12.8 CHILD PHYSICAL ABUSE
A child is considered to be abused if he or she is treated in a way that is unacceptable
in a given culture at a given time (772HFig. 12.4). Child physical abuse or non-accidental
injury (NAI) is now recognized as an international issue and has been reported in
many countries. Each week 2-3 children in Britain and 80 children in the United
States will die as a result of abuse or neglect. At least one child per 1000 in Britain
suffers severe physical abuse; for example, fractures, brain haemorrhage, severe
internal injuries or mutilation, and in the United States more than 95% of serious
intracranial injuries during the first year of life are the result of abuse. Although some
reports will prove to be unfounded the common experience is that proved cases of
child abuse are four to five times as common as they were a decade ago. Physical
abuse is not a full diagnosis, it is merely a symptom of disordered parenting. The aim
of intervention is to diagnose and cure the disordered parenting. It has been estimated
in the United States that 35-50% of severely abused children will receive serious re-
injury and 50% will die if they are returned to their home environment without
intervention. In some cases the occurrence of physical abuse may provide an
opportunity for intervention. If this opportunity is missed, there may be no further
opportunity for many years.
More than 50% of cases diagnosed as physical abuse have extra and intraoral facial
trauma and so the dental practitioner may be the first professional to see or suspect
abuse. Injuries may take the form of contusions and ecchymoses (773HFig. 12.50),
abrasions and lacerations, burns, bites, dental trauma (774HFig. 12.51), and fractures. The
incidence of common orofacial injuries are shown in 775HTable 12.4.
The following 11 points should be considered whenever doubts and suspicions are
aroused.
- Could the injury have been caused accidentally and if so how?
- Does the explanation for the injury fit the age and the clinical findings?
- If the explanation of cause is consistent with the injury, is this itself within
normally acceptable limits of behaviour? - If there has been any delay seeking advice are there good reasons for this?
- Does the story of the accident vary?
- The nature of the relationship between parent and child.
- The child's reaction to other people.
- The child's reaction to any medical/dental examinations.
- The general demeanour of the child.
- Any comments made by child and/or parent that give concern about the child's