Child Protection 2: Dental Neglect PDF

 Dental Institute At Guy’s & St Thomas’ Hospital Child Protection 2 Dental Neglect Mr. Sanjeev Sood Consultant in Paediatric Dentistry Aims of Presentation Understand the responsibilities of dental professionals in rel...

 Dental Institute At Guy’s & St Thomas’ Hospital Child Protection 2 Dental Neglect Mr. Sanjeev Sood Consultant in Paediatric Dentistry Aims of Presentation Understand the responsibilities of dental professionals in relation to safeguarding children Be able to recognize dental neglect Know how to act on concerns  Article 19 Children should be protected from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation Article 24 Children have a right to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation. United Nations Convention on Rights of the Child 1989 Papers to read "A Policy Document on Dental The mouth and maltreatment: Neglect in Children" , JC Harris, safeguarding issues in child dental RC Balmer, PD Sidebotham, Int J health. Harris JC. Arch Dis Child. Paed Dent; 2009; 2018 Aug;103(8):722-729. Your responsibility GDC Responsibility of Dental Team Familiarize yourself Be alert to the Record incidents & with local contacts & possibility of abuse concerns procedures Be prepared to discuss concerns Follow guidelines for with a senior safe staff Keep up to date colleague & refer if recruitment appropriate Public Health England (3rd April 2019) https://www.gov.uk/government/publications/safeguarding-in-general-dental-practice Types of Abuse Types of Abuse 14% 42% 16% 19% 9% Multiple, 3,600 children Physical abuse, 4,100 children Emotional abuse, 5,100 children Sexual abuse, 2,500 children Neglect, 11,000 children Neglect Persistent failure to meet a child’s needs, physical, emotional and/or psychological, likely to result in the serious impairment of the child’s health/development Failure to make Failure to provide proper arrangements Inadequate clothing adequate diet for healthcare Leaving children Lack of appropriate Lack of stimulation alone at an supervision inappropriate age Signs of Neglect Frequent minor injuries / Poor hygiene: Abnormalities recurrent smelly, dirty of hair/skin infections Inappropriate / Developmental Non-attendance inadequate delay at school clothing Constant hunger / stealing Dental Neglect Dental caries is one of the most common chronic diseases in the world, the mere presence of dental caries or other oral pathology cannot be considered to constitute dental neglect. There is no ‘threshold’ number of carious teeth, beyond which a diagnosis of dental neglect is made Dental Neglect The persistent failure to meet a child’s basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development. (British Society of Paediatric Dentistry, 2009) Impact of dental neglect Severe un-treated dental disease can cause: Difficulty with Toothache Disturbed sleep eating Exposure to the Absence from Repeated morbidity school antibiotic use associated with GA Life threatening Turner’s tooth systemic illness Dental Neglect Features of particular concern: Severe untreated dental Dental disease resulting in disease, particularly that is a significant impact on the obvious to a lay person child Parent or carers have access to but persistently fail to obtain treatment for the child Irregular attendance Repeated failed appointments Failure to complete treatment Returning in pain at repeated intervals Requiring repeated GA for extractions Dental Neglect Paediatric dento-facial infections – a potential tool for identifying children at risk of neglect? J. Schlabe, M. Kabban, D. Chapireau, K. Fan BDJ volume 225, pages 757–761 40.7% of children presenting dento-facial / cervico-facial infection were already know to social services. More than 50% of children presenting with dento-facial infection were between 5-8 years old, suggesting this group is at greater risk of dental neglect Responding to dental neglect Preventive dental team management When dental neglect has been recognised, a tiered response has been recommended, Preventive multi- with three stages of agency management intervention, implemented according to the level of concern: Child protection referral “Was Not Brought” - WNB Parents are responsible for ensuring that children are brought to appointments Missed healthcare appointments may be an indicator of neglect Dentists are encouraged to consider the child as ‘was not brought’ (WNB) and to assess the Development and evaluation of a 'was not need for early multidisciplinary brought' pathway: a team approach to information sharing managing children's missed dental appointments. Kirby J, Harris JC. Br Dent J. 2019 Aug;227(4):291-297.  