Psychological/Emotional Abuse

A dental professional, including any members of the dental staff, may observe other concerning signs and symptoms in the waiting area or during the exam itself. Depending on their severity, these signs and symptoms might not suggest maltreatment standing alone, but when observed in combination or with any of the signs of physical abuse, sexual abuse or neglect as outlined above, indicate possible maltreatment.

• Concerning signs and symptoms exhibited by the child:^19,20

  • Extreme lack of self-esteem

  • Significant, unexplained delays in development

  • Inappropriate or underdeveloped social skills and poor personal boundaries

  • Inability to regulate mood and/or behavior, manifesting extremes

  • Pronounced nervous or repetitive behavior such as sucking and rocking or self-inflicted injuries such as lip or cheek biting

  • Change in the child’s mood, demeanor or routine from the last visit

    • Acting out behavior

    • Fears, anxiety or distress

    • Regressive behavior

    • Sexualized behavior

  • Atypical interaction between the child and caregiver

  • Failure to make eye contact when discussing suspected abuse or neglect

  • Severe symptoms of self-destructive behavior – self-harming, suicide attempts, engaging in drug or alcohol abuse

  • Statements by the child disclosing abuse or neglect

• Concerning signs and symptoms exhibited by the caregiver/s:

  • Lack of supervision in waiting area

  • Extreme discipline, including hitting, slapping, yelling, berating

  • Disinterest in the child’s dental needs and recommendations for treatment

  • Disinterest in the child in general

• Bullying

  • 30% of children in the 6th to 10th grades report having been bullied and/or having bullied others.

  • Children with orofacial or dental abnormalities (including malocclusion) are frequently subjected to bullying, and, as a result, may suffer serious psychological consequences, including depression and suicidal ideation.

  • The psychosocial consequences that can be associated with bullying behavior should be of great concern. Health care providers (including dental providers) can ask patients about bullying and advocate for antibullying prevention programs in schools and other community settings.

  • Health care providers can become familiar with “Connected Kids: Safe, Strong, Secure,” a violence prevention protocol from the AAP that offers preventive education, screening for risk, and linkages to community-based counseling and treatment resources.⁷