CHILD ABUSE

AND NEGLECT
 Introduction
CONTENTS
 Definitions

 Prevalence

 consequences

 Types of child abuse

 Recording of child abuse and neglect

 Clinical assessment

 Examining child abuse/neglect

 Situation in India

 Role of Pedodontist in child abuse and neglect

 Conclusion

 References
INTRODUCTION

 India is home to almost 19% of the world’s children.

 More than one-third of the country’s population, around 440 million, is

below 18 years of age.

 Though in India, child is considered to be the gift of God, child abuse is

still common in tribal, remote and even in urban areas.

 It is presumed that 50% of the cases are not reported.

 Out of 3.8% cases reported, the majority of the girls are prime victim of

sexual abuse and boys of physical abuse.

 History
 Mary Ellen Wilson (March, 1864– October 30, 1956) - an American whose case

of child abuse

1870s: New York society for Prevention of Cruelty to Children

established to work in coherence with “House of Refuge”

 1946: Medical discovery of child abuse was documented by Caffey

 1962: Term ‘Battered child syndrome’ by Henry Kempe

 1974: Child Abuse Prevention and Treatment Act

 1978: Mclain: coined CAN: Child abuse and neglect

 DEFINITIONS

Child Abuse:
The World Health Organization (WHO) has defined ‘Child Abuse’ as a violation
of basic human rights of a child, constituting all forms of physical, emotional ill
treatment, sexual harm, neglect or negligent treatment, commercial or other
exploitation, resulting in actual harm or potential harm to the child’s health,
survival, development or dignity in the context of a relationship of
responsibility, trust or power.
 Child abuse: According to Gill 1968, it is defined as the ‘nonaccidental

physical injury, minimal or fatal, inflicted upon children by persons

caring for them’. It is an overt act of commission of a caretaker—
physical, emotional or sexual.

 Battered baby: A child who shows clinical or radiographic evidence of

lesions or ‘Parent–Infant Traumatic Stress Syndrome’ (PITS) (Caffey)

that are frequently multiple and involve mainly the head, soft tissues,
long bones and the thoracic cage, and that cannot be unequivocally
explained.
 PREVALENCE
• Average age of identification of
Incidence and severity of child abuse and
maltreatment victims: 7.4 years neglect in year 1979 – 1980

• Infants -2 years : Most often victims

of child neglect

Winship reported that parents are

most likely to be abusers, with the
mother being implicated in 50% of
cases.
 PREVALENCE IN INDIA

• India has largest number of children

• 69% of Indian children are victims

• New Delhi, has an over 83% abuse rate.

• 89% of the crimes are committed by family members.

• >70% of cases - unreported and unshared even with parents/ family.

 PREVALENCE

Summary report

• 25-50% of children around the world suffer from physical abuse.

• 5-10% of boys and 20% of girls experience sexual abuse.

 CONSEQUENCES
• All aspects of development are affected including brain, cognitive, and social
development.

• Characteristics of a child’s exposure to abuse or neglect including ---.

PSYCHOLOGICAL NEUROBIOLOGICAL
Agid et al 1999, Hill 2003:

 Psychiatric problems: Mood and anxiety disorders, Unipolar depression, bipolar

disorder, panic attacks, phobias and post- traumatic stress disorder.
 Childhood trauma: increases the risk for later suicide attempts

Heim et al 2000, Newport et al 2001:

 Neurobiological problems : long term disturbance of hypothalamic-

pituitary axis.

 Early life stress produces effects on developing brain, leading to adult

phenotype with vulnerability to stress, depression and anxiety.
 Features of Abuser

 Poor self esteem, coping skills

 Violent temper or outbursts.
 Inappropriate responses to the seriousness of the child’s condition
 Reluctance to give the history of the accident or giving unrealistic explanation.
 Request for treatment long after the injury has occurred.
 Immature, depressed or demanding.
 Features of Abused child

 Child is unduly afraid or passive, Stoic behavior

 Evidence of repeated skin or other injuries

 Inappropriate treatment of injuries by parents

 Child is undernourished.

 Child is wearing inappropriate dress for weather condition.

