UNPLEASANT TOPIC; NECESSARY INFORMATION

The majority of children receiving dental care are seen in general practices rather than in pediatric dental offices.  This fact points to the importance of all dentists being aware of the laws and responsibilities involved when child abuse or neglect is suspected.

The first step in prevention of on-going child abuse and neglect is recognition and reporting.  Dentists and their staff members must become familiar with indicators and symptoms associated with child abuse and neglect, regulations concerning reporting requirements in their state, and agency telephone numbers or email addresses on which to report suspected problems. 

When child abuse is suspected, a dentist or any other health care provider MUST report the suspicion to the appropriate agency in his/her area.  If a local number or email address is not available, call the National Child Abuse Hot Line at 1-800-422-4453 or go online to www.childhelp.org/hotline.   All states have laws granting immunity when a report of suspected child abuse or neglect is made in good faith.

When physical trauma is visible, experts recommend that a dentist talk with the parents or caretakers to obtain their story on how the injuries happened.  Do not mention a suspicion of child abuse because accusing the parents regarding abuse may cause further harm to the child if the parents are, in fact, the perpetrators.  If parents object to the implication and questioning, explain that signs of physical abuse or neglect must, by law, be reported by a health care provider.  The dentist may tell the parents that he/she is concerned about visible physical injuries and are legally bound to inquire about them.

If the child talks to the dentist about abuse and wants to disclose more, it is appropriate to listen and to provide support for the child.  Detailed observations should be made in the dental record, recording the date, time, location of the injury, size, number if more than one, color if bruised, and condition.  An examination is of little or no value unless the findings are recorded permanently and accurately.  Everything the child tells the dentist and staff members should be precisely recorded in the patient’s chart, indicated by quotation marks.

Take pictures if possible.  Provide a picture of the entire child and then a close-up of any injuries or bruises.  Be sure to place information in the picture to identify the child (chart or patient number) and date (month, day, year).  A ruler or tape measure should be included in the photograph to establish size.  It is also wise to include something of known color so that hues of injuries and bruises can be compared to true color.  Have duplicate copies of photographs made for investigating agencies so that originals can be maintained in the dental office.  If no camera is available, draw sketches to show location and size of injuries and bruises.

Do not try to solve the case; let the investigating agency handle the problem.  Assure the child that it is right for them to have told you; however, do not make promises to the child or to the family that cannot be kept.

This is a difficult topic, a horrible reality no child should suffer and no dental team should have to manage.  However, when necessary, recognition of symptoms, knowledge about how to handle suspected cases, recording evidence, and prompt reporting to the appropriate agency is an unpleasant-but-real duty for dentists and team members.