# data[].attributes.body
A 4-year-old girl with widespread dental caries which is progressing to a facial abscess. Her mother does not follow advice to stop giving her bottles of milk and juice despite dental and health visitor advice

# data[].attributes.attachment_link.readable_text
​Recognising abuse and neglect

​
An approach to assessment

Abuse or neglect may present to the dental team in a number of different ways:

a direct allegation (sometimes termed a 'disclosure') made by the child, a parent or some other person

signs and symptoms which are suggestive of physical abuse or neglect

or through observations of child behaviour or parent-child interaction

signs of domestic abuse of a parent, such as bruises or an injury, or the parent (female or male) may disclose domestic abuse to you

concerns about the mental or general health (alcohol, substance misuse or deteriorating health condition) of the parent.

Be cause of the frequency of injuries to areas routinely examined during a dental check-up, the dentist has an important role in intervening on behalf of an abused child. It is assumed that the dentist will be examining a child who is fully dressed.

In some instances, the diagnosis of child abuse is clear. However, there are occasions when evidence is inconclusive and the diagnosis merely suspected. Members of the dental team are not responsible for making a diagnosis of child abuse or neglect, just for sharing concerns appropriately. If, having viewed the information on this site on how to recognise , , sexual abuse and

Concerns related to a parent

Concerns about the mental or general health (alcohol, substance misuse or deteriorating health condition) of the parent should prompt a discussion with the parent and a referral to children's services, particularly when other signs of abuse and neglect are present. Children's services will assess the need for child and family support and identify remedial action.

In respect of domestic abuse, if a parent makes a disclosure to you or a member of your staff, and requests help, contact your local children's services office. If you suspect domestic abuse, enquire about this with the parent and inform them of your concern for their own and their child's welfare. You are obliged to make a referral to the local children's services office if you have concerns about domestic abuse and to inform the parent you are doing so. This is a very sensitive area and must be dealt with carefully so as not to increase any risks for the parent and child. Take advice from your named nurse or doctor for child protection, your local children's services office or the local police domestic abuse unit.

# data[].attributes.attachment_link.description
​Recognising abuse and neglect ​An approach to assessment Abuse or neglect may present to the dental team in a number of different ways: a direct allegation (sometimes termed a 'disclosure') made by the child, a parent or some other person signs and symptoms which are suggestive of physical abuse or

# data[].attributes.body
A toddler aged 2 years with a swollen leg, refusing to weight bear, presented 5 days after the 'accident’

# data[].attributes.attachment_link.readable_text
Abstract

Objectives: Because physicians may have difficulty distinguishing accidental fractures from those that are caused by abuse, abusive fractures may be at risk for delayed recognition; therefore, the primary objective of this study was to determine how frequently abusive fractures were missed by physicians during previous examinations. A secondary objective was to determine clinical predictors that are associated with unrecognized abuse.

Methods: Children who were younger than 3 years and presented to a large academic children's hospital from January 1993 to December 2007 and received a diagnosis of abusive fractures by a multidisciplinary child protective team were included in this retrospective review. The main outcome measures included the proportion of children who had abusive fractures and had at least 1 previous physician visit with diagnosis of abuse not identified and predictors that were independently associated with missed abuse.

Results: Of 258 patients with abusive fractures, 54 (20.9%) had at least 1 previous physician visit at which abuse was missed. The median time to correct diagnosis from the first visit was 8 days (minimum: 1; maximum: 160). Independent predictors of missed abuse were male gender, extremity versus axially located fracture, and presentation to a primary care setting versus pediatric emergency department or to a general versus pediatric emergency department.

Conclusions: One fifth of children with abuse-related fractures are missed during the initial medical visit. In particular, boys who present to a primary care or a general emergency department setting with an extremity fracture are at a particularly high risk for delayed diagnosis.

Similar articles

Controversies in the evaluation of young children with fractures.

Egge MK, Berkowitz CD. Egge MK, et al. Adv Pediatr. 2010;57(1):63-83. doi: 10.1016/j.yapd.2010.08.002. Adv Pediatr. 2010. PMID: 21056735 Review. No abstract available.

