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defined as non accidental physical injury, minimal or fatal, inflicted upon children by persons caring for them.
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.
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.
Medical health care neglect Dental health care neglect Educational neglect Developmental neglect Supervisory Neglect Safety neglect Failure to thrive
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
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
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.
Upper lip or labial frenum /floor of Impatient or mouth feeding Neck strangulation Corners of mouth Gagging of child
Bizarre marks
Bite marks Human hand marks Slap marks Crescent shapped marks
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.