|Year : 2011 | Volume
| Issue : 6 | Page : 79-82
Child abuse and neglect
Department of Pedodontics, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda District, Andhra Pradesh, India
|Date of Web Publication||12-Dec-2011|
Department of Pedodontics, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda district, Andhra Pradesh - 508254
| Abstract|| |
Child abuse and neglect are important public health problems and recent estimates of their prevalence suggest that they are considerably more common than had hitherto been realized. Intervening to change parenting practices may, however, be important in their treatment. Despite their frequent occurrence among dental patients, neglect is the least known and identified type of abuse. The present case reports a 3-year-old girl suffering from abuse and neglect. The girl had dental neglect and also performed poorly in all parameters of growth and development. This case describes the process that was followed in order to reach a diagnosis and safeguard the child. The parent was counseled and the girl got her due share of access to comprehensive oral and general health. This case emphasizes that the dental professional should always be vigilant and collaborates among like-minded individuals to increase the prevention, detection and treatment of these conditions.
Keywords: Child abuse, dental professional, neglect
|How to cite this article:|
Kiran K. Child abuse and neglect. J Indian Soc Pedod Prev Dent 2011;29, Suppl S1:79-82
| Introduction|| |
Every child deserves a loving environment where they are not afraid of parental or elderly figures. In recent years, the community has become increasingly aware of the problem of child abuse in our society. Child abuse is prevalent in every segment of the society and is witnessed in all social, ethnic, religious and professional strata. 
India is home to almost 19% of the world's children. More than one-third of the country's population, around 440 million, is below 18 years of age. In a country like India with its multi-cultural, multi-ethnic and multi-religious population, the problems of socially marginalized and economically backward groups are immense. Within such groups, the most vulnerable section are the children. 
Child abuse is a state of emotional, physical, economic and sexual maltreatment meted out to a person below the age of 18 and is a globally prevalent phenomenon. The growing complexities of life and the dramatic changes brought about by socioeconomic transitions in India have played a major role in increasing the vulnerability of children to various and newer forms of abuse. 
Child abuse is a violation of the basic human rights of a child and it is the outcome of a set of inter-related familial, social, psychological and economic factors. The problem of child abuse and human rights violations is one of the most critical matters on the International Human Rights agenda .In the Indian context, acceptance of child rights as primary inviolable rights is fairly recent, as is the universal understanding of this concept. 
Child abuse and neglect (CAN) is defined by the World Health Organization as "Every kind of physical, sexual, emotional abuse, neglect or negligent treatment, commercial or other exploitation resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power." 
Maltreatment of children includes physical, sexual or emotional abuse as well as child neglect.  Dental neglect is the wilful failure of the parent or guardian to seek and follow through with the treatment necessary to ensure a level of oral health for adequate function and freedom from pain and infection. The point at which to consider a parent negligent and to begin intervention occurs after the parent has been properly alerted by a health care professional about the nature and extent of the child's condition, the specific treatment needed, and the mechanism of accessing that treatment. 
Among the health professionals, dentists are probably in the most favorable position to recognize child abuse and neglect because 50-75% of the reported lesions involve the mouth region, the face and the neck. ,,,, Besides, dentists have a continuing relationship with their pediatric patients and their families, as it is often necessary for a given patient to be seen several times a month. This fact gives the dentist an opportunity to observe not only the physical and the psychological condition of the children, but also the family environment. Often the abuser, usually the parent, delays bringing the child to the hospital because he or she feels being "watched over" by the medical personnel. The same kind of caution is not used with dentists who are expected to provide only a "technical service."  Despite the opportunities available to the dentists in detecting child maltreatment, they seldom report suspected oro-facial injuries. ,, The lack of clinical knowledge of child abuse and neglect is also attested to by the fact that only a few dentists know that the highest occurrence of lesions due to physical abuse is found in the head face and neck regions. ,,
Abuse or neglect may present to the dental team in a number of different ways: a) through a direct allegation made by the child, a parent or some other person; b) through signs and symptoms which are suggestive of physical abuse or neglect; c) through observations of child behavior or parent-child interaction.  Here, the author presents a case of a girl who was not directly reported but was accompanying her sibling who in turn had come for routine dental treatment.
