Healthy Kids-Healthy Virginia Child Abuse: The Face-An Easy Target Photos with permission of VCU School of Dentistry

1. Healthy Kids-Healthy Virginia�Child Abuse: The Face-An Easy Target�Photos with permission of VCU School of Dentistry JoAnn Wells, School Age Oral Health Education Coordinator Virginia Department of Health Division of Dental Health 109 Governor Street, 9th Floor Richmond, Virginia 23219 Phone: (804) 864-7777 Email: joann.wells@vdh.virginia.gov

2. The Problem: The Child�s View 3 million children were reported abused or neglected in the US last year (Littel et al, 2004) On the average, child abuse is reported every 10 seconds (Littel et al, 2004) Child abuse and neglect is leading cause of death in children 4 and under (Littel et al, 2004) 2,000 children died from abuse last year (Littel et al, 2004) Maybe under-reported by one-half (Littel et al, 2004) 3 children die each day in a home in the US (Littel et al, 2004) Average age of the abused child is 3 years of age (Littel et al, 2004)

3. The Problem: Mandate to report In all 50 states, dentists and dental hygienists are required to report suspected cases of child abuse and neglect (Kellogg et al., 2005) Dental professionals have reported only 0.32% of all cases (Beem et al., 2005) -Only 1/2 of people report abuse when faced with an actual situation (Littel et al., 2004)

6. Definition of Child Abuse When a parent or other caregiver Creates or inflicts, threatens or allows, a physical or mental injury by other than accidental means, or creates a substantial risk of death, disfigurement or impairment of bodily or mental functions Commits or allows sexual exploitation of a child

7. Consultation

8. RED FLAG Children with special needs are particularly vulnerable to abuse (Kenney et al., 2006)

9. Contributing Factors to Child Abuse Drug and alcohol abuse Stress Lack of support network Domestic violence �Learned behaviors� - many abusers are, themselves, victims of child abuse (Kenney et al., 2006)

10. Possible Indicators of Child Abuse Patterns Bruises, welts, bite marks, tattoos Lacerations or abrasions Burns Fractures Head injuries (Kellogg el at., 2005) Photos with permission of VCU School of Dentistry

11. Warning Signs Repeated injuries (multiple bruises) Inappropriate behavior Neglected appearance Strict, super-critical parents Extremely isolated families

12. Behavior Indicators of Abuse

13. Clinical Protocol General physical assessment Behavior assessment Patient history Oral examination Documentation Consultation

14. Patient Histories Obtain histories from child and parent. Do they match? Is the injury consistent with the history? History of similar injuries in the past?

16. Physical Findings That Mimic Child Abuse Genetic Acquired Accidental

18. Signs of Oral Trauma in Abuse Avulsed teeth Non-vital teeth Lip lacerations Tongue injuries Frenum injuries Jaw fractures (Kellogg et al., 2005) Photos with permission of VCU School of Dentistry

19. Definition of Child Neglect Neglecting or failing to provide care necessary for a child�s health Abandonment (Kellogg et al., 2005) VCA Sec. 63.1-248.2(A)

20. Identification of Dental Neglect Willful failure of a parent or guardian to seek and follow with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection Untreated, rampant caries Untreated pain, infection, bleeding or trauma Lack of continuity of care once informed that above conditions exist (American Academy of Pediatric Dentistry Oral Health Policies and Guidelines, 2003)

21. The Need For Education