VFPMS Guideline: Forensic investigation of ENT and mouth injuries

The head is a common target organ for child physical abuse. Although not pathognomonic of abuse, frenal injuries are a concerning oral finding in very young children. It must be remembered that neglect can have a significantly detrimental impact on oral health. 

Key points:

• Oral injuries can be sentinel injuries for severe abuse such as abusive head trauma.
  
• Consideration should be given to possible asphyxiation in children less than 2years-old who present with epistaxis in the absence of known trauma or haematological disorder.
  
• Asphyxiation does not always cause overt symptoms.
  
• Frenal injuries in the absence of reported accidental trauma should raise suspicion for abuse. Abusive frenal injuries can be caused by force feeding.
  
• Children who experience pain, discomfort, social embarrassment or medical complications because of dental caries should receive appropriate timely treatment.

Useful resources and articles:

• The Royal College of Paediatrics and Child Health’s review (UK, 2014) Child Protection Evidence – Oral injuries evaluates the literature on oral injuries and presents data on the following questions: Is a torn labial frenum diagnostic of child abuse? What other intra-oral injuries are caused by physical abuse to children?
  
• The Royal College of Paediatrics and Child Health’s review (UK, 2015) Child Protection Evidence – Ear Nose and Throat evaluates the literature on ENT injuries and presents data on the following questions: What are the identified characteristics of epistaxis indicative of asphyxiation in children less than 2years of age? What are the ear, nose and throat manifestations of physical abuse or fabricated or induced illness?
  
• The Royal College of Paediatrics and Child Health’s review (UK, 2014) Child Protection Evidence – Dental neglect evaluates the literature on dental neglect injuries and presents data on the following questions: What are the parent/carer characteristics of a child with dental neglect, and what oral features are present in these children?