 Aggressive, demanding or hyperactive.

 Child is cranky or irritable or cries easily.

PREDISPOSING FACTORS
PARENTAL CHARACTERISTICS

CHILD CHARACTERISTICS

ENVIRONMENTAL CHARACTERISTICS
 Types of child abuse

 Physical abuse

 Sexual abuse

 Emotional abuse

 Educational abuse

 Munchausen syndrome by proxy

 Intentional drugging or poisoning

 Physical abuse

 Most common type of child abuse

DEFINITION- It is defined as the infliction of bodily damage that causes serious

pain, leaves physical sign of, impairs physical functioning, or significantly puts
in danger the child’s safety.
 Physical abuse by parents or caregivers includes beatings, shaking,

scalding, and biting, even some forms of corporal punishment are

widely accepted.

 It has been reported that in more than half of the cases of child

abuse, craniofacial, head, face, and neck injuries are found more
commonly.
It can be rated as –

 Mild
 Moderate
 Severe

Physical punishment in the name of corporal punishment is

common in our society…..
Guidelines to use physical discipline techniques –
 Parent or caretaker should only use hand
 Child should only be struck on buttocks, hands or legs

SLAPPING IS INAPPROPRIATE AT ANY AGE

 Child should not be vigorously shaken

 Striking is inappropriate before a child has learned to walk
 Physical punishment should not be used for aggressive misbehavior
 Eye-witness history- 3 aspects
History is helpful when a child reports with non-descript findings.

• Child states that injury is caused by parents

• One parent accuses the other about the injury
• Parent accepts that one of the many injuries is caused by them but not all.
Unexplained injury
self inflicted injury
Delay in seeking medical care
 ORAL MANIFESTATIONS
Some authorities believe that the oral cavity may be a
central focus for physical abuse because of its significance in
communication and nutrition
•Lips:
•scars from persistent trauma,
•burns caused by hot food or cigarettes,
•Bruising, scarring or erosion at corners of mouth
(gag trauma)
•Mouth:
•Tears of labial or lingual frenum
•Burns or lacerations of gingiva, tongue, palate or floor
of the mouth
•Teeth:
•Fractured, Displaced,
•Mobile, Avulsed,
• Non vital and darkened,
• Multiple residual roots with no plausible history to account for the injuries

• Maxilla/ Mandible:

• Signs of past or present fracture of bones, condyles, ramus or symphysis,

• Unusual malocclusion resulting from previous trauma.
  BRUISES:

 Inflicted bruises:

Location of bruise Indicative of

Ear lobe Pinch marks
Cheeks Slapping of the child

Upper lip/ labial frenum /floor Impatient or forceful feeding

of the mouth

Neck Strangulation
Circumferential bruises or Placement of restraints
burns on ankles/wrists

Corners of mouth Gagging of child

 Colour changes in bruises

AGE COLOUR
0-2 days Swollen, tender
0-5 days Red, blue or purple
5-7 days Green
7-10 days Yellow
10-14 days Brown
2-4 weeks Cleared
 Maguire, Mann, Sibert, et al Can you age bruises accurately in children? A systematic
Review Arch Dis Child 2005;90:187–189

• Bariciak et al: state that the accuracy of ageing a bruise to within 24 hours of its
occurrence is less than 50%.

• Broadly, red/purple/blue colour: associated with recent bruising and

yellow/ brown and green: with older bruising.

• Not all colours appear in every bruise and different colours appear in the same bruise
at the same time.
• Conclusion:
– Photography of a bruise is misleading as 2-d image loses the contours of the bruise
and any associated swelling and the photographic colour reproduction is unreliable.
– Spectrophotometry and ultraviolet photography are more reliable
techniques.
 Marks in physical child abuse:
 Human hand marks:
Grab marks: oval shaped bruises that resemble finger prints due to holding of child in
violent shaking.

 Strap marks:
 1-2 inches wide, sharp bordered rectangular bruises of various lengths
 Often caused by belt

 Lash marks:
 Narrow, straight, edge bruises or scratches
 Thrashing with tree branch or switch
 Loop marks:
 Doubled-over lamp cord, rope or fan belt.
 The distal end of the loop strikes with the most force, commonly breaking the skin.

