FORENSIC ODONTOLOGY SECTION: REVIEW ARTICLE
Year : 2017 | Volume
: 29 | Issue : 1 | Page : 74--77
Child abuse reporting: Role of dentist in India – A review
Bharti Patil, Sushmini Hegde, Anisha Yaji
Department of Oral Medicine and Radiology, Oxford Dental College and Hospital, Bengaluru, Karnataka, India
Department of Oral Medicine and Radiology, Oxford Dental College and Hospital, Bengaluru, Karnataka
Healthy, protected, educated and well developed child population who will grow up to be productive citizens of the country are pillars of the nation. However, they are dependent on their parents or care givers, which makes them vulnerable to abuse. The primary responsibility of protecting children from abuse and neglect lies with the families or the primary caregivers. However, communities and civil society and all other stakeholders are also responsible for the care and protection of children. The injuries of child abuse may be different for different children, however, several types of injuries are characteristic to abuse. Many of these injuries are easily observed by the dental professional in the course of routine dental treatment and are within the scope of dentistry for identification. This literature review shows that there are very few attempts made to report child abuse from dental offices in India whereas it is mandatory to report child abuse in many other parts of the world. This difference could be attributed to laws regarding this matter and lack of awareness and knowledge of the procedures to be followed. The objective of this paper is to review briefly the role of dentist in identifying child abuse and the norms about reporting it in our country.
|How to cite this article:|
Patil B, Hegde S, Yaji A. Child abuse reporting: Role of dentist in India – A review.J Indian Acad Oral Med Radiol 2017;29:74-77
|How to cite this URL:|
Patil B, Hegde S, Yaji A. Child abuse reporting: Role of dentist in India – A review. J Indian Acad Oral Med Radiol [serial online] 2017 [cited 2022 Aug 8 ];29:74-77
Available from: https://www.jiaomr.in/text.asp?2017/29/1/74/212087
Child abuse has become a burning issue in the recent years. This abuse and violence have no geographic and cultural boundaries. It is prevalent among the rich and the poor, educated and uneducated, young and middle-aged, and city dwellers and rural folks. In the United States, the Center for Disease Control and Prevention (CDC) defines child maltreatment as any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child. According to the Journal of Child Abuse and Neglect, child abuse is “any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation, an act or failure to act which presents an imminent risk of serious harm.”
Dental professionals have a unique role in identifying abused children than other health professionals as it has been reported that orofacial trauma is present in approximately 50–75% of all reported cases of physical child abuse. Routinely, the children visit a dentist once or twice a year, depending on their need, and usually the dentist spends at least 45 minutes with that child conversing, observing, and providing treatment. This provides an opportunity not only for the dentist but also for the hygienists and assistants to observe and report any suspicions of child abuse. It has been observed that to avoid suspicion, an abusive parent or caregiver may take the child to various physicians or hospitals over a period of time for treatment, but will visit the same dental office repeatedly.
A study conducted by Human Rights Watch in India reports that no doctor, whether a general practitioner, gynecologist, pediatrician or dentist, has been given any training whatsoever regarding child abuse examination, interviewing, care taking, the rehabilitation procedures, and the medical and psychological needs of the child. The objective of this paper is to briefly review the role of dentists in identifying child abuse and the norms about reporting it in our country.
Child abuse in India is often a hidden phenomenon, especially if it happens at home or by family members. The union ministry of women and child development (MWCD) released a study report in 2007 which assessed the incidence of child abuse nationwide. Recently released data by the NCRB highlights the fact that there is a 70% rise in rape and abduction of minors whereas it has increased to 40% in case of dissertation.
Child abuse is rarely due to one cause, it is rather a result of interaction between multiple risk factors. Some of the risk factors are:
Children with learning disabilities, conduct, or developmental disorders; chronic illnesses; mental retardation; or other handicapsTeenage, unwanted, or twin pregnancy; lack of knowledge of parenting, child health, and developmentDepressed parent or intimate partner violence within a familyDangerous neighbourhoods or poor recreational facilitiesPoverty and associated burdens.
However, physicians need to be open minded about the fact that not only low income but children from all socioeconomic strata can be maltreated.
Indicators of Child Abuse
Conducting and documenting interviews with the child and parents forms the first and key step in recognizing and reporting child abuse. A dentist should begin with an overall assessment of the child as soon as he or she walks into the treatment room. For example, when a dentist observes a particular injury he should ask about its history and check if it is uncommon for that age.
