Safeguarding children

abuseSimran Bains urges the importance of keeping up-to-date with changes in child protection policies and procedures.

According to the NSPCC, over 58,000 children in the UK needed protection against abuse in 2016. The estimation stands that one to two children in the UK die each week from abuse or neglect.

The CQC defines safeguarding as protecting a person’s health, wellbeing and human rights, and enabling them to live free from harm, abuse and neglect.

As healthcare professionals, we have a shared responsibility to safeguard children from suffering any form of abuse or improper treatment whilst receiving care.

Although members of the dental team are not responsible for making a diagnosis of child abuse or neglect; the eighth GDC standard clearly states the dental team has an ethical obligation to raise concerns if a patient is at risk and take the appropriate action.

Types of abuse

Dental neglect

The British Society of Paediatric Dentistry defines dental neglect as: ‘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.’

Severe untreated dental disease can lead to toothache, malnutrition and absence from school. It is imperative we discuss maintaining oral health by eating a balanced diet, being aware of the sugar content of certain foods and drink and dental maintenance with parents.

Healthcare professionals should monitor a lack of compliance through a series of cancelled/failed appointments or repeated emergency ‘pain’ appointments.

Physical abuse

This involves deliberately hurting a child causing injuries such as broken bones, burns, bruises or cuts.

Orofacial traumas occur in at least 50% of children diagnosed with physical abuse. Injuries in the ‘triangle of safety’ (ears, side of face, neck, shoulders) should raise concerns and all children who are said to bruise easily should be screened for bleeding disorders.

Emotional abuse

Emotional abuse can cause low self-esteem, developmental delay and lack of social responsiveness.

It is important to monitor a child’s emotional state, their behaviour and interaction with their parents.

Sexual abuse

This is when someone forces an individual to take part in sexual activities. This is most likely detected through direct allegation, STIs, pregnancy, trauma or emotional or behavioural signs.

Intraoral signs associated with sexual abuse include erythema ulceration and vesicle formation at the junction of the hard and soft palate.

Identifying abuse and neglect

Abuse and neglect may present to any member of the dental team in the following ways:

  1. Direct disclosure made by the child
  2. Signs and symptoms, which are indicative of physical abuse or neglect
  3. Observation of child-parent interactions
  4. Signs or direct disclosure of domestic abuse of a parent
  5. Concerns about the mental or general health of a parent (substance misuse or deteriorating health conditions).

If there are any areas of concern, meticulous notes should be made and discussed with the safeguarding lead in the dental practice, an experienced dental colleague, consultant paediatrition or child protection nurse. If you still remain concerned then you should talk to the child and parents explaining your concerns and inform them of your intention to refer them to children services.

A referral to the local children’s services should be made by telephone detailing your concerns and followed up in writing within 48 hours.

Assessment

A comprehensive history and examination is vital when assessing a child with an injury or possible signs of abuse. Areas of concern would include:

  • A delay in presentation after injury
  • Discrepancies between the presenting injury and history
  • Any previous concerns about the child or siblings
  • Any concerns about the child’s behaviour or interaction with their parent/carer.

You should not discuss your concerns with the parents if:

  • It places the child at greater risk
  • The discuss would impede a police investigation
  • You suspect a family member is sexually abusing the child
  • Where fabricated or induced illness is suspected
  • If parents/carers are being violent
  • If it’s not possible to contact parents or carers without causing undue delay in making the referral.

It is paramount that healthcare professionals keep up-to-date with changes in child protection policies and procedures. This ensures that we learn lessons from previous tragedies.

We must look after the safety and welfare of our patients holistically.


This article first appeared in Young Dentist magazine.

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