# data[].attributes.attachment_link.keywords[]
accidental falls / statistics & numerical data*

# data[].attributes.attachment_link.keywords[]
child abuse / statistics & numerical data

# data[].attributes.attachment_link.keywords[]
delayed diagnosis / statistics & numerical data*

# data[].attributes.attachment_link.keywords[]
national center for biotechnology information

# data[].attributes.attachment_link.title
Delayed identification of pediatric abuse-related fractures - PubMed

# data[].attributes.attachment_link.description
One fifth of children with abuse-related fractures are missed during the initial medical visit. In particular, boys who present to a primary care or a general emergency department setting with an extremity fracture are at a particularly high risk for delayed diagnosis.

# data[].attributes.body
A 6-year-old girl admitted with an exacerbation of asthma who reveals to the play therapist a knowledge of sexual acts/behaviours that would not be expected for the child's age

# data[].attributes.body
A 33-year-old female patient with pancreatitis who, when asked if she is the carer for any children or vulnerable adults, reveals that she is a single mother and that her 13-year-old daughter is at home minding her two younger children.

# data[].attributes.attachment_link.title
Carers and safeguarding: a briefing for people who work with carers

# data[].attributes.attachment_link.description
This briefing provides an update of the ADASS Advice note ‘Carers and Safeguarding Adults’ produced in 2011 for frontline workers and brings it in line with the Care Act 2014. It is intended to be used as a practical tool and does not seek to amend or replace existing statutory guidance that may be…

# data[].attributes.body
A 17-year-old girl, usually accompanied everywhere by her 30-year-old husband, reveals that her husband is physically violent and emotionally controlling.

# data[].attributes.attachment_link.readable_text
Abstract

Adolescent mothers and their offspring are a high risk group broth physically and emotionally. Poverty, malnutrition, complications of pregnancy, emotional problems such as depression, drug and alcohol use, are all risks for the mother. Children are also at greater risk for physical, cognitive and emotional problems. It is therefore important to identify factors which influence outcome on adolescent mothers and their children in order to suggest interventions which will more positively affect the physical and psychological health of this increasing population.

PIP: Adolescent mothers and their offspring are a high risk group both physically and emotionally. Poverty, malnutrition, complications of pregnancy, and emotional problems such as depression, drug, and alcohol use, are all risks for the mother. Children are also at greater risk of physical, cognitive, and emotional problems. Therefore, it is important to identify factors which influence the outcome of adolescent mothers and their children in order to suggest interventions which will more positively affect the physical and psychological health of this increasing population. Hechtman draws the following conclusions: 1) There is no single cause for the rising rate of adolescent pregnancy, but rather a combination of factors. These can generally be grouped under biological factors, societal factors, personal attitude/needs, ignorance/misunderstanding concerning sexual matters, and problems inherent in modern contraceptive methods. 2) The consequences of pregnancy on the adolescent are multiple and can be divided into health, economic, and emotional outcomes. 3) The effects on the child who results from the adolescent pregnancy can be subdivided under physical health, cognitive, behavioral and emotional effects. 4) Early sex education programs which combine education with family planning or counselling, and readily available inexpensive contraception and abortion would do much to decrease the prevalence of adolescent pregnancy.

Similar articles

Teenage parenting and child development: a literature review.

Roosa MW, Fitzgerald HE, Carlson NA. Roosa MW, et al. Infant Ment Health J. 1982 Spring;3(1):4-18. doi: 10.1002/1097-0355(198221)3:1<4::AID-IMHJ2280030103>3.0.CO;2-#. Infant Ment Health J. 1982. PMID: 12265630

Teenage pregnancy and motherhood: a review of the literature.

Phipps-Yonas S. Phipps-Yonas S. Am J Orthopsychiatry. 1980 Jul;50(3):403-431. doi: 10.1111/j.1939-0025.1980.tb03302.x. Am J Orthopsychiatry. 1980. PMID: 7406027

Predictors of repeat pregnancies among low-income adolescents.