Interview should be done in the presence of a witness, and if possible the child and parent should be interviewed separately. Questions should be open ended and nonthreatening that require a descriptive answer. While dealing with the parent, they should be informed regarding the reason for the interview. The dentist needs to be objective, discuss concerns regarding the child’s injury or lesion, reassure the parent of support, and should not attempt to prove abuse or neglectThe dentist should determine if the parent’s story conflicts with the child’s story or their explanation makes any sense before making the decision to report the case to the appropriate authoritiesIn cases of severe abuse where the dentist suspects the parents may abscond with the child, it is recommended to notify the appropriate authorities prior to informing the parents of suspicions of abuse. However, the ideal situation is that the oral healthcare professional should make an effort to gain as much information as possible as well as the confidence of the parent before making any report.
The following behaviors when observed should raise a concern of child abuse:
Child wary of adult contact or he or she displays passive behavior to avoid conflict or seems frightened of their parents and afraid to go homeChild seems overly aggressive, violent, demanding, or displaying abusive behavior; may also exhibit dramatic mood changesParents seem extremely overprotective of their childChild’s behavior may not be consistent with that of other children at the same maturity levelIt seems that the child is lying about any abuse so the parent will not retaliate or while talking patient makes indirect hints about abuse.
When suspicion of child abuse is present, a thorough examination is needed. The dentist should begin with examination of the child’s lips and proceed in a systemic order to other parts of the oral cavity and the body.
Lips: lacerations or scars from trauma, burns from heated implements, or rope marks on the corners of the mouth from a gag being placed over the mouthPalate: any unexplained petechiea or bruises that may be indicative of forced oral sex (fellatio) particularly at the junction of the hard and soft palateFloor of the mouth: ContusionsTeeth: fractured or nonvital teeth that appear to be from nonaccidental trauma and any teeth missing or displaced for which there is no obvious explanationEdentulous patients: bruises on edentulous ridges or severe lacerationsLabial frenum: lacerated from forced feeding or from blunt trauma from an instrument or handTongue: scars or abnormal mobility from repeated trauma or damage from forcibly biting downOral mucosa: burns in the mouth from caustic substances or scalding liquids. This will appear as a white slough from necrotic epithelium. In addition, the child may salivate excessively, drool, and may have difficulty in swallowing.Radiographs: exhibit healed or recent fracturesVenereal warts, HIV-associated lesions, or any STDsInjuries, bruises, and hand cuff marks on the overlying soft tissues that are not directly supported by bone, such as the cheeks (below the zygoma), lips, neck, inner thighs, and inner aspect of the upper arm should be viewed with suspicion, as they are more likely to result from abuse.
Why to Report?
The purpose of reporting child abuse is to identify children suspected to be victims of abuse as well as to prevent them from facing further abuse. Without detection, reporting, and intervention, these children may remain victims for the rest of their lives both emotionally and/or physically, and also, in some cases, they may repeat the pattern of abuse with their own children. The reporting is required not only for ethical reasons but also Section 21(1) of the Protection of Children from Sexual Offences (POCSO) Act, 2012 has made it mandatory to report cases of child sexual abuse to the law enforcement authorities, which applies to everyone including parents, doctors, and school personnel. Failure to report a suspicion of child abuse is an offence under the act. Further, it makes it clear that the obligation to report exists regardless of whether the information was acquired through the discharge of professional duties or within a confidential relationship of information.
What to Report?
A report of child abuse should contain the following information, if it is known:
The names and home address of the child and the child’s parents or other persons believed to be responsible for the child’s careThe child’s present whereaboutsThe child’s ageBe specific about the nature and extent of the child’s injuries, including any evidence of previous injuries. Description of lesion should start with the size, shape, color, location, and radiographic description (if applicable) of the injury. Along with that mention the number of injuries present at each site, and if necessary, sketch the injury and the body part where it is located. If it appears suspicious, detail the child’s behavior alone as well as when they interact with their parentThe name, age, and condition of other children in the same householdAny other information that you believe may be helpful in establishing the cause of the abuse to the childThe identity of the person or persons responsible for the abuse or neglect to the child, if knownDocument all aspects of your interviews with the child and parent. Record verbatim the comments made by the child and parent explaining the injurySign and date the report, and obtain the signature of a witness to the injuries and interviews.
According to the POSCO Act, it is not mandatory for a reporter to inform the child and/or his/her parents or guardian about the dentist’s duty to report child abuse to authorities. However, it is advised to let them know as this will help establish an open relationship and minimize the child’s feelings of betrayal if a report needs to be made.
