In a clinical situation where child abuse is suspected, it is best to first separate the caregiver from the child. Often a caregiver will accompany the child to the operatory when the child is seated for the appointment. The dental team should ask the caregiver to return to the reception area while the child is being treated.
Once the caregiver has left the operatory, the child should be asked about their injuries, including how they occurred, when they occurred and if there is any untreated pain. During this conversation, close attention should be paid to the verbal responses and non-verbal physical behavior of the child.
The signs and symptoms of an abused child include such things as inappropriate responses to questions or sudden physical withdrawal when touched. Responses to questioning can range from total silence to dubious answers that either do not comport with the appearance of the injuries or seem carefully coached.
Perhaps the most obvious clinical sign of an abused child is a blank stare and unresponsiveness during attempted conversation. There is little-to-no eye contact nor any emotion; certainly not the typical behavior for a child who has presented for dental care. If the child exhibits multiple injuries in various stages of healing, coupled with unresponsive behavior in the absence of the caregiver, serious consideration should be given that the child may be an abuse victim.
On the other hand, if the child offers explanations for various visible injuries, the dental team should then go to the caregiver, in the absence of the child, ask about the same injuries. If the stories do not match, there is a good chance the child has been the victim of abuse.
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