Child abuse: recognition and reporting

SUMMARY Child abuse is a preventable adult disease. Dentists are in a unique position to identify suspected cases of physical abuse because many of the injuries involve the head and neck. Although abusive parents are careful about changing physicians or emergency rooms, they do not exercise the same caution when dealing with dentists. Therefore, the dentist may be the only health care practitioner to see the child with any regularity. The first step in the prevention of this disease is recognition of its symptoms and signs. Dentists should be familiar with the types of bruises and diseases that result from child abuse. A medical history will help identify those symptoms that result from systemic disease as well as possible cases of child neglect. Once child abuse is suspected, the dentist must, by law, report the suspicion to the appropriate agency. Although the dentist may not be required to testify, the dental records could be called as documentation of the abuse. Therefore, dental records should be complete and illustrative. Although it is not always possible, the dentist should attempt to discuss the suspected abuse with the parent and child. In some cases, this interest may be all that is needed for a parent to seek help. When interviewing a parent, the dentist should avoid appearing judgmental or accusatory. When speaking with the child, the dentist should phrase the questions in language that the child will understand. Finally, when in doubt, report. Failure to report suspected cases is considered professional negligence under the law. The result of waiting to see what develops can result in the permanent injury or death of a child.