with child’s normal
healthy development, both
emotionally and physically.

27. EFFECTS OF SEXUAL ABUSE
• Guilt
• Flashbacks/nightmares/Insomnia
• Fear of things associated with the abuse (including
objects, smells, places, doctor's visits, etc.),
• Low self-esteem
• Sexual dysfunction,
• Self-injury
• Suicidal tendency
• Depression, anxiety , bulimia nervosa
• Increased risk of sexually transmitted infections

29. EMOTIONAL ABUSE
• Abuse that expresses to
children that they are
worthless, flawed or only of
value when meeting another
needs.
• The least defined form of
abuse.
• Emotional abuse unlike
physical abuse is difficult to
diagnose due to lack of
evidence.

30. TYPES OF EMOTIONAL ABUSE
•Rejection
•Ignoring
•Terrorization
•Isolating
•Blaming(scapegoatin
g)

31. NEGLECT
 It is the failure or lack of prudent care for a child's well-
being through lack of adequate supervision, food, clothing,
shelter, education or medical care.
 It may not produce visible signs, and it usually occurs over a
period of time.
 Physical abuse tends to be episodic, neglect tends to be
chronic. ABUSE IS AN ACT OF COMMISSION,NEGLECT IS AN
ACT OF OMISSION

32. TYPES OF NEGLECT
NUTRITIONAL
NEGLECT
HEALTHCARE
NEGLECT
DENTAL NEGLECT
SAFETY NEGLECT
EMOTIONAL NEGLECT
PHYSICAL NEGLECT

33. Nutritional Neglect
 Failure to thrive refers to
an underweight,
malnourished condition in
a child has a weight that is
below the 3rd or 5th
percentile for their age
and/or whose growth has
fallen off precipitously and
crossed two major growth
percentiles.

34. FAILURE TO THRIVE
 The infants have gaunt faces, prominent
ribs, wasted buttocks, and spindly
extremities and is expressed in first two
years of life.
 The causes of failure to thrive are
estimated as 30% organic, 20%
underfeeding due to understandable error
and 50% underfeeding from parental
neglect.

35. HEALTHCARE NEGLECT
 When a child with a treatable chronic disease
has serious deterioration of the condition
because the parents or caretakers repeatedly
ignore healthcare recommendations,
healthcare neglect occurs.
 It occurs in situations where an emergency
exists and the parents/caretakers will not
acknowledge it much.
 Refusals because of religious beliefs also lead to
healthcare neglect.

36. DENTAL NEGLECT
 Dental neglect, as defined by the American
Academy of Paediatric Dentistry(2003), is
the “ failure of parent or guardian to seek
and follow through with treatment
necessary to ensure a level of oral health
essential for adequate function and freedom
from pain and infection.”

37. DENTAL NEGLECT
 Dental caries, periodontal diseases, and
other oral conditions, if left untreated, can
lead to pain, infection, and loss of function.
 These undesirable outcomes can adversely
affect learning, communication, nutrition,
and other activities necessary for normal
growth and development.

38. SAFETY NEGLECT
 Safety neglect occurs when injury results from lack
of supervision.These situations usually involves
children younger than 4 years of age, when it is
important that parents directly supervise them.
This leads to injuries like burns, poisonings, falls
because children are not being watched.

39. EMOTIONAL NEGLECT
 Emotional neglect is a failure to notice,
attend to, or respond appropriately to a
child's feelings.
 It is ,in some ways, the opposite of
mistreatment and abuse.Whereas
mistreatment and abuse are parental
acts, emotional neglect is a parent's failure
to act.

40. PHYSICAL NEGLECT
 Failure to care for children according to
accepted or appreciated standard.
 This is usually coaxial with physical abuse
and involves presentation of child with
unkempt hair, dirty or insufficient
clothing, incomplete immunization,
unsanitary home environment and
inadequate after-school supervision.

41. IDENTIFICATION OF CHILD ABUSE
 While some forms of
abuse or neglect are
more difficult to detect
than others, there are
always signs or indicators
which, may suggest a
child is in need of help.

42. INDICATORS OF PHYSICAL ABUSE
• Injuries unusual for a specific age group (e.g.,
fractures in an infant ).
• Lacerations and Abrasions - on lips, eye, any
portion of an infant’s face, on gum tissues (from
forced feeding).
• Specific bruising patterns such as cigarette
burns, belt buckle mark, finger imprints, etc.
• Bruises on the body, in unusual patterns, in
various stages of healing.

43. INDICATORS OF
EMOTIONAL ABUSE
• Poor self-esteem
• Destructive behaviour
• Angry acts
• Withdrawal ,poor
development of basic skills
• Alcohol or drug abuse
• Difficulty in forming
relationships

44. INDICATORS OF SEXUAL ABUSE
PHYSICAL INDICATORS
• Difficulty in walking or
sitting
• Bruises or bleeding from
external genitalia, or
presence of semen.
• Torn, stained or bloody
underclothes.
• Pain or itching in the
genital area
• Positive tests for sexually
transmitted diseases
• Pregnancy
BEHAVIOURALINDICATORS
• Poor peer relationships
• Regression
• Aggressiveness or
delinquency
• Reluctance to participate
in recreational activities
• Preoccupations with the
genital area.

45. MEDICOLEGAL
ASPECTS

46. MEDICOLEGAL CONSIDERATIONS
 A separate doctrine ‘ Parens Patriae ’ (father of
the country) was developed to understand laws
made to protect children.
 In the Constitution Bench decision of Supreme
Court in 1990, the doctrine was passed. It
stated that parens patriae is the inherent
power and authority of a legislature to provide
protection to the person and property of
persons such as minor, insane, and
incompetent person.

47. MEDICOLEGAL
CONSIDERATIONS
 Dentists should know the definitions
of child abuse and related laws
proposed under the Draft Model Child
Protection Act 1977, to protect
themselves and apply it correctly in
such cases.

48. REPORTING
 Dentists are mandated to
report based on
“reasonable suspicion,”
and they are not
responsible for an further
investigations.

49. REPORTING
 The same laws that mandate dentists to report
suspected abuse often also protect them from
legal litigations, often brought by angry or
vengeful parents. This law also makes the
dentist liable for any damage to child caused by
the failure to report abuse.
 Although the laws vary, generally the dentist
who fails to report such case is considered
guilty of misdemeanour and is subject to a fine
or jail sentence , usually 30 days in length.

50. WHERE TO MAKE A COMPLAINT
• A complaint alleging the commission of any
act amounting to abuse of a child can be
made to the police.
• The Police helpline number is 100.
• In case the police fails to register a FIR or
does not investigate the case, then the
aggrieved party can write an application to
the Superintendent of Police under Section
154(3) of Criminal Procedure Code (CrPC).

51. WHERE TO MAKE A COMPLAINT
 Even if there is failure on the part of the
Superintendent of police to take action, or that
even after registering it no proper investigation
is held, the aggrieved party can file an
application under Section 156(3) of CrPC before
the learned Magistrate concerned.
 In such cases the Magistrate can direct the FIR
to be registered and also can direct a proper
investigation to be made.

52. WHERE TO MAKE A
COMPLAINT
• An online complaint can be made at the website of
the National Commission for Protection of
Children’s Rights(NCPCR) by clicking on the
following link:
http://ncpcronline.info/OnlineForm/onlineform.asp
x
• Online complaint can also be made at the website
of the National Commission of Human Rights by
clicking on following link :http://nhrc.nic.in/

53. WHERE TO MAKE A
COMPLAINT
• A complaint can also be addressed to:
Chairperson National Commission for Protection of
Child Rights,
5th Floor, Chanderlok Building, 36, Janpath,
New Delhi - 110 001
(E-Mail: complaints.ncpcr@gmail.com)
• A call can be made to CHILDLINE , a 24 hours free
telephone helpline service at the number 1098.

55. The most
effective strategy
for the
management of
child abuse in its
various forms is
prevention and
awareness.

56. PREVENTION OF CHILD ABUSE
Some of the preventive
measures are:
 Dental Professionals Against
Violence(DPAV)
 Prevent Abuse and Neglect
through Dental Awareness
(PANDA)
 National Plan of Action for
Children (NPAC)

57. Dental professionals against
violence(DPAV)
 Dental professionals against violence was
initiated by Californian Dental Association
in 2001.
 It consists both Train the trainer and direct
provider training programs designed to
assist dental professionals and their teams
in recognizing and responding to child
abuse and neglect, intimate partner
violence and elder abuse and neglect.

58. Prevent abuse and neglect
through dental awareness
(PANDA)
 The objective of PANDA
is to educate
professionals and dental
auxiliaries about their
role and responsibility in
recognition, reporting
and prevention of child
abuse and neglect.

59. National plan of action for
children (NPAC)
 The National Plan of Action for Children was
formulated by the then Department of
Women and Child Development {now,
Ministry of Women and Child Development
(MWCD)} in 2005.
 It aims at ensuring all rights to children up to
18 years of age.
 It also aims at creating an enabling
environment to ensure protection of child
rights.

60. CHILD RIGHTS
The National
Commission for
Protection of Child
Rights (NCPCR) was set
up in March, 2007 under
the Commission for
Protection of Child
Rights Act, 2005, an Act
of Parliament (December
2005).

61. CHILD RIGHTS
• The Protection of Children from
Sexual Offences(POCSO)Act,
2012, was passed by the Lok
Sabha, 22nd May, 2012. The Bill
was earlier passed by the Rajya
Sabha on 10th May, 2012.

62. National Policies
 The Constitution of India contains a number of
provisions for the protection and welfare of the
children. It has empowered the legislature to make
special laws and policies to safeguard the rights of
the children.
 Articles 14, 15, 15(3), 19(1) (a), 21, 21A- Right to
Education, 23, 24-Prohibition Of Employment Of
Children, 39(e) 39(f) of the Constitution of India
contain provisions for the protection, safety, security
and well-being of children.

63. conclusion
more than 50% of child abuse injuries occur to the face and oral cavity, the dentist has a unique
opportunity to identify and report suspicious cases, thus lessening the high mortality rate.
Fifty per cent of the severely abused children will die of recurrent abuse if proper therapeutic
measures are not introduced.
The best thing that can be done for an abused or neglected child is to report suspicions to the
appropriate authority immediately.
Thousands of children die from child abuse each year.
Thirty-five per cent of the victims of nonfatal abuse will be abused again within a 1-year period.

66. REFERENCES
 McDonald and Avery’s Dentistry for the child and the
Adolescent, 9th edition
 Textbook of Paediatric Dentistry , Nikhil Marwah,3rd
edition
 Paediatric Dentistry Principles & Practice, MS Muthu,2nd
edition
 Guideline on Oral and Dental Aspects of Child Abuse and
Neglect(2010)
 Reporting child abuse and neglect ,Kentucky Guidelines.