Protecting our children from abuse - Part 3

In the first post in this series we discussed the importance of good communication with our children for giving safety guidelines and listening to their concerns. In the second, we looked at signs of potential abuse and what to do if you know, or suspect a child is being abused.

In this post we will discuss safety guidelines for various situations.

Staying safe while out and about

Starting to go outside without adult supervision is an important part of growing up and gaining independence. You will need to decide how and when to start giving your child more freedom based on their age and maturity. 

Children need challenges and responsibilities, but they also need adults to support, guide and step in when needed. Children under eight years old should not be left to play out of sight or near busy roads.


Talk with your child about the following:

• That they must always tell you where they are going, what they are doing and who they are with.
• Warn them never to go into dangerous areas such as construction sites.
• Discuss what to do and who to contact in an emergency.
• Talk about bullying and what they should do if they are being bullied.
• Not to talk to adults they don't know and never to go off with an adult - even if they know them - without telling you first.
• If someone makes them feel uncomfortable, worried or scared to talk to someone in authority eg. police, park keeper, watchman. (If there is no one available speak to an adult with a child, if possible).
• Come home as quickly and safely as possible or, if you are out, go to a friend or neighbour's house whenever they feel worried or scared.

Schools, daycare, clubs and activities

When our children are at daycare, school or other organised activities we want to make sure that they are safe and well looked after. 

• Get recommendations from friends and family on the best school or club for your child.
• Make sure that the facilities are clean and safe and staff are caring and well trained.
• Ask about the school or club's policies on child protection and health and safety. 
• Always discuss with your child what they have been doing each day and allow them to share any problems or concerns.
• Maintain good communication with the teacher or organizer. This will enable you to discuss your child's progress and development, as well as any concerns or problems.

Leaving your child home alone

Before deciding whether it is safe to leave your child, or children, home alone consider these important factors:

• The age and maturity of the child.
• The place where the child will be left.
• How long and how often the child will be left alone.
• Whether there are any other children present and their ages.

Babies and young children should not be left alone, even for short periods of time. If possible, find a trusted adult who can look after your child while you are away.

If you do leave an older child alone make sure they are happy and confident about the arrangements. A child under 16 years old should never be left overnight.

Here are some guidelines to follow:

• Talk to your child about keeping safe at home and point out potential dangers.
• Put obvious dangers (eg. medicines, matches) out of child's reach.
• Leave a contact phone number and be available to answer it immediately.
• Give numbers of other trusted people they can contact if needed.
• Give clear instructions about what to do in an emergency and phone numbers for emergency services.
• Tell them not to answer the door to strangers.
• If they answer the phone, tell them to say mum and dad are busy (not out) and take the person's name and number.
• Tell your child when you will be back and make sure you are back on time.
• Talk with your child after you return home to discuss and problems or uncertainties.

On-line Safety

As computer, mobile and internet technology has progressed at a rapid pace over the last decade, our children often know more than we do. They may go on-line to connect with friends, make new ones, to browse the internet for information, chat with others and play games. The internet can be a very useful source of information. However, most children and many parents are unaware of potential dangers of being online.

The risks and dangers of being online:

• Exposure to pornography, violent games and videos and other inappropriate content
• Ignoring Age restrictions
• Cyber bullying
• Friending or communicating with people they don't know
• Sharing personal information
• Grooming and sexual abuse
• Addiction to computer games
• Gambling or running up debts

Guidelines for using the internet safely:

• Discuss with your child about the benefits and dangers of using the internet.
• Set rules and agree boundaries - this will depend upon your child's age and what you feel is appropriate.
• Explain that internet access is a privilege which can be taken away (by confiscating computers, smartphone etc.) if the rules are broken. 
• Know which websites your child is using and who they are talking to online.
• Explain that they should not share personal information online, and never accept friend request from someone they do not know.
• Limit the time your children can spend online and the material or websites they can access. 
• It is best to have the computer in a family area, so that you can monitor usage. If children and teenagers have an internet connect computer in their bedroom, or a smart phone they can go online anytime day or night, unsupervised.
• Use parental and privacy controls. These can be activated from the control panel of the computer or other device, on certain websites, or from a software package (some are free). Click here for more information on parental controls.
• No tool is 100% effective and these should not replace conversations with your child.
• Encourage your child to talk to you if they are concerned about anything they have seen, or communication they have received, on the internet.

Protecting our children from abuse - Part 2

In the second post in our series on protecting children from abuse we will look at signs that may indicate a child is being abused and what to do if you know, or suspect that abuse has occurred.

What is Child Sexual Abuse?

Child sexual abuse involves persuading or forcing a child to take part in sexual activities, exposing a child to adult sexuality or encouraging a child to behave in sexually inappropriate ways.

If we don't make a fuss about the abuse, won't a child forget it?

Children do not forget abuse, it can cause devastating emotional, physical and social effects for the child, even into adulthood. Adult survivors of child sexual abuse may develop harmful sexual behaviours, experience inability to trust close family and friends and have marital problems. If abuse is not reported once discovered, not only will the abuse continue, but the abuser is also likely to harm other children.

Signs could indicate abuse

The majority of children do not report abuse. They may feel too scared, fear that they will not be believed, or have been threatened by their abuser not to tell anyone. Changes in a child's behaviour may be the first sign that something is wrong. 

One or two of the following changes may be a normal part of development but more should raise suspicion of possible abuse:

• Nightmares or sleeping problems
• Becoming withdrawn or unusually clingy
• Changes in personality, become more insecure
• Problems with studies or missing school
• Excessive anger
• Sexual language or behaviour (inappropriate for the child's age)
• Going back to younger behaviours eg. thumb sucking, bed-wetting
• Sudden changes in eating habits
• Become secretive, not talking
• Shows signs of fear of, or avoids being alone with, a particular adult. 

If you suspect or discover that a child is being sexually abused, get professional advice (see options below).  Seek medical advice immediately if you see physical signs of abuse, such as unexplained soreness/bruising of genitals or symptoms of sexually transmitted diseases eg. an unusual discharge.


What to do if a child discloses that they have been abused

A very small proportion (estimated to be 12%) of abused children report it. Even then, the reporting is often ambiguous as they may be too shy to narrate the incident clearly, or a younger child may not have the vocabulary to explain what has happened.

Your response is crucial. If the adult does not believe the child, or makes them feel ashamed, they may never risk telling anyone again and the abuse will continue. 

For example, a child may say, "I don't like that Uncle."

If the adult replies "How can you speak like that, don't be so rude!" the child will feel scