At times of personal stress, such as the current COVID-19 pandemic, the most vulnerable groups of people are often those who cannot defend or speak for themselves, such as children in abusive homes. Dr Kiran Keshwara, Dentolegal Consultant at Dental Protection, outlines some timely advice.

In an environment of rising unemployment, social restrictions and an increase in alcohol consumption, home confinement has shown an increase in domestic abuse.

In the provision of dental care to children, it is important to be aware of the signs and symptoms of abuse or neglect, and how to raise your concerns – while acknowledging the fact that children can be clumsy and innocuous accidents are inevitable.

What signs should I look for?

Oral and facial trauma occurs in approximately 50% of physically abused children, and this may manifest in a number of ways, including:

•  fractured teeth
•  bruising, lacerations and abrasions of the tongue, lips, oral mucosa, fraenum and hard and soft palate
•  dislocations
•  avulsed teeth
•  mandibular and maxillary fractures

Along with the physical signs, a child may be withdrawn, aggressive or fearful, and the parents or guardians failing to seek proper dental care may indicate other underlying issues.

What can I do if I suspect a child is being abused?

If any physical injuries are found, it is important for you to delicately question the child, in a non-judgemental and non-leading manner, on how the injury happened, and try to compare the stories told by the child and their carer. It is important to accurately record the injuries by means of photographs, x-rays and thorough note-taking. You should record an accurate medical history, in which the patient’s GP contact details should be included.

It can be a difficult decision to discuss concerns with the parents or guardians, as there may be a fear that they will get offended or, worse still, angry or violent. However, most parents would understand that you have the child’s best interests at heart and would be appreciative of a frank discussion. In all cases, it is important for you to trust your judgement of the situation based on how well you know the parents or guardians and the child.

In circumstances where a child’s health and safety are considered to be at risk, the records can be released without consent of the carers.

In summary, a dental professional is required to make a report to child protection services if they are to form a reasonable belief that the child has been, or currently is, at risk of abuse. All states and territories in Australia have enacted mandatory reporting for suspected abuse and neglect; however, there are differences between them with regards to who is mandated to report. If you believe a child is in immediate danger, call the police on 000.

Clinicians are advised to raise their concerns with the team at Dental Protection so we can guide you through what can be a very complex issue.

Additional resources

Each state’s relevant reporting authority for suspected child abuse and neglect can be found here and you can also talk to trained professionals at Kids Helpline on 1800 55 1800 or Lifeline on 131 114.

Further information

https://aifs.gov.au/cfca/publications/mandatory-reporting-child-abuse-and-neglect

www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/white-book/child-abuse#ref-num-142