Sign In Safeguarding describes the wider range of measures taken to minimise the risks of harm to children. Non-accidental injury is the term used to describe any injuries that are due to abuse.
The Department of Education and Skills “Every Child Matters” document states that the outcomes for the well-being of children and young people are:
- Be healthy
- Stay safe
- Enjoy and achieve
- Make a positive contribution
- Achieve economic well-being
This is based on the international human rights (United Nations Convention on the Rightsof the Child)
- Article 19 – Children should be protected from all forms of physical or mental violence, injury or abuse
- Article 24 – Children have the right to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and the rehabilitation of health
- Physical – either physical e.g. hitting, shaking, burning, poisoning and also if a parent/carer fabricates or induces symptoms of illness in a child.
- Emotional – some level of emotional abuse is involved with all other types of abuse and can include bullying, making the child feel worthless, seeing other abuse, overprotection, preventing social participation.
- Sexual – both physical and non-contact including sexual acts, indecent images, grooming.
- Neglect – failure to meet a child’s basic physical and psychological needs including failure to provide food, clothes, shelter, supervision.
Prevalence:
Children who have been recognised to be at a high risk due to safeguarding issues become subject to a child protection plan. In 2010 there were 35,700 children with a child protection plan in place (3 children per thousand). Forty-four percent of these were due to neglect.
- Local government children’s services
- Health services
- Education
- Police and probation
- Family courts
- Youth/community workers
- Sport and leisure
- Voluntary and private sector organisations
- Faith communities
- Record any noted injuries. The head and neck is a frequent site of injury for physical abuse
- Ensure notes are clear, concise, complete and contemporaneous (4 C’s)
- Untreated disease can be a sign of neglect
- Children attend the dentist regularly and the dentist may be the first health professional to notice signs of neglect or any other safeguarding issues
- Dentists often treat families therefore can gain insight to any other issues that may impact on the child.
- Direct allegation or child says something about injury that gives cause for concern
- Worrying child behaviour or child-parent interaction
- Delay in seeking medical help
- Vague history of accident
- History of trauma not matching the presenting injury
- Abnormal parent moods or behaviours e.g. Hostility/aggression.
- Bruising in children/babies who aren’t able to crawl/walk independently
- Bruising on soft tissues such as cheeks and neck, injuries tend to more commonly occur on bony prominences such as forehead and cheekbones
- Bruising on the ear caused by pinching or pulling
- Patterns of bruising with perhaps similar bruises of various ages
- Lacerations on the face without a consistent history
- Burns including cigarette burns however beware of medical conditions such as bullous impetigo
- Bite marks
- Peri-orbital bruising
- Torn labial frenum in a child under 1 yr– be aware children can tear this easily when learning to walk.
- Poor growth
- Developmental delay
- Education failure
- Social immaturity
- Lack of social responsiveness
- Aggression
- Attachment disorders
- Indiscriminate friendliness
- Challenging behaviour
- Attention difficulties
- Short stature/failure to thrive through poor diet
- Ill-fitting clothing
- Sunburn
- Animal bites
- Dirty/smelly or persistent infection with head lice
- Missed appointments or immunisations
- Withdrawn or attention seeking behaviour.
- Intraoral bruising/ulceration
- Sexually transmitted disease e.g. Vesicle from gonorrhoea
- Disclosure made by child
- Pregnancy in a child
- Emotional signs e.g. Self harm/ delayed development/ depression
Parent Factors:
- Young/single parents
- Parents with learning difficulties/mental health problems
- Substance abuse
Social Factors:
- Poor social environment such as housing, poverty, isolation
- Asylum seekers/refugees
Child Factors:
- Age-younger children experience the most physical abuse and neglect with older children experiencing more sexual abuse
- Children with disabilities
- Children who are “looked after” such as foster or residential care
1. Take a thorough history (4 C’s) – inconsistencies in trauma history can be a worrying sign as well as any physical injury. Also include the parent child relationship and the child’s behaviour
2. Avoiding asking leading questions, respond calmly and in a non judgemental manner. If asked to keep a secret explain that you cannot but then explain who you will share it with and when
3. Discuss case with an experienced colleague. In a Dental Hospital, this will be either the tutor or the consultant. (However, when in practice this may be a dental colleague, social worker or a paediatrician).
If the consultant or tutor agrees that there is cause for a safeguarding concern for that child they will then discuss this with the family and seek consent to share information. The only circumstances for when this is not needed is:
1. Where the discussion may put the child at greater risk/ impede police investigation/social work enquiry
2. When sexual abuse is suspected
3. Where fabricated or induced illness is suspected
4. Where parents are violent or abusive and the discussion may put yourself at risk
5. Where contact to parents isn’t possible without delaying the referral.
Referrals should be made by telephone so that a direct discussion with regards to safeguarding can be made, this should be followed by a referral in writing within 48 hours.
Cairns AM, M. J. W. R., 2005. Injuries to the head, face, mouth and neck in physically abused children in a community setting. International Journal Of Paediatric Dentistry, Issue 15, pp. 310-318.
Harris J, S. P. W. R. T. R. G. M. G. J. F. C., 2006. Child protection and the dental team: an introduction to safeguarding children in dental practice. [Online]
Available at: https://www.bda.org/childprotection/Pages/default.aspx
Jenny C. Harris, R. C. B. P. D. S., 2009. British Society of Paediatric Dentistry: a policy document on dental neglect in children. International Journal of Paediatric Dentistry.
Kate Wilson, A. J., 2007. The Child Protection Handbook: The Practitioner’s Guide to Safeguarding Children. Third ed. London : Elsevier Limited .
National Institute for Health and Care Excellence, 2009. Child maltreatment: when to suspect maltreatment in under 18s. [Online]
Available at: https://www.nice.org.uk/guidance/CG89
Patricia G. Schnitzer, B. G. E., 2005. Child Deaths Resulting From Inflicted Injuries: Household Risk Factors and Perpetrator Characteristics. Pediatrics , 116(1), pp. 687-693.
See also Radiography
