Dental neglect as a marker of broader neglect: a qualitative investigation of public health nurses' assessments of oral health in preschool children.

Caroline Bradbury-Jones,Nicola Innes,Fiona Ballantyne,Julie Taylor,Dafydd Evans

doi:10.1186/1471-2458-13-370

Abstract

BackgroundChild neglect is a pernicious child protection issue with adverse consequences that extend to adulthood. Simultaneously, though it remains prevalent, childhood dental caries is a preventable disease. Public health nurses play a pivotal role in assessing oral health in children as part of general health surveillance. However, little is known about how they assess dental neglect or what their thresholds are for initiating targeted support or instigating child protection measures. Understanding these factors is important to allow improvements to be made in care pathways.MethodsWe investigated public health nurses’ assessment of oral health in preschool children in relation to dental neglect and any associations they make with child neglect more broadly. A qualitative study was conducted in Scotland during 2011/12. Sixteen public health nurses were recruited purposively from one health region. Individual, semi-structured interviews were undertaken and data were analyzed inductively using a framework approach. Categories were subsequently mapped to the research questions.ResultsPublic health nurses assess oral health through proxy measures, opportunistic observation and through discussion with parents. Dental neglect is rarely an isolated issue that leads on its own to child protection referral. It tends to be other presenting issues that initiate a response. Threshold levels for targeted support were based on two broad indicators: social issues and concerns about child (and parental) dental health. Thresholds for child protection intervention were untreated dental caries or significant dental pain. Barriers to intervention are that dental neglect may be ‘unseen’ and ‘unspoken’. The study revealed a communication gap in the care pathway for children where a significant dental problem is identified.ConclusionsPublic health nurses take their child protection role seriously, but rarely make a link between dental caries and child neglect. Clear guidance on oral health assessment is required for public health nurses. Establishing formal communication pathways between child dental care providers and public health nurses may help close gaps in care pathways. However, further research is required into how these communication mechanisms can be improved.

Highlights

Child neglect is a pernicious child protection issue with adverse consequences that extend to adulthood
We investigated the role of public health nurses in assessing oral health in preschool children in relation to dental neglect
Threshold levels of dental decay that indicate the need for targeted support We found that, levels of dental decay were not directly assessed by the public health nurses, they considered it part of their decision-making regarding targeted support

Summary

Introduction

Child neglect is a pernicious child protection issue with adverse consequences that extend to adulthood Though it remains prevalent, childhood dental caries is a preventable disease. Little is known about how they assess dental neglect or what their thresholds are for initiating targeted support or instigating child protection measures. The economic burden to the UK caused by maltreatment is enormous, with particular long-term consequences for health and social services and the criminal justice system [8,9] It is not just the UK though: in the United States the annual cost to the taxpayer from neglect is estimated to be more than $100 billion [10]. But both recognition of, and responses to, neglect remain inconsistent

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Conclusion