 Bizarre marks:
 Blunt instrument

 Circumferential tie marks:

 Ankles or wrists of the child
 Use of restraints such as narrow rope, cord, strap.

 Gag marks:
 Abrasions at the corner of the mouth
 Facial injuries

 Contusions/ ecchymosis

 Abrasions/ lacerations - Penetrating injuries to the palate, vestibule and

floor of the mouth - forceful feeding of young infants

 Abrasions and lacerations on the face - variety of objects - due to rings or

finger nails
 Eye Injuries

 Involve both sides of the face.

 Ocular damage includes

• dislocated lens,
• detached retina.

 More than half of these injuries result in permanent impairment of vision

affecting one or both eyes.
 Burns
 Burns of the oral mucosa - forced ingestion of hot or caustic fluids in young
children.

 Burns from hot solid objects applied to the face - without blister formation
and the shape of the burn often resembles its agent.

 Cigarette burns -circular, punched out lesions of uniform size.

 Bone fractures
 Occur in almost any bone.

 Most fractures in physically abused children occur under the age of 3years.

 Accidental fractures occur more commonly in children of school age.

 Merten DF, et al Facial fractures during physical assault - nasal fractures occurring most
frequently (45%), followed by mandibular fractures (32%) and zygomatic maxillary
complex and orbit fractures (20%).

 Feldman et al :Force required to produce a facial fracture in a child is greater than that
required to produce fractures in long bones.
 Sexual abuse

It is defined as the involvement of dependent, developmentally young children

and adolescents in sexual activities which they do not fully understand, to
which they are unable to give agreement, or that be false to the social
something not to be done of family roles.

 Any sexual activity with a child under age 18 by an adult.

Causes of under-reporting:
• Cultural mores- stigma for victim, family
• Victims are often young children
• Health professionals unaware of signs and symptoms
• Hidden with no visible physical manifestations
• Health professionals unwilling to report due to lack of physical evidence
• Verification of sexual abuse by physical examination may be more than
legal extent
 The victim- most often a female child; F:M- 9:1.
 Children of all ages are abused sexually but those in the
early teens seem to be most at risk.

 Features:
◦ Emotional effects
◦ Functional disturbances
◦ Frequent masturbation
◦ Preoccupation with genital area
◦ Regression in behaviour
◦ Guilt and anxiety

Perpetrator- known person

 Abusive , withdrawn, sexual problems with spouse, alcoholism.
 Bite Marks
DEFINITIONS:

 BITE: is tear or seize with teeth

 BITE MARK: mark caused by teeth alone or in combination with other oral parts or
consists of teeth marks produced by the antagonist teeth can be as two opposing
arch marks
 TOOTH MARKS: produced by two or more teeth
 ARCH MARK: four or five marks of adjacent teeth must be present before a mark
can be identified as a human arch mark
Identification of bite marks
Appearance of bite marks depends on:
• Magnitude and duration of bite

• Character of tissue involved.

Recognition: specific bruising, abrasions or lacerations to complete avulsion of the

tissue.
• Comprise of two opposing (facing)

• Central bruising, an area of hemorrhage, representing a ‘suck’ or ‘thrust’ mark is

often present
 Incisors cause: rectangular markings
 Canines: triangular
 Premolar: either single or dual triangles or diamonds
 Molars: seldom represented due to posterior positioning.
Location:
 Randomly on the body of abused child.
 Usually on cheek, back, side, arms or buttocks.

Perpetrators:
 – Siblings/ playmates: often located on cheek
 – Animal bites: deep tissue penetration with accompanying tearing and
lacerations.
Recognition of bite marks in child abuse cases. Stephen A Jessee. Pediatr Dent
1994;16(5):336-339
 Permanent dentition or deciduous dentition ???
 Distance b/w 2 canine marks

 Bite mark caused by arches:

 Maxillary
 Mandible
Role of pediatric dentist :

Factors complicating dentist’s ability –

 Sexual abuse occurs without physical findings
 Lack of equipments required for testing
 Unaware of oral manifestations of venereal disease.