You have concerns about a child’s welfare Assess the child: History, examination, talk to the child Discuss with experienced colleagues Examples of where to go for help: Local safeguarding children board, safeguarding children advisory service telephone helpline, consultant paediatrician, child protection nurse, children’s services, social services, health visitor, GP You still have concerns You no longer have concerns Action needed: Provide urgent dental care Talk to the child and parents and explain your concerns No further child protection Inform of your intentions to refer and seek action consent to sharing information Refer for medical examination if necessary Keep full clinical record Other action needed: Refer to children’s services, following up in writing Provide necessary dental care within 48 hours Keep full clinical records Consider liaison with child’s health visitor or school nurse Further action later: Arrange dental follow up Confirm that the referral has been received Arrange dental follow up Be prepared to write a report for case conference Talk your experiences through with a trusted colleague Summary The dental team has an Sadly significant numbers of important role in recognizing children worldwide are concerns and sharing harmed as a result of information with child maltreatment protection professionals If you recognise signs of possible maltreatment but fail to refer appropriately, a Severe dental caries in further opportunity to children should be considered intervene may not present, a healthcare priority therefore putting the child at risk of ongoing maltreatment. Next seminar……………. Medically Compromised Children 1 Please read and review the seminar in advance and review information from your human diseases seminars from other disciplines References The mouth and maltreatment: safeguarding issues in child dental health. Harris JC. Arch Dis Child. 2018 Aug;103(8):722-729. Paediatric dento-facial infections - a potential tool for identifying children at risk of neglect? Schlabe J, Kabban M, Chapireau D, Fan K. Br Dent J. 2018 Oct 26;225(8):757-761. Development and evaluation of a 'was not brought' pathway: a team approach to managing children's missed dental appointments. Kirby J, Harris JC. Br Dent J. 2019 Aug;227(4):291-297. "A Policy Document on Dental Neglect in Children" , JC Harris, RC Balmer, PD Sidebotham, Int J Paed Dent; 2009; www.bspd.co.uk GDC LOC 1.1.1 Explain, evaluate and apply the principles of an evidence-based approach to learning, clinical and professional practice and decision making 1.2.1 Obtain, record, and interpret a comprehensive and contemporaneous patient history 1.2.2 Undertake an appropriate systematic intra- and extra-oral clinical examination 1.2.4 Undertake relevant special investigations and diagnostic procedures, including radiography 1.4.1 Synthesise the full results of the patient’s assessment and make clinical judgments as appropriate 1.7.2 Identify, explain and manage the impact of medical and psychological conditions in the patient 1.7.9 Explain the role and organisation of referral networks, clinical guidelines and policies and local variation 1.7.10 Explain the need to take responsibility for establishing personal networks with local dental and medical colleagues, specialists and other relevant individuals and organisations 1.7.11 Critically evaluate all components of patient management 1.8.5 Comply with current best practice guidelines GDC LOC 1.8.7 Explain the importance of and maintain accurate, contemporaneous and comprehensive patient records in accordance with legal and statutory requirements and best practice 1.8.8 Identify the signs of abuse or neglect, explain local and national systems that safeguard welfare and raise concerns where appropriate 1.10.1 Recognise the responsibilities of a dentist as an access point to and from wider healthcare 3.1 Communicate appropriately, effectively and sensitively at all times with and about patients, their representatives and the public and in relation to: patients with anxious or challenging behaviour referring patients to colleagues, particularly where patients are from diverse backgrounds or there are barriers to patient communication difficult circumstances, such as breaking bad news, or discussing issues such as alcohol consumption, smoking, or diet 3.2 Recognise the importance of non-verbal communication, including listening skills, and barriers to effective communication 4.1 Communicate appropriately with colleagues from dental and other healthcare professions in relation to: the direct care of individual patients oral health promotion the day to day working of the clinical department/practice in which the individual works the wider contribution which the department/practice makes to dental and healthcare in the surrounding community raising concerns when problems arise GDC LOC 5.2 Use appropriate methods to provide accurate, clear and comprehensive information when referring patients to other dental and healthcare professionals 5.3 Explain the importance of and maintain accurate, contemporaneous and comprehensive patient records in accordance with legal and statutory requirements and best practice 5.5 Recognise and act within the principles of information governance 6.1 Put patients’ interests first and act to protect them 6.2 Act with integrity and be trustworthy 6.4 Protect the confidentiality of all personal information 7.1 Recognise and act within the GDC’s standards and within other professionally relevant laws, ethical guidance and systems 7.2 Recognise and act upon the legal and ethical responsibilities involved in protecting and promoting the health of individual patients 7.3 Act without discrimination and show respect for patients, colleagues and peers and the general public 8.2 Co-operate effectively with other members of the dental and wider healthcare team in the interests of patients 10.1 Put patients’ interests first and act to protect them 11.7 Recognise, take responsibility for and act to raise concerns about their own or others’ health, behaviour or professional performance as described in The Principles of Raising Concerns 11.8 Recognise the need to ensure that those who raise concerns are protected from discrimination or other detrimental effects