The dilemma of reporting suspicions of child maltreatment in pediatric dentistry

Abstract

This study examined the factors that lead specialists in pediatric dentistry to suspect child abuse or neglect and the considerations that influence the decision to report these suspicions to social services. Focus group discussions were used to identify new aspects of child maltreatment suspicion and reporting. Such discussions illuminate the diversity of informants' experiences, opinions, and reflections. Focus groups included 19 specialists and postgraduate students in pediatric dentistry. We conducted video-recorded focus group discussions at the informants' dental clinics. All sessions lasted approximately 1.5 hours. We transcribed the discussions verbatim and studied the transcripts using thematic analysis, a method well-suited to evaluating the experiences discussed and how the informants understand them.The analysis process elicited key concepts and identified one main theme, which we labeled "the dilemma of reporting child maltreatment." We found this dilemma to pervade a variety of situations and divided it in three subthemes: to support or report, differentiating concern for well-being from maltreatment, and the supportive or unhelpful consultation.Reporting a suspicion about child maltreatment seems to be a clinical and ethical dilemma arising from concerns of having contradicting professional roles, difficulties confirming suspicions of maltreatment, and perceived shortcomings in the child protection system.

Child maltreatment – prevalence and characteristics of mandatory reports from dental professionals to the social services

“…The decrease in incidence after 2011 may have different causes. Studies describe a lack of continuous education, lack of cooperation with the social services, and previous negative experiences with reporting as reasons for not reporting . Wiklund found that collaboration with the social services leads to fewer reports, in contrast to what might be expected.…”

“…Also, dental professionals may have had already referred the most vulnerable children in their caseload, and thereafter identified fewer new cases. Furthermore, there is a well‐known difficulty in differentiating dental caries from dental neglect …”

“…Swedish studies show that few reports of maltreatment involve child abuse and child neglect – instead, the main triggers for reporting are child behaviour, engaging in criminal acts, parental conflicts, and deficits in care – and these are often reported by the police and schools whereas health care represents a minor source of reports . According to dental professionals in Sweden, dental neglect is the most common reason for a report . There are, however, no national or international studies regarding the submission of mandated reports from a dental professional to the social services, nor are there studies of the content of these reports.…”

Experience with suspecting child maltreatment in the Norwegian public dental health services, a national survey

“…[22][23][24][25][26][27][28][29][30][31] The challenges dental health personnel experience when suspecting child maltreatment and deciding whether to report to CWS may be related to difficulties making decisions under uncertainty. [32] More specifically, signs of child maltreatment are often unclear and ambiguous and the consequences of reporting to CWS are often unclear. According to Baumann et al, [33] decisions made under uncertainty in CWS are best understood within a decision-making ecology model.…”

The mouth and maltreatment: safeguarding issues in child dental health

“…Even among paediatric dentists, a gap is evident between 67% ever having recognised and 29% ever having referred concerns 54. These gaps reflect dentists’ dilemmas about their contradictory roles of supporting or reporting families, differentiating compromised well-being from significant maltreatment and perceived shortcomings of the child protection system 62. Lessons learnt in a number of SCRs indicate that harm might have been avoided had dental professionals raised concerns earlier.…”