Factors alerting dentist –

 H/O sexual assault
 Physical findings of sexual abuse
 Pregnancy in a child younger than 12 yrs of age
 Signs of physical abuse
 Direct reports from children
 Oral manifestations:
 Visible oral infections
 Oral/Perioral gonorrhea – pathognomonic of sexual abuse
 HPV infection – presence of warts
 Unexplained injury or petechiae – at junction of hard and soft palate

When oral-genital contact is confirmed by history or examination findings, universal testing

for sexually transmitted diseases within the oral cavity is controversial; the clinician should
consider risk factors (eg, chronic abuse, perpetrator with a known sexually transmitted
disease) and the child’s clinical presentation in deciding whether to conduct such testing.

Guideline on Oral and Dental Aspects of Child Abuse and Neglect American Academy
Of Pediatric Dentistry Reference Manual 2012; 34(6).
 EMOTIONAL ABUSE
•It is maltreatment which results in impaired psychological growth and development.

• Involves words, actions and indifference.

• Examples:
• Verbal abuse,
• Excessive demands on a child’s performance,
• Discouraging caregiver and child attachment,

Garbarino, J. & Garbarino, A. Emotional Maltreatment of Children. (Chicago, National Committee

to Prevent Child Abuse, 2nd Ed. 1994).
 Etiology
• Stressful life of parents

• Reduced capacity to understand children

• Alcoholism

• Drug abuse

• Psychopathology

• Mental retardation

• Controlling personality of parents

• Family stress

A single factor may not lead to abuse, but in combination they can create social
and emotional pressures that lead to emotional abuse.
 EMOTIONAL ABUSE: Effects

•Psychopathologic symptoms are more likely to develop in emotionally abuse

children.
•Lifelong pattern of depression, estrangement, anxiety, low self-esteem, lack of

empathy
 Educational abuse

 Exists when a parent or caretaker intentionally keeps the child at home or fails to
enroll the child in school.
 Intentional drugging or
poisoning
 Administration of a drug which is not indicated for normal use by a child.

 Drugs given:

◦ Sedatives
◦ Hallucinogenic drugs
 Battered child syndrome

 Dr C Henry Kempe in 1962

 Evidence of fracture of long bones

 Soft tissue swelling or skin bruising

 Sub- dural hematoma

 Failure to thrive
 Shaken baby syndrome

• Subdural hematoma, retinal hemorrhage and cerebral edema

• Child abuse caused by intentional shaking.
• No visible sign of external trauma.
• Severe brain damage, resulting in lifelong disability.
• Nonfatal consequences include varying degrees of visual impairment (including
blindness), motor impairment (e.g. cerebral palsy) and cognitive impairment.
Munchausen Syndrome :

 Definition: Intentional production of physical or psychological symptoms in another

person who is under individual’s care for the purpose of assuming sick role

 Etiology:
 Developmental disturbances

 Mother – suffered from same

 To prevent child from being independent

 Munchausen syndrome by proxy

 First described by Dr. Richard Asher in 1951.

 Dr. Roy Meadow first coined the term to describe the preservation of the
deception in regard to the child.

 Describes children who are victims of parentally fabricated or induced illness.

 Involves children who are too young (<6 years).

Symptoms:
 Bleeding from various sites
 Recurrent sepsis- from injecting contaminated fluids
 Chronic diarrhea- from laxatives
 Rashes- from rubbing skin/ applying caustic substances

Warning Signs:
 Recurrent illness that cannot be explained
 Discrepancy b/w clinical findings and history
 Mother overly protective
 Child seen by multiple hospitals and physician
 Signs and symptoms do not occur when mother away from child
 Child Neglect
• Child Neglect’ is stated to occur when there is failure of a parent/guardian
to provide for the development of the child, when a parent/guardian is in
a position to do so (where resources available to the family or care giver;
distinguished from poverty).
• Act of omission or the failure to provide food, shelter, clothing, health care,
safety need, dental care and supervision.
Types :
Health care neglect
Dental neglect
Nutritional neglect
Physical neglect
Emotional neglect
Safety neglect
 Dental Neglect
 Definition: AAPD – Willful failure of parent or guardian to seek and follow
through with treatment necessary to ensure a level of oral health, essential
for adequate function and freedom from pain and infection

