2: Child Abuse and Neglect

CHAPTER 2 Child Abuse and Neglect

Child abuse and neglect affect millions of children in the United States each year. The health harms from child maltreatment are long reaching and clearly correlate with morbidity in adulthood. Health care and dental professionals are in unique positions to identify the possibly abused child and must be knowledgeable in the recognition, documentation, treatment, and reporting of suspected child abuse cases. To appropriately intervene, professionals must be willing to consider abuse or neglect as a possibility-if it is not considered, it cannot be diagnosed.1 This chapter includes a discussion of the types of child maltreatment frequently encountered, the clinical presentation and management of such issues, and the documentation and reporting of suspected child abuse.

IS IT CHILD ABUSE?

Child abuse and neglect encompass a variety of experiences that are threatening or harmful to the child and are the result of acts of commission or omission on the part of a responsible caretaker. Child maltreatment is usually divided into categories of physical abuse, sexual abuse, emotional or psychological abuse, and neglect in its many forms. Children living in violent homes are increasingly recognized as victims of maltreatment. Many gray areas exist in the determination of threat or harm, and disagreements about the “abusive” nature of some experiences are common. No one individual is responsible for deciding what is abuse or neglect. Identification, treatment, and intervention are the tasks of professionals from multidisciplinary backgrounds working together to provide care and evaluation in the best interests of the child.

Maltreatment is not always willful; that is, the harm or injury inflicted is not always the intent of the act. Emotion expressed actively or passively against the child is often unplanned, but nonetheless can result in significant harm or death. Education and prevention efforts may teach parents to redirect their actions and explore more appropriate discipline techniques and ways to manage anger or frustration.

PHYSICAL ABUSE

Physical abuse is often the most easily recognized form of child maltreatment. The battered child syndrome was initially described by Kempe and colleagues in 1962 and elaborated further by Kempe and Helfer in 1972 as the clinical picture of physical trauma in which the explanation of injury was not consistent with the severity and type of injury observed.2,3 These injuries are inflicted 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. Physical abuse is usually recognized by the pattern of injury and/or its inconsistency with the history related. Bruises, welts, fractures, burns, and lacerations are commonly inflicted physical injuries. Approximately 50% of physical abuse results in facial and head injuries that could be recognized by the dentist; 25% of physical abuse injuries occur in or around the mouth.

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. Statistics on child abuse reflect only those cases known or suspected, and all studies struggle with the component of the unknown. In 2006, the U.S. Department of Health and Human Services reported almost 65% of child maltreatment encompasses neglect, 16% involves physical abuse; 9% involves sexual abuse, and 7% involves emotional abuse. A little more than 2% of victims experienced medical neglect. Children who are victims of one form of maltreatment often are maltreated in other ways as well.

Sociodemographic characteristics of maltreated children vary somewhat by type of abuse or neglect. The average age of identification of maltreatment victims is 7.4 years; 48% are male; 49% are white, 23% are black, and 18% are Hispanic. Females are slightly overrepresented as abuse victims because sexual abuse is more prevalent among females. The youngest children (infants to 2 years) tend to be neglected most often and sexually or emotionally abused least often. Older children (12 to 17 years) are the least neglected, but the most sexually and emotionally abused. Family characteristics overrepresented among families of maltreated children and therefore considered risk factors include the presence of more children in the home, lower socioeconomic status, spousal abuse, drug or alcohol abuse, and significant health or economic stresses. Risk factors play a role, but ultimately every child is a potential victim.

IDENTIFICATION OF POSSIBLE CHILD ABUSE

As stated earlier, child abuse and neglect are not identified if they are not considered as a diagnostic possibility. One must be willing to consider the diagnosis of abuse to make the diagnosis. A number of characteristics of the child, parent, or story given to explain the child’s condition may lead a professional to suspect child maltreatment.

Indicators of child abuse and neglect are those signs or symptoms that should raise one’s suspicions of the possibility of child maltreatment. The presence of such indicators does not “prove” maltreatment, but should lead one to be more thorough in thinking through a medical versus abusive or neglectful etiology. Many of the signs and symptoms are nonspecific and may be present for a variety of reasons-child abuse is only one of those reasons. Indicators of abuse and neglect often depend on the child’s age and developmental level, and vary with the child’s experiences and resiliency.

Jan 14, 2015 | Posted by in Pedodontics | Comments Off on 2: Child Abuse and Neglect
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