Measures Taken by the Government for Protecting the Child
After the MCWD study on child abuse conducted in 2006, various measures have been taken to shield children from violence and abuse and the Integrated Child Protection Scheme is one among them. The MWCD launched a CHILDLINE service in 1998–1999. The 24-hour toll-free emergency service provides assistance to children in need of care and protection. As of March 2013, a total of 27 million calls have been serviced. It operates in 291 cities/districts in 30 states and Union Territories across India.
In May 2012, India’s parliament took a major step by passing the POCSO Act. Under the law, all forms of child sexual abuse are now specific criminal offenses for the first time ever in India. The law states that, when a doctor has reason to suspect that a child has been or is being sexually abused, he/she is required to report this to the appropriate authorities (i.e., the police or the relevant person within his/her organization who will then have to report it to the police). Failure to do so would result in imprisonment of up to 6 months, with or without fine. In 2014, a bill was passed to amend Juvenile Justice Act which included corporal punishments also as criminal offence.
Apart from its domestic laws, India is a part of a number of international human rights treaties, including the International Covenant on Civil and Political Rights and the Convention on the Rights of Child, which provide specific protections for the rights of children. These regulatory bodies call for measures to prevent and punish abuses by government officials and place a burden on governments at the central and state levels to adopt measures to prevent and punish abuses by private citizens.
Nongovernmental Organizations in Child Protection
Apart from government, there many nongovernmental organizations (NGOs) in India which are also striving toward betterment of children by rehabilitating abused children or providing underprivileged children education and mid-day meals or implementing the laws to protect children. In case a dentist wishes to approach an NGO for rehabilitating his abused patient, the list of NGO’s in the nearest locality is available online at http://www.ngosindia.com/(NGO resources, database and information project).
Despite having these support systems, child abuse is often under reported, especially by the dental health professionals. This could be due to lack of training and experience in identifying and intervening effectively in such situations, fear of litigation, and concern about offending patients or embarrassment about bringing up the topic. These shortcomings can be overcome by legislatively making it mandatory for all healthcare professionals to undergo:
Training regarding examining and careful handling of abused patientsTraining about reporting norms and rehabilitation programs once they encounter an abuse caseCMEs/CDEs to learn about India’s juvenile justice and child protection systemsImplementing laws to protect healthcare professionals who report the cases.
Whenever a dentist suspects abuse, he/she should make a report. One such report may not prevent/eradicate the problem of child abuse from the world but it is definitely a step towards it.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
|1||Somani R, Kushwaha V, Kumar D, Khaira J. Review paper- Child abuse and its detection in the dental office. J Indian Acad Forensic Med 2011;33:361-5.|
|2||Weidinger DK. Infant & your health – Dental team’s responsibility in reporting child abuse and neglect. Arizona Department of Health Services. Available from: http://www.azdhs.gov/phs/owch/oral-health/infant-children/abuse/index.php [Last accessed on 2015 Oct 14].|
|3||Human Rights Watch. Breaking the silence: Child sexual abuse in India. Human Rights Watch 2013;February: 39. Available from: https://www.ecoi.net/file_upload/1476_1360257470_india0113forupload.pdf [Last accessed on 2015 Oct 14].|
|4||Gupta N, Aggarwal NK. Child abuse. Delhi Psychiatr J 2012;15:416-9.|
|5||Kacker L, Varadan S, Kumar P. Study on child abuse: India 2007. Ministry of Women and Child Development, Government of India. New Delhi, India: Kriti; 2007. p. 7.|
|6||Shastri P. Children at greater risk of abuse reveals NCRB data. The Times of India; 2014 Jul 7. Available from: http://timesofindia.indiatimes.com/india/Children-at-greater-risk-of-abuse-reveals-NCRB-data/articleshow/37920725.cms [Last accessed on 2015 Oct 10].|
|7||Model Guidelines under Section 39 of the Protection of Children from Sexual Offences Act, 2012. Ministry of Women And Child Development; 2013:September. Available from: http://wcd.nic.in/sites/default/files/POCSO-ModelGuidelines.pdf [Last accessed on 2015 Oct 14].|
|8||Anand U. Soon you may land in jail for beating child. New Delhi: The Indian Express; 2014 Aug 3. Available from: http://indianexpress.com/article/india/india-others/soon-you-may-land-in-jail-for-beating-child/#sthash.yT1cUa0f.dpuf [Last accessed on 2015 Oct 14].|
|9||Available from: http://www.ngosindia.com [Last accessed on 2015 Oct 14].|