 Dental caries, periodontal diseases and other oral conditions, if left

untreated can lead to pain, infection and loss of function.
Etiology

 Family isolation

 Lack of finance

 Parental ignorance

 Lack of perceived value of oral health

 Use of narcotics by parents

 Failure of parent to obtain appropriate care following identification of
serious pathology

 INDICATORS : by Davis et al in 1979

 Untreated rampant caries

 Untreated pain, infection, bleeding and trauma

 Lack of continuity of care

 Severe neglect should be reported and management depends on individual

circumstances
Guideline on Oral and Dental Aspects of Child Abuse and Neglect. AAPD :
Reference Manual 2012; 34 (6)

 Caregivers with adequate knowledge and willful failure to seek care must be
differentiated from caregivers without knowledge or awareness of their child’s
need for dental care.

 Family isolation, lack of finances, parental ignorance, or lack of perceived

value of oral health.

 The physician or dentist should be certain that the care-givers understand the
explanation of the disease and its implications
Treatment
 Provide the necessary treatment
 Referral for a complete pediatric history taking and physical examination
 Nutritional Neglect
 Failure to thrive due to nutritional neglect can be defined as an underweight,
malnourished condition who’s weight is below 3rd percentile and a height and head
circumference are above 3rd percentile on growth curve
 C/F:
◦ Gaunt faces
◦ Prominent ribs
◦ Wasted buttocks
◦ Spindle extremities
Usually Seen In First 2 Years Of Life
Causes :
 Mother depressed
 Single parenting

 Overwhelmed with responsibilities

 Hostile towards child

Management :
 Nutritional rehabilitation program
 Hospitalized and placed on unlimited feeding

Infant who gains weight rapidly and easily in hospital was underfed at home
 Safety Neglect
 Most accidents are due to breach in safety and could have been
prevented
 Usually occur in children younger than 4 yrs.

 Examples:

 burns, accidents, falls

 Health care neglect

 When parents or care takers repeatedly ignore a child with a treatable chronic
disease leading to serious deterioration of the condition.

 Refusals due to religious beliefs.

 Emotional Abuse And Neglect
 Definition : Continuous rejection of a child by parents or
caretakers
 Most difficult to detect

 Characteristics of parents :

 Violent/non-violent threats

 Use of degrading language

 Withholding love and affection

 Non-communication

 High expectations-socially, mentally, physically

Indicators:
 Stop communicating

 Play on its own and not become involved

 Wetting ones self after being toilet trained.

 Low self-esteem and lack of confidence

 Pinching and self biting

 Possible speech disorders

Management:
 Build positive attitude

 Never draw a reference to other children as standard

 Physical Neglect
 Definition: Failure to care for children according to accepted or
appreciated standards

 May be confused with poverty, ignorance

 C/F
 Dirty hair and clothing

 Inadequate lunch

 Inadequate immunization

 Unsanitary home environment

 Inadequate after school supervision

 Excessive work
 IDENTIFICATION OF CAN
 Doctors of Medicine are expected to practice 4 Rs,
 Recognize
 Record
 Report
 Refer

 Clinician should be able to recognize the specificities of oral and dental

status, since it could be the first indications of abuse.

 All members of dental team: Administrators, Assistants, Nurses,

Hygienists

*Kenney JP. Domestic violence: a complex health care issue for dentistry
today. Forensic Sci Int. 2006 May 15;159 Suppl 1:S121-5.
 Interaction between the parent and child is assessed on entry into dental
office.

 History: – Taken from child as well as from parents/ custodians regarding:

 Nature of trauma

 Type of trauma

 Time of trauma

 Differences in history and lack of consistency between severity of the

trauma and the story told by parents may point to abuse.

 Trauma of primary teeth usually occurs at age 2-3 years

documentation
HISTORY
 Record what the child said in their own words, and whether the disclosure was
spontaneous or to what specific question.

 Interview the parent (s) separately and record their explanation, including any
discrepancies in the history,

 Record what happened, when, where and how- any witnesses? •Who lives with the
child/ takes care of the child?