| Case Report|| |
A 3-year-old girl [Figure 1] and [Figure 2] presented with her mother and her 6-year-old elder sister to the pediatric dental department at the Kamineni Institute of Dental Sciences, Narketpally, Andhra Pradesh, India, for routine dental evaluation and treatment. The mother had visited the department for the dental treatment of her elder daughter while the younger daughter had only accompanied her mother and sister. The author accidentally saw the accompanying 3-year-old child and requested a check-up for her.
The 3-year-old girl had a very poor oral hygiene and almost all the teeth were affected with dental caries [Figure 3] and [Figure 4]. In spite of her parents being educated and financially sound, the girl was malnourished.
On questioning the child and the mother, it was evident that the child was not given adequate medical and dental care. The child was suffering from abuse and neglect as she was an "unwanted" baby girl. The child was severely malnourished and performed miserably in all parameters of growth and development. On further questioning, the mother revealed that the father was an alcoholic and the mother admitted to the lapses of not providing adequate nutritious food and medical/dental care to her child. The parents were expecting their second child to be a baby boy. However, when that did not happen, the parents neglected the needs and concerns of this girl, leading to the existing poor medical and dental condition.
The author reported the case to a social worker and counseling of the patient's mother was carried out. The mother was educated and counseled about the negligence and the detrimental effects on the well-being of the child. The child is now being treated for complete general health by the pediatricians and pediatric dentists for oral rehabilitation.
| Discussion|| |
Safeguarding children from maltreatment and neglect is part of the responsibility of all health professionals, and dental practitioners may be in a unique position to recognize and respond to concerns of this kind. Considering how damaging abuse and neglect can be to the child's health, life and development, dental professionals must act to detect, treat and prevent it. ,
In assessing a child with suspected abuse or neglect, it is important to get a thorough history, preferably directly from the child, and to assess this against the clinical findings. In contrast to physical abuse, neglect is insidious and may be harder to detect.  It may present to the dental team through neglected dentition or failure to take the child for appropriate dental care. Such markers may be just one manifestation of a wider picture of neglect with associated failure to thrive, developmental delay and poor hygiene. Several untreated dental diseases may lead to pain or other adverse consequences. A parent who fails to attend appointments regularly, does not comply with planned treatment or ignores symptoms in a child who is displaying other features of more general neglect should be a cause for concern and should lead to a further multidisciplinary assessment of the child's needs. Even though 73% of professionals consider neglect a kind of abuse, 60% do not consider dental neglect in this way, despite it being the most frequent type of abuse seen by dentists. ,, The high frequency with which dental neglect presents itself does not seem to influence the importance ascribed to it.  Considering the importance of a healthy dentition in digestion, knowing the role of primary dentition in tooth exchange, and being aware of the consequences of infections and toothaches in the child's social life, we should feel it our duty to detect and treat cases of neglect.
| Conclusion|| |
All members of the dental team have a responsibility to respond to concerns and to share such concerns with their colleagues and with professionals in other fields who are able to respond appropriately. Multidisciplinary management and long-term follow-up of cases with abuse and neglect is recommended. Neglect, in general, and dental neglect, in particular, are the least known and detected types of abuse, even though they are the most frequent ones. There is a need for further information and training at all levels of the dental profession in the recognition and reporting of child abuse and neglect. Awareness campaigns, designed to awaken not only physicians and dental professionals, but also parents and society in general, could reduce the frequency of dental abuse and neglect. As a moral responsibility to care for children and young people, members of the dental team have both professional and legal requirements to work with other agencies to safeguard and promote the welfare of children.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]