Assessing a child with an injury or with possible signs of abuse or neglect starts with a thorough history, including:
- details from the child and carer of any injury or presenting complaint
- past dental history
- medical history
- family and social circumstances.
Features of concern would include:
- a delay in the presentation
- discrepancies between the history and examination findings
- developmentally inappropriate findings (does not fit with the age of the child)
- previous concerns about the child or siblings.
A full examination should be carried out, noting in particular:
- any dental, oral or facial injuries, their site, extent and any specific patterns
- the general appearance of the child, their state of hygiene, whether they appear to be growing well or are “failing to thrive”
- their demeanour and interaction with their parents or carers and others (e.g. look particularly for signs of “frozen watchfulness” where the child seems to take in everything going on, but in a detached, wary or fearful manner).