Acc to SELWYN ET AL, 1985, Child abuse is

defined as non accidental physical injury, minimal or fatal, inflicted upon children by persons caring for them.

TYPES OF CHILD ABUSE

Physical Abuse
Emotional Abuse Sexual Abuse

Munchausen syndrome by proxy

Shaken baby syndrome Intentional Drugging or poisoning Persecuted child

PHYSICAL ABUSE :
According to WHO in 1999

Physical abuse of child is that which results in actual or potential physical harm from any lack of interaction, which is reasonably within the control of parent or person in a position of power, or trust. There may be single or repeated incidents.

 Severe form of physical abuse is BATTERED CHILD

SYNDROME.
The battered child syndrome was initially described

by Kempe et al in 1962

CLINICAL MANIFESTATION
Physical abuse is suspected when injury is unexplained, unexplainable. Hair that is pulled causes alopecia in which the hairs are broken at various lengths Petechiae of the face and shoulders. Approximately 10% of cases of physical abuse involve burns.

CHILD NEGLECT
Acc to Subramanian EM et al , J. ISPPD,2005 A

failure by a caretaker, either deliberately or through negligence or inability, to provide a child with minimally adequate food, clothing , shelter, medical care, supervision, emotional stability and growth, or other essential care provided that such inability is not solely due to inadequate economic resources or to a handicapping condition.

TYPES OF CHILD NEGLECT

Physical neglect Emotional neglect Health care neglect

Medical health care neglect Dental health care neglect Educational neglect Developmental neglect Supervisory Neglect Safety neglect Failure to thrive

ETIOLOGY OF CHILD ABUSE & NEGLECT

Socio cultural factors
Childs factors Parental factors.

SOCIO-CULTURAL FACTORS
Values and norms of discipline and physical

punishment. Family structure number of members in family, joint or nuclear family system, socio-economic status etc. Family and situational stresses poverty, unemployment, alcohol abuse, isolation, poor housing etc. Parent-child relationship, excess or unwanted children. Poverty and crisis relating use of money.

THE PARENTS
Young parents are more likely to maltreat their child.
Parents who were abused or have experienced family

disruption in their childhood. Lack family support and unreasonably fearful of caring for their child. May be generally rigid or authoritarian; for example, the incidence of abuse is greater in some strict religious groups and in the families of military personnel. Aggressively psychopathic

THE CHILD
Is disappointing either because of a defect or because a

child of the opposite sex was wanted. Is hyperactive day by day or cries at night. Is difficult because of illness. Is different from the rest of the family, may be 'ugly

MANAGEMENT OF CHILD ABUSE & NEGLECT

History Behavior assessment General physical examination Documentation Written observation

Number Type Location Resolution Possible cause Photographs Radiographs Bite marks Intra- oral examination Treatment Reporting Parental Consultation

HISTORY
Eye witness history
Unexplained history Implausible history

Alleged self-inflicted history

Delay in seeking medical care

BEHAVIOUR ASSESMENT
SPEIGHT (1989) has given 6 classical points for assessment of an abused child. Details of the incident are vague. A delay in seeking medical help The parents mood is abnormal Account of the accident is not compatible with the injury observed. The parents behaviour gives a cause of concern The childs interaction with the parents is normal.

GENERAL PHYSICAL EXAMINATION

Observe the patient's posture, gait
Inappropriate dress may be an indication of neglect and/ or abuse. For example, a child who appears with a long-sleeved shirt in the middle of the hot summer may be dressed in this manner to cover old injuries Start the examination at the top, beginning with the hair and scalp, and systematically work down. Any bruise should be checked carefully acc. to area distribution, shape, healing stage because it can alert the practitioner to inflicted trauma.

AREA DISTRIBUTION OF BRUISES

LOCATION OF BRUISES INDICATION

Genital or inner thighs

Cheek Ear Lobes

Toilet mishaps or sexual abuse Slapping of child

Pinching or pulling forceful

Upper lip or labial frenum /floor of Impatient or mouth feeding Neck strangulation Corners of mouth Gagging of child

Circumferential bruises on ankles or Placement of restraints wrist

SHAPE OR TYPES OF MARK

MARKS Strap marks Lash marks Lash marks FEATURES These are 1-2 ins wide, sharp, bordered rectangular marks Narrow, straight, edged, due to thrashing with a tree branch Narrow, straight, edged, due to thrashing with a tree branch Wide assortment of instruments used to abuse children Marks of teeth and surrounding structures Prevalent in 22% cases. Seen as 2-3 parallel linear bruises at finger width spacing Seen facing each other mainly due to pinching by finger nails

Bizarre marks
Bite marks Human hand marks Slap marks Crescent shapped marks

DATING THE BRUISES

TIMING 0-2 days
0-5 days 5-7 days 7-10 days 10-14 days 2-4 weeks

SIGN & COLOR OF LESION Swollen & tender

Red,blue, circumscribed Green Yellow, localized Brown, diffuse Cleared purple,

INTRA ORAL EXAMINATION

missing teeth or previously traumatized teeth
mandible should be examined for any deviation on

opening Bleeding under the tongue condition of the maxillary labial frenum and the lower lingual frenum. Bruising or petechia of the soft and hard palate presents with extensive, untreated dental caries, untreated infection, or dental pain

DOCUMENTATION

All data collected in the medical history and physical examination must be documented in a complete and objective manner. For visible injuries, photographs should be taken if possible.

PARENTAL CONSULATION Once the suspicion is confirmed, the parent should be informed that an injury has been noticed. The parental cause of injury should be understood fully by doctor. If the findings & explanation are not compatible, or if the suspicion still exists, the doctor is mandated by law to contact the appropriate CA/CN authority.

REPORTING The dentist is obligated by law to report suspected findings of child abuse to the appropriate authorities, that is, child protective service agencies and/or law enforcement officials. Failure to do so may result in the filing of civil or criminal charges against the dentist.