Journal of the Louisiana Dental Association

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LDAfeatureDionne J. Richardson, D.D.S., M.P.H., DHHOral Health Program Directorchild is abused every 48 minutes in Louisiana, accordingA to Louisiana Court Appointed Special Advocates (LACASA), the local chapter of a nationally recognized childadvocacy group 1 . In addition, very young children (ages 3and under) are most often the victims of child abuse andneglect and caretakers are commonly the perpetrators. 2These startling statistics are apparent to abuse andneglect advocacy programs like LA CASA on a dailybasis. However, the burden of identifying these casescannot be borne by advocacy groups alone. In order tocombat the problem, reporting suspects requires the keenobservation of individuals in schools, social services, childcare, law enforcement, and healthcare professionals. Inaccordance with the Keeping Children and Families SafeAct of 2003 3 , health professionals are obligated to reportsuspected cases of abuse or neglect. This act is the amendedChild Abuse Prevention and Treatment Act, which wasenacted in 1974 (Keeping Children and Families Safe Act of2003(P.L. 108-36), www.4.law.cornell.edu/uscode/42/ch67.html.) As defined by the LA Children’s Code [Art. 603(13)],all health professionals, including dentists and dentalhygienists, are mandated to report suspected cases of abuseand neglect to the Louisiana Office of Community Services. 4Dentists as ReportersDentists and dental hygienists are considered “mandatedreporters” along with other health care professionals.Although many abuse and neglect cases go unreported,A Reminder: Dentistry’s Role in PreventingChild Abuse and Neglectthe media are revealing disturbing cases of abuse and neglectof children in Louisiana. Dentists reported 20 cases ofabuse and neglect in 2007. Of these cases, 8 were validated.Studies show that abuse and neglect are under reported,and there is no sure way of determining the actual numberof abused children. The LA Office of Community Servicesreports that of the 23,730 cases investigated in Louisiana,dental health professionals represent 0.08% of those reportingthese cases. It is important for dental health professionals toactively participate in keeping children safe.Reporting Abuse and NeglectLouisiana’s reporting protocol requires reports to be madeimmediately to the Louisiana Office of Community Services, anagency in the Department of Social Services. The cases to reportinclude: “child abuse or neglect or that such was a contributingfactor in a child’s death, where the abuser is believed to bea parent or caretaker.” If someone other than a caretaker isbelieved to be the perpetrator and the caretaker is not believedto have any responsibility for the abuse or neglect, reportsshall be made immediately to a local or state law enforcementagency. 5 (LA Children’s code) A list of reporting agencies canbe obtained from the Department of Social Services www.dss.state.la.us/departments/ocs/Reporting_Child_Abuse-Neglect.html and the Louisiana Children’s Trust Fund (www.ltcf.org). Several facts should be included in the report and aresummarized in the box below.The report should contain the followinginformation, if known:1. The name, address, age, sex and race of the child.2. The nature, extent and cause of the child’s injuriesor endangered condition, including any previousknown or suspected abuse to this child or thechild’s siblings.3. The name and address of the child’s parent(s)or other caretaker.4. The names and ages of all other membersof the child’s household.5. The name and address of the reporter.6. An account of how this child came to thereporter’s attention.7. Any explanation of the cause of the child’s injuryor condition offered by the child, the caretaker, orany other person.8. Any other information that the reporter believesmight be important or relevant.30 LDA Journal
The Louisiana Code also advises that the report shall alsoname the person or persons who are thought to have caused orcontributed to the child’s condition, if known, and the reportshall contain the name of such person if he is named by thechild. If the initial report was in oral form by a mandatoryreporter, it should be followed by a written report made withinfive days to the local child protection unit of the department or,if necessary, to the local law enforcement agency.Definitions, signs and symptoms ofabuse and neglectOne might ask, “how do I recognize child abuse;” and “whatis considered neglect in children.” The Children’s Trust Fundreports that Federal law defines child abuse and neglect as,at a minimum, any recent act or failure to act: serious physical or emotional harm, sexual abuse,or exploitation of a child (person under the age of 18,unless the child protection law of the State in whichthe child resides specifies a younger age for cases notinvolving sexual abuse). residential facility or any staff person providing out ofhome care) who is responsible for the child’s welfare.In Louisiana, child abuse and neglect are defined (Children’sCode, Title VI Child in Need of Care) as the infliction by acaretaker of physical or mental injury or the causing of thedeterioration of a child including but not limited to such meansas sexual abuse, sexual exploitation, or the exploitationor overwork of a child to such an extent that his health, mentalor emotional well-being or safety is endangered.Furthermore, neglect is defined as the refusal or willfulfailure by a caretaker to provide for a child the proper ornecessary support or medical, surgical, or other care necessaryfor his well-being. Child neglect is characterized by failure toprovide for the child’s basic needs. Examples of physical neglectinclude, inadequate clothing for cold weather or refusal toseek health care when a child clearly needs medical attention.Emotional neglect can occur when chronic or extreme spouseabuse occurs in the child’s presence. Severe neglect oftenresults in death, particularly in the case of very young children.Failure to thrive is also a form of neglect that affectsinfants and young children. This form of neglect may occurwhen a child does not grow or develop during the first threeyears of life. It can either be caused by a child’s physiologicalproblems or it may be due to environmental problems relatedto nurturing and/or feeding. Infants exhibiting this type ofneglect are often spastic or rigid or have extremely poormuscle tone. Behavioral signs of neglect in infants may includeunresponsiveness and withdrawal. Mothers of these childrenmay feel incompetent and unable to meet their children’sneeds. They may appear to have a low tolerance for irritationand seem angry and depressed.Like neglect, abuse can also manifest in several forms. Theyinclude: physical abuse, sexual abuse and emotional abuse.Physical abuse according the LA Children’s code, includes anynon-accidental physical injury caused by the child’s caretaker.This type of abuse occurs when an adult is frustrated or angryand strikes, shakes or throws a child. Occasionally physicalabuse can be intentional, especially when a caretaker burns,bites, pokes, cuts, twists limbs or otherwise harms a child. Themost common physical-abuse related death is head injuries.Sexual abuse can entail a wide range of behavior includingfondling of genitals, intercourse, rape, sodomy, exhibitionism,and commercial exploitation through prostitution orpornography. Sexual abuse may be committed by a personunder the age of 18 when that person is significantly older thanthe victim or when the victim is in a position of authority overanother child.Emotional abuse or maltreatment includes blaming,belittling, or rejecting a child; constantly treating siblingsunequally; or persistent lack of concern by a caretaker forthe child’s welfare. This type of abuse is most often the mostdifficult to recognize because the signs are rarely physical.Effects of mental injury include lags in physical development orspeech and are not as obvious as bruises and lacerations.Some children exhibit behavior such as rocking motions,facial tics and odd reactions to persons in authority.Brannon and Strother offer 9 questions to consider inrecognizing child abuse or neglect. 61. Has there been an extreme delay in seeking treatment?2. Is the caretaker willing to discuss the circumstances ofthe injury?3. Is the injury consistent with history given by thecaretaker and or child?4. Is the injury unusual for that child’s age group orphysical development?5. Are there conflicting explanations?6. Does the caretaker or child exhibit unusual behaviorthat may indicate abuse?7. Is the present injury one of a series of repeatedinjuries? Is there any history or signs of previoustrauma?8. Are there any cutaneous manifestations of abuse, suchas bruises in various stages of healing?9. Is there any evidence of neglect of the child?Previous articles on abuse and neglect have highlightedseveral common signs and symptoms of abuse and neglect.(See Table) It is important to note that bilateral injuries andmultiple injuries are also important to observe. In addition,injuries in varied stages of health can indicate repeated trauma.For example, bruises can undergo a number of color changesbefore they are completely healed. Ear injuries are oftenconsidered pathognomonic. Therefore, authorities recommendtaking note of bruises behind the ear. Dentists most oftenreport contusions, abrasions, and lacerations, according to theLouisiana Office of Community Services.Dental neglect is also important to recognize in the dentalprofession. The American Academy of Pediatric Dentistry (AAP)definition gives guidance to dental professionals to deal withpotential cases of dental neglect. The AAP defines dental neglectas the “willful failure of parent or guardian to seek and followthrough with treatment necessary to ensure a level of oralhealth essential for adequate function and freedom from painFall 2008 31
Page 1: JournalLDAJournal of the Louisiana
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Page 6: LDAfrom the presidentMaurice B. “
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