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What to do if Child Abuse is Known or Suspected

EthicalIf there is reasonable concern that a child might be at risk of significant harm this will always override a professional or agency requirement to keep information confidential. The main responsibility is to the child. The following text is a summary of the main steps described in ‘Child Protection and the Dental Team: An Introduction to Safeguarding Children in Dental Practice ’ [1]. It is important to read this guidance and follow your local procedures provided by your Child Protection Committee.

Locate and follow your local child protection procedures.

Document fully the history, including details from the child and parent/carer, of any injury or presenting complaint, the child’s past dental history and medical history, and details of the family and its social circumstances.

Conduct a full dental examination of the child and take note of the general appearance and behaviour of the child and their interaction with their parent/carer.

Record your observations, including details of any dental, oral or facial injuries, and record the reasons given for seemingly trivial injuries, which might, over a period of time, show a repeating pattern of injury.

Make drawings and record observations in a way that will be understandable to colleagues so that, even if no single team member gets to know the child, a written record builds up over time.

Clearly state any differences between the facts and your opinion.

Document any changes or inconsistencies in the child’s history (including discrepancies between the child’s history and the examination results), delays in presentation to the practice (including non-attendance or cancelled appointments), signs of inappropriate development, and any previous concerns for the child’s (or their siblings) well-being.

Talk to the child, letting them volunteer information, and record their responses. (Do not ask leading questions.)

If the child requests that information is kept a secret, do not do this, but explain that you might have to share the information and will inform the child who will be informed and when.

Be aware that, although injuries to children should be regarded with suspicion, the diagnosis of child physical abuse is never made on the basis of one sign because various diseases can be mistaken for physical abuse, and there are other causes of injuries (e.g. playground fighting).

Do not intervene on your own. Share your concerns with someone you can trust (e.g. a senior, experienced colleague within the practice, child protection team, a social worker, child protection nurse or child protection doctor). (Your local child protection procedures should name a designated person with whom to discuss initial concerns.)

If you still have concerns, explain to the child and the parent/carer your concerns and intention to make a referral to your local social services, and seek consent to share information.

On the rare occasion that talking to the parent/carer is likely to put the child at greater risk of harm (e.g. child sex abuse or fabricated or induced illness) or is likely to impede a police investigation or social work enquiry or, if consent is withheld, discuss this with your defence organisation or senior colleagues before proceeding.

Refer to your local social services department by telephone, and follow-up in writing within 48 hours.

Refer to a medical practitioner, if required.

For brief details of how social services deal with a referral and possible implications for you, in addition to further details about what to do if child abuse is suspected, including flow charts, see Section 3 ‘Child Protection: Responding’ of ‘Child Protection and the Dental Team: An Introduction to Safeguarding Children in Dental Practice‘ [1].

Sources of Information

  1. Child Protection and the Dental Team: An Introduction to Safeguarding Children in Dental Practice. Department of Health (2009)