n.d.). One theory holds that parents’ unrealistic expectations for the child and for themselves can contribute to the abuse (Smith, Robinson, et al., 2018). Another theory is that the abusers’ attitude toward children is based on the conviction that children exist to satisfy parental needs. Characteristics of a parent, legal guardian, or caregiver that can increase their risk of being abusive toward a child include having been abused as a child themselves, having difficulty in bonding with a newborn, having unrealistic expectations of child development, suffering from poor impulse control, having low self-esteem, and having employment and financial problems (World Health Organization, 2022). Some parents may have unrealistic expectations of their children and view their children as a source of constant, unconditional affection and as a source of support that the parents themselves never received (Pekarsky, 2022). This combination of unrealistic parental expectations of their child/ children and the aforementioned parental characteristics can increase the potential for child abuse. Other abusers explain the maltreatment of children as a suitable means of parenting. In one notable study, researchers interviewed abusers about their feelings subsequent to the
abuse. Of those adults interviewed, 62.5% felt justified in injuring the child, 58.9% felt no remorse for their actions, and 50.7% blamed the victim for the abuse. Combining the three factors studied, fully one-third of the adults felt justified, blamed the victim, and felt no remorse (Dietrich et al., 1990). It is well understood that several social factors contribute to child abuse. The most cited contributing factor in child abuse is substance abuse (Kaliszewski, 2022; Smith, Robinson, et al., 2018). Although substance abuse does not cause family violence, it may contribute to making a bad situation worse. The abuse of alcohol or other drugs can be an indicator of other risk factors, including poverty, unemployment, depression, and feelings of hopelessness. Other common contributing factors include stress, lack of a family support network, and the cyclic problem of abuse as a learned behavior (i.e., abusers are likely to have been abused as children; Smith, Robinson, et al., 2018). Intrafamily violence is a learned behavior—people parent the way they were parented, they treat spouses/intimate partners the way they saw their parents interact, and they treat their elders the way they saw their parents treat them. Intrafamily violence is a cycle that needs to be broken.
CHILD NEGLECT
Definition, data, and demographics Child abuse occurs among all races, ethnicities, single and dual parent families and socioeconomic levels. (Gonzalez et al., 2022). State legislatures have provided definitions of child neglect to help differentiate it from simple lack of care. Although what is considered child neglect, the most common form of child abuse, varies considerably among the states (see Appendix A Confounding factors A diagnosis of suspected child neglect must consider multiple factors that involve the child and their parents or caregivers (Oliván Gonzalvo & de la Parte Serna, 2021). Because neglect may involve many factors, making a report of suspected neglect may require more consideration than a case of suspected abuse. For example, a parent who cannot access dental care or the financing of that care may not be neglecting the child. Lack of transportation or access to healthcare, inability to take time off from work, lack of providers of medical assistance (e.g., for patients who have Medicaid), and lack of insurance programs may all contribute to a child not receiving appropriate healthcare. However, if the dental professional determines that the resources are available but the child is not receiving proper care, they will need to report a suspected case of neglect. Dental neglect Although dental professionals often see children who have gone without adequate dental care yet differentiating dental caries as a component of dental neglect can be very difficult (Spiller et al., 2020). Dental neglect is the willful failure of parent or guardian to seek and obtain treatment for dental problems that cause pain or infection or those that interfere with adequate function (Voelker, 2022). Studies on caries rates and maltreatment have shown higher rates of disease and early childhood caries in children who are abused or neglected compared with the general population (Hartung et al., 2019; Smitt et al., 2018; Spiller et al., 2020).
for Florida’s legal definitions of child abuse and neglect), all definitions specify acts of omission, including failure to provide adequate care, support, nutrition, shelter, and medical or other care necessary for a child’s health and well-being (Gonzalez, et al., 2022; Pekarsky, 2022).
Another area of concern, on a smaller scale, is child neglect stemming from strongly held religious beliefs. Several states have enacted legislation that provides religious exemptions for various medical and dental procedures, some of which are basic while others could prevent high morbidity or even death (Swan, 2020). Florida has a religious exemption. However, according to Florida statute §39.01(34)(f), this exemption does not: ● Eliminate the requirement that such a case be reported to the department. ● Prevent the department from investigating such a case. ● Preclude a court from ordering, when the health of the child requires it, the provision of medical services by a physician, as defined in this section, or treatment by a duly accredited practitioner who relies solely on spiritual means for healing in accordance with the tenets and practices of a well- recognized church or religious organization. (Florida Senate, 2022) Questions often arise concerning when to report a suspected case of child neglect following missed dental appointments. State statutes do not give any guidelines for when these cases should be reported. The clinician must carefully evaluate the seriousness of the child’s untreated condition, the family’s resources, and other factors affecting access to care when deciding to make a report. Where one case may not need to be reported even after two or three missed appointments, another case may require a report after just a single broken appointment if the child is in imminent danger of serious physical sequelae from lack of care.
CHILD ABUSE AND NEGLECT REPORTING PROTOCOL
Dentists in every state and the District of Columbia are mandatory reporters of child abuse. In Florida, anyone who suspects child abuse is expected to report child abuse, though only mandated reporters must leave their names when calling the hotline (Florida Department of Children and Families, 2019c).
Based on the child’s condition, a decision must be made about whether members of the dental staff should visit with the parent or caregiver before making the report. If it is in the child’s best interest to speak with the adult(s) before making a report, the dentist will need to speak with them in private, but with another
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