Violence and abuse: core competencies for identification and access to care

Self-reported knowledge, attitudes, and practice of final-year dental students in relation to child abuse: A multi-centre study

BACKGROUND

The number of child abuse cases is increasing worldwide; therefore, it is important to educate individuals having contact with children about it. This includes dentists who play a pivotal role in detecting and reporting child abuse.

AIM

To identify and compare the final- year dental student's knowledge, attitudes, and practice in relation to child abuse.

DESIGN

A 38- item and four- part online questionnaire was distributed to students of 11 dental schools in 10 countries. SPSS and GraphPad Prism were used for data analysis. The levels of statistical significance were determined using a chi- square test. P ≤ .05 was considered to be statistically significant.

RESULTS

A total of 660 students completed the survey. Fifty- six percent of the students received formal training on child abuse, and 86% wanted additional training. The knowledge of child abuse was significantly higher in Australia, the United States, and Jordan compared with other countries. Internet (60.3%) was commonly used as an information source for child abuse.

CONCLUSIONS

The study showed that dental students lack knowledge and experience in recognizing and reporting child abuse. Most respondents indicated a desire for additional training; therefore, dental schools should review what they are currently teaching and make changes as appropriate.

Tea or Thrush?: A Case of Nonaccidental Oral Injury in an Infant

A 5-month-old girl child patient presented to the emergency department for oral thrush and poor feeding but instead demonstrated concern for abuse after physical exam, as findings were consistent with oral injury. Correct identification of the oral findings as traumatic necessitated navigating language and cultural issues before the mechanism of injury and abuse determination could be made. Exploring the involvement of other caregivers was a crucial piece for investigation of the clinical scenario. The incidence of child abuse and pediatric oral injuries concerning for abuse were reviewed in this case report.

Concomitant Pediatric Burns and Craniomaxillofacial Trauma

ABSTRACT

This study is the first to investigate pediatric craniomaxillofacial (CMF) trauma patients that present with concomitant burns. The authors aim to identify differing etiologies, presentations, facial fracture patterns, interventions, and outcomes between pediatric CMF trauma patients with versus without concomitant burns. In this retrospective cohort study of a tertiary care center between the years 1990 and 2010, concomitant burns were identified among pediatric patients presenting with CMF fractures. Patient charts were reviewed for demographics, presentation, burn characteristics (total body surface area %, location, and degree), imaging, interventions, involvement of child protective services, and long-term outcomes. Data were analyzed using two-tailed Student t tests and chi-square analysis. Of the identified 2966 pediatric CMF trauma patients (64.0% boys; age 7 ± 4.7 years), 10 (0.34%) patients presented with concomitant burns. Concomitant burn and CMF traumas were more likely to be due to penetrating injuries (P < 0.0001) and had longer hospital lengths of stay (13 ± 18.6 versus 4 ± 6.2 days, P < 0.0001). 40% were due to child abuse, 40% due to motor vehicle collisions, and 20% due to house fires. All four child abuse patients presented in a delayed fashion; operative burn care was prioritized and 70% of the CMF fractures were managed nonoperatively. Concomitant burn and CMF trauma is a rare injury pattern in pediatrics and warrants skeletal surveys with suspicious injury patterns. Future research is necessary to develop practice guidelines.

Animal Bite in a 6-month-old Child and Facial Injury with Associated Unusual Nasal Injury: Management of Injuries along with 1-year Follow-up

In children, accidental injuries (AI) are the most common cause of major trauma. Although rare, nonaccidental injuries (NAI) can also cause major trauma. Among NAI, animal bites form a significant fraction. Animal bites form a significant fraction of NAI in children. Amongst animal bites, dog and cat bites are the most common. In adults, the likelihood of bites is on leg/thigh but in children due to their low stature, bites are more common on scalp, head, neck, or chest region. As children have lower tissue mass/size, what appears a small wound in adults comparatively appears as a larger wound in children, causing severe disfigurement. The present paper discusses cat bite injury to maxillofacial region, distinguishing from other differential diagnoses. Potential complications, initial management, and total rehabilitation of facial injuries especially nasal injury caused by a cat in a 6-month-old child are also discussed.

Oral and Dental Aspects of Child Abuse and Neglect

In all 50 states, health care providers (including dentists) are mandated to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this report is to review the oral and dental aspects of physical and sexual abuse and dental neglect in children and the role of pediatric care providers and dental providers in evaluating such conditions. This report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, and diseases that may raise suspicion for child abuse or neglect. Oral health issues can also be associated with bullying and are commonly seen in human trafficking victims. Some medical providers may receive less education pertaining to oral health and dental injury and disease and may not detect the mouth and gum findings that are related to abuse or neglect as readily as they detect those involving other areas of the body. Therefore, pediatric care providers and dental providers are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions in children.

Pediatric craniomaxillofacial trauma

Trauma is a leading cause of death in children. The pediatric facial skeleton goes through progressive development and major changes, including change in the size ratio of the cranium to the face; change in the ratio of facial soft tissue to bone, and pneumatization of the sinuses. The main goal of maxillofacial fracture repair is to reestablish normal or preinjury structure and function. Follow-up is typically recommended until children reach skeletal maturity as trauma may affect growth of the facial skeleton. Problems not obvious immediately after the injury may become an issue later, and secondary surgery might be needed to address such issues.