 Note history of past injuries, hospitalizations,

 Note medical conditions which might mimic abuse pattern.

Physical Examination:
 Note the physical and emotional state of the child when disclosing

 Note hygiene, state and appropriateness of clothing

 Perform a complete physical exam-

 If sexual abuse is suspected,

---- visual inspection, as it may relate subsequent forensic exam evidence
collection.
Methods Of Photographing Specific Injuries

General criteria

 A tag with date and reference number

 Millimeter reference scale placed close to the area being photographed

 Reference scale most widely used and accepted by forensic odontologists

 Methods For Photographing Specific Injuries-
Bernstein ML.
Punctures, slashes, rope burns, or pressure injuries
 Take photographs straight on and at a slight angle.

 Provides an overall view of the surface and extent of the injury

Bruises
 Bruising goes through several stages of development—

 Both old and new bruises should be photographed.

 To help minimize the reflections, take photographs from several different

angles, then do a follow-up series when the swelling has gone down.
Burns
 In cases of burns or severe scalding, take pictures from all angles before
and after treatment.

Facial injuries
 If aninjury is inside the mouth, use a plastic or wooden tongue
depressor to keep the mouth open and the injury visible.

 If there is an eye injury

Neglect
 When there is suspected child neglect, the child’s general appearance should be
photographed,

 Bite marks

 Black-white as well as colour photographs

 Orientation photos: for location of the bite mark
 Captured from 3-5 feet from the subject
Bite marks
 Macrophotography
 First photo without a scale
 Second one with the scale placed adjacent to the injury without covering
any portion of it
 L shaped scale
 A sticky label can be attached to one arm of the scale
Collection Of Lab Samples From Bite Marks

 Affected area to be swabbed in a circular manner with a cotton applicator

moistened with saline to detect secretory antigens left by saliva of
perpetrator.

 A second or control swabbing should be done from a site away from the
bite mark.

Collection of Lab samples from Bite marks Recognition of bite marks in child
abuse cases. Stephen A Jessee. Pediatr Dent 1994;16(5):336-339
 Role Of Pedodontist In CAN:
Documentation
 Observe and examine any suspicious evidence
 Treat dental injuries
 Hold child who’s life is in danger and transfer him to hospital for
proper care
 Documentation: permanent, accurate and reproducible records It
includes:

 Written observation
 Photographs
 Radiographs
 Cast models
Role Of Pedodontist
At Reception:
 Routinely observe children for unusual behaviour.

 Evaluate hygiene, outward signs of proper nourishment, clothing and

general health.

 Check for any wounds or bruises in the child’s face or body.

 Abused children may act aggressively by showing inappropriate anger and loss of

control, or they may be stoic or withdrawn.

Extra oral examination:
 Head and neck: asymmetry, swelling, bruising.
 Scalp: signs of hair pulling
 Ears: scars, tears and abnormalities.
 Bruises/abrasions or varying colour, which indicates different stages of
healing.
 Distinctive pattern marks on skin left by objects.
 Middle third of face
 Check for bite marks: especially in areas that cannot be self-inflicted.
Intra-oral examination:
 Burns/ bruises near commissures of the mouth

 Scars on lips, tongue, palate or lingual frenum

 Labial frenum/Hard tissue injuries

Legal aspects:
 laws proposed under the Draft Model Child Protection Act 1977, to protect
himself and apply it correctly in such cases.

Informing the parents

 “Based on my training, I am concerned that this injury could not have happened this
way. Because of this, I am requesting by law to make a report to child protection
services.”
 Levels of prevention of child abuse and
neglect

 Primary level

 Secondary level

 Tertiary level
 Primary level

 Approaches applicable to a population in general, without targeting specific

groups.
 Screening children at high risk for maltreatment
 Explore psychological issues during routine health supervisory visit
 Parents at risk for abusing children should be counselled
 Comprehensive evaluation of child’s and family situation should be done.
 Secondary level

 Efforts directed to those who are known or at a specially high risk for child

abuse and neglect.

 Interdisciplinary team approach.