Gispert M, Brinich P, Wheeler K, Krieger L. Gispert M, et al. Hosp Community Psychiatry. 1984 Jul;35(7):719-23. doi: 10.1176/ps.35.7.719. Hosp Community Psychiatry. 1984. PMID: 6745880

# data[].attributes.attachment_link.keywords[]
national center for biotechnology information

# data[].attributes.attachment_link.title
Teenage mothers and their children: risks and problems: a review - PubMed

# data[].attributes.attachment_link.description
Adolescent mothers and their offspring are a high risk group broth physically and emotionally. Poverty, malnutrition, complications of pregnancy, emotional problems such as depression, drug and alcohol use, are all risks for the mother. Children are also at greater risk for physical, cognitive and e ...

# data[].attributes.body
An 18-month-old boy who is noted to have a torn frenulum when being intubated. Further examination reveals bruising to both ears and the buttocks

# data[].attributes.body
A young teenager with mild learning difficulties and vulvar abrasions, accompanied by an adult male.

# data[].attributes.body
A 6-year-old boy repeatedly brought to surgery by his mother for minor illnesses such that his school attendance is only 85%. The mother herself has a history of repeated presentations with many symptoms.

# data[].attributes.attachment_link.readable_text
The RCGP is working towards the vision that the safeguarding of adults and children will be embedded into every day routine general practice and become a normal part of our ongoing holistic care.
GPs as well as all primary care staff, play a key role in safeguarding people of all ages by providing care throughout their lifetime. Patients and their families allow us into their lives, often at times of great distress, to support and help them. This is a great privilege but also gives us great responsibility. It is when we get into the realms of safeguarding that these two roles, privilege and responsibility, most clearly meet. Combining these roles enables us to be powerful advocates for our most vulnerable patients.

The RCGP is working towards the vision that the safeguarding of adults and children will be embedded into every day routine general practice and become a normal part of our ongoing holistic care.

Our short Good Practice Safeguarding Video demonstrates the important role every practice team member plays in safeguarding patients.

National standards and policies

Adult Safeguarding: Roles and Competencies for Health Care Staff

The Adult Safeguarding: Roles and Competencies for Health Care Staff intercollegiate document outlines the professional standards that all staff at healthcare organisations will need to meet if they are to be involved in adult safeguarding. Published in August 2018, the guidance aims to safeguard anyone over the age of 18 at risk of abuse, harm or neglect because of their need for care and or support, who is unable to safeguard themselves.

Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff

Published in January 2019, the Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff intercollegiate document provides a clear framework which identifies the safeguarding competencies for all staff, clinical and non-clinical, who work in any healthcare setting.

The safeguarding intercollegiate documents provide a robust framework to ensure that primary care staff are equipped for their safeguarding duties.

The RCGP supplementary guide to safeguarding training requirements (PDF file, 534 KB) for all primary care staff provides a brief summary of the safeguarding training requirements for all who work in a primary care setting (clinical and non-clinical staff).

Domestic abuse

Domestic violence is an abuse of human rights and a major public health problem because of the long-term health consequences for people who have experienced it. Many people experiencing abuse believe that their GP can be trusted with disclosure and GPs can offer practical support to protect people who disclose abuse.

Please find below a range of domestic violence resources.

For detailed and specific guidance on recording domestic abuse information (including MARAC - Multi Agency Risk Assessment Conference) in the patient record, go to Section 3 of the Adult Safeguarding Toolkit.

Training resources

RCGP eLearning Resources

eLearning for Health (e-LfH) Resources

About the writer

RCGP have produced an adult safeguarding and child safeguarding toolkits for general practice.

# data[].attributes.attachment_link.title
Good practice safeguarding in general practice

# data[].attributes.attachment_link.description
The RCGP is working towards the vision that the safeguarding of adults and children will be embedded into every day routine general practice and become a normal part of our ongoing holistic care. GPs as well as all primary care staff, play a key role in safeguarding people of all ages by providing care throughout their lifetime.