Elsevier

Child Abuse & Neglect

Volume 24, Issue 4, April 2000, Pages 521-534
Child Abuse & Neglect

Original Articles
A profile of the oro-facial injuries in child physical abuse at a children’s hospital

https://doi.org/10.1016/S0145-2134(00)00114-9Get rights and content

Abstract

Objective: The aim of the present study was to determine the head, face and neck injuries associated with child abuse cases in the Cape Peninsula, Cape Town, South Africa.

Method: A retrospective, record-based analysis (n = 300) of non-accidental injuries at a Children’s Hospital over a 5-year period (1992–1996) was carried out.

Results: The mean age of the sample was 4.75 years—54.3% were boys and 45.7% were girls. Most of the crimes were committed in the child’s own home (88.7%). Crimes were reported by mothers (48.7%), grandmothers (11.7%) and day hospitals (13%). Ninety percent of the perpetrators were known to the victim. The majority of the perpetrators were male (79%)—20% the perpetrators were the mother’s boyfriend; 36% the father or step father, and in 12% the mother was responsible. Thirty-five percent of perpetrators were under the influence of alcohol or drugs when they committed the offence; 64.7% of cases suffered serious injuries, 48.7% had to be hospitalized, four children were critically injured and died. The head, face, neck, and mouth were the sites of physical injury in 67% of the 300 cases reviewed. The face was the most frequently injured (41%) part of the body, with the cheek being the most common site for the injury. The range and diversity of the oro-facial injuries included skull fractures, subdural hematomas, retinal hemorrhages, bruises, burns, and lacerations. Injuries to the mouth included fractured teeth, avulsed teeth, lacerations to the lips, frenum, tongue, and jaw fractures.

Conclusions: The main conclusions of this study were (i) under 2-year-old children were most at risk from abuse (36%); (ii) the number of the reported injuries to the oral cavity was extremely low (11%); and (iii) no dentists participated in the examination of any of the patients. Intra-oral injuries may be overlooked because of the medical examiner’s unfamiliarity with the oral cavity. Oral health professionals should be consulted for diagnosis, advice and treatment.

Introduction

THROUGHOUT THE WORLD there is an awareness that child abuse and neglect is a serious and growing problem. Child abuse is prevalent in every segment of society and crosses all social, ethnic, religious, and professional strata. Although legislation in South Africa, has been in place since 1983, reporting by dentists, doctors and nurses has been virtually non-existent. The purpose of the present study is to highlight the importance of head, face and mouth injuries seen in child abuse cases. It is only through increased awareness of it’s importance, that health care workers will assume their role in diagnosing and reporting this pervasive problem. For the purpose of this study, (Johnson’s, 1990) definition of child abuse is used: “An injury to a child caused by a parent or caregiver, for any reason, including injury resulting from a caregiver’s reaction to unwanted behavior. Injury includes tissue damage beyond erythema or redness from a slap, to any area other than the hands or buttocks.”

Section snippets

Literature review

Prevalences on child abuse have been reported in different countries and reflect multifactorial social and cultural differences. In the 1980s at least four children in Britain (Creighton & Gallagher, 1988) and 80 children in the USA (Schmitt, 1986) died weekly as a result of abuse or neglect. In Scandinavia, the estimated frequency of mortality from child abuse is lower than 10 child deaths a year (Gregersen & Vesterby, 1984). In Britain at least 1 child in every 1,000 under the age of 4 years

Method

The study site was a university affiliated children’s hospital located in the Cape Metropole and is the only comprehensive children’s hospital in South Africa. It is the major pediatric referral centre for approximately 3 million people in metropolitan Cape Town and also functions as a primary care facility for many children in Cape Town (Strebel, Lachman, Painter, Stander, & Ireland, 1992). The sampling frame comprised hospital records of proven non-accidental injuries with oro-facial trauma

Results

A retrospective analysis of the records of known child physical abuse cases for a five year period from 1992–1996, forms the basis of the results. The study consists of a record of 300 cases. The mean age of the sample was 4.75 years. 56% occurred in 0–4-year-olds and 44% in 5–14-year-olds; with the boys outnumbering the girls marginally—54% were boys and 46% were girls (SD 4.0, range 1 month–14.25 years).

As a rule, only one victim and one offender were involved per crime. Victims usually made

Demography of the sample

This study reports on child abuse in South Africa. Children of all ages are subject to child abuse, but the majority of cases occur in younger children (Creighton, 1984). The age distribution of the sample in this study demonstrates that the age group 0–4-year-old were most at risk from abuse (56%). This finding is consistent with most studies Adelson 1961, Cameron et al 1966, Lauer et al 1974, Macintyre et al 1986, O’Neill et al 1973, Sperber 1981, Symons et al 1987, ten Bensel 1975. The

Conclusions

The most prominent findings from the present study are:

  • Under 2-year-old children were most at risk from abuse (36%);

  • The head, face, neck and mouth were the sites of physical injury in 67% of the 300 cases reviewed;

  • The number of the reported injuries to the oral cavity was extremely low (11%), especially when taking into consideration that the face was the most often injured part of the body;

  • No dentists participated in the examination of any of the patients. Dental professionals need to take a

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