 To enhance parenting capabilities, family functioning , thereby enabling them to

provide a more adequate care for children.

 Tertiary level

 Intervention after the condition is already identified.

 To prevent recurrence of the condition or the potential negative sequelae.

 Depends on accurate identification of abuse and neglect.

 The pedodontist should ensure that the child is referred to a designated child

protection agency and the child’s situation is further evaluated.

 Child protective agencies

Indian police
National Human Rights Commission(NHRC)
Indian laws for child abuse
Physical abuse:
Violence in home- IPC 323/ IPC324

Sexual abuse:
Girls- IPC 376
Boys- IPC 377
 Government and Non-government organizations

working against child abuse
UNICEF
 Childline India Foundation
 PANDA - Prevention of Abuse and Neglect through Dental Awareness
 ISPCAN- International Society for Prevention of Child Abuse and Neglect
 CRY
 TULIR (CPHCSA) – CHENNAI
 Situation in India
 50% cases not reported due to lack of awareness.

 Out of 3.8% cases reported majority of girls are prime victim for sexual abuse and boys
for physical abuse.

 Attempt to prevent child abuse in India:

 In India, child labour is the commonest type of abuse.
 1986 Child Labour(Prohibition and Regulation)Act stated that children under 14 years
could not be employed in hazardous occupations.
 Telephonic help lines (CHILDLINE 1098) and Child Welfare Committees (CWC) under the
Juvenile Justice Act (2000) have been established
 The Protection of Children from Sexual Offences (POCSO)Act, 2012
 Right to Free and Compulsory Education Act (2009)
 Commissions for Protection of Child Rights Act (2005)
 Juvenile Justice (Care and Protection of Children) Act 2000, amended in 2006,
 Goa Children’s (amendment) Act 2005
 Integrated Child Protection Scheme, 2009.

 Narendra Saini. Child Abuse and Neglect in India: Time to act. JMAJ, September/October 2013;
56(5): 302-309.
 MANAGEMENT AND PREVENTION OF CAN

•Management of manifestations of abuse:

•Physical: Dental and Medical treatment
•Emotional : Psychological counselling
•Review

•Educating the school-children and making them

comfortable to confide in their parents, teachers etc.
 Family counselling and education:

 Educate parent and focus on enhancing behaviour, such as developing and

practicing positive discipline techniques and learning age-appropriate child
development skill (Parent Education Programs)
CONCLUSION
 References
 McDonald and Avery’s Dentistry for the child and adolescent – 9th edition

 Preventing child maltreatment: a guide to taking action and generating

evidence and International Society for Prevention of Child

 Textbook of pediatric dentistry- Nikhil Marwah- 3rd edition

 Guidelines on Oral and Dental Aspects of Child Abuse and Neglect American
Academy Of Pediatric Dentistry Reference Manual 2012; 34(6).
 Nancy D. Kellogg. Evaluation of Suspected Child Physical Abuse. Pediatrics
2007;119:1232.

 Murarka P, Thosar N, Vaidya S, Rathi N, Baliga S. Child Abuse and Neglect –

A Dentist’s Perspective. Int J Oral Health Med Res 2015;2(2):85-88.

 Narendra Saini. Child Abuse and Neglect in India: Time to act. JMAJ,
September/October 2013; 56(5)

 Collection of Lab samples from Bite marks Recognition of bite marks in child abuse
cases. Stephen A Jessee. Pediatr Dent 1994;16(5):336-339
 METHODS FOR PHOTOGRAPHING SPECIFIC INJURIES Bernstein ML. The application of
photography in forensic dentistry. Dental Clinics of North America 27:151–170, 1983
 Sanders, B. & Becker-Lausen, E. “The measurement of psychological maltreatment: Early
data on the child abuse and trauma scale”. Child Abuse and Neglect. 1995; 19(3)
 Prasanna T. Dahake, Yogesh Kale, Mahesh Dadpe, Shrikant Kendre, Snehal Shep ,
Snehal Dhore Impact of Child Abuse & Neglect on Children: A Review Article MIDSR
J.Dent.Research | Vol. 1 Issue 1 | Jan – June 2018