This document summarizes two illustrative cases examined by Dr. Laura Somerville: 1. A 4-year-old boy from a Chinese family was referred for concerns of neglect. Examination found dental caries requiring extraction, developmental delays, and unusual social interactions. Occupational therapy, speech therapy, and pediatric follow up were recommended. 2. A 13-year-old girl with a history of chronic neglect and dental treatment issues. Examination found she had missed many dental appointments, leading to suboptimal treatment outcomes. Input from all health services is important for assessing child welfare cases.

1. Baspcan
Comprehensive medical assessments
NHSGGC
Illustrative cases
Dr Laura Somerville

2. Case 1.
• 4 year old boy
• Concerns raised by school
• Pale,thin,toileting problems,physical
care/appearance
• Brother cerebral palsy+complex needs
• Child protection concerns.On CPR.
• Chinese.Mandarin speaking
• Referred for CMA

3. CMA
• Seen by gp.Bloods ok.
• Update from school “autism”
• Attended with dad ,social worker and
interpreter
• Social work information
• Information – delay in immunizations
• Dental caries- dental extractions planned
after A+E attendance with tonsillitis

4. Examination
• Weight 9th
height 25-50th
BMI 9th
centile
• Shy initially. Eye contact used at times
• 2-3 word sentences in Mandarin and
echolalia
• “Great job” in American accent
• Play on his terms
• Physical examination normal tone,power,gait.
• Immature pencil grasp and skills

5. Conclusion/Opinion
• Physical neglect –dental
• Unusual social interaction
• Difficulties with fine motor skills
• Background history of lack of
opportunities and developmental
stimulation
• Occupational therapy,SLT,paediatrician
follow up

6. Update- review 4 months later
• Child protection register.High level of support.
• Dental extractions all primary teeth
• School- progress toileting,starting to mix with other
children,eating variety of foods
• HT/wt/bmi increasing trend
• Developmental assessment(age5) speech,language
and social skills 36months,fine motor skills
48months,locomotor 60 months

7. ?Attachment?Autism?both
• Less sensory issues-food,textures,senses
• Observations school,speech therapist feedback and
in the clinic suggest progress
• Still issues with social interaction and communication
• Particular about things eg shapes
• CAMHS suggested structured parenting assessment
• Paediatric follow up

8. Learning points
• Challenges in giving clear statements to
social work and reporter
• Joint working with other colleagues with
emotional neglect,attachment,autism
• Neglect of disabled children

9. Case 2
Christine Park
Clinical lecturer/ Honorary post CCST StR
Paediatric Dental Dept
Glasgow Dental Hospital & School

10. Case Study 2
• 13 year old female
• Dental concerns identified by a new general dental
practitioner who raised concerns with social worker
• Social worker contacted CPU for early sharing and to
request CMA
• Child already placed on Child Protection Register due to
chronic neglect

11. Case Study 2 – Summary of
Concerns
• Missed health appointments including dental
• Concern raised by child’s new GDP
• 84% school attendance
• Taking caring role for younger siblings
• Calls to Police from neighbour
• Home conditions – “very poor cleanliness”
• Bereavement issues
• Otherwise well and healthy looking

12. Case 2- Dental history elicited
at CMA
• Significant previous dental treatment including exposure
and bonding of gold chain to buried upper incisor
• Missed essential appointments with dental hospital, not
seen for 18 months
• Letter sent to GDP regarding this

13. Case 2- Dental history elicited
at CMA• Then seen again for 4 appointments in dental hospital
• “Social issues” noted in casenotes as reason for previous
missed appts
• Missed further 4 essential appointments
• Standard letter sent no further hospital appointments,
discharging patient to care of previous GDP
• Siblings missed dental GAs and letters sent to previous GDP
regarding this

14. Case 2- Dental impact on child
• Space now lost for buried front tooth to be
pulled down
• Gold chain has been sticking through oral
mucosa for years
• Treatment options are now limited, remedial
treatment required which is sub-optimal
• Affect on oral health and aesthetics

15. Case 2 - Key learning points
• Missed dental appointments one concern of many but
main concern in this case
• Social history important as is rigorous follow up for
dental teams in general practice and in dental
hospitals
• GDPs hold info re family situations that dental
hospitals etc do not have information regarding e.g
siblings
• Input from health services including dental is
essential in assessment of child’s circumstance

16. Case - Outcomes
• Child and siblings accommodated with foster family
• Close contact with social worker to ensure
attendance at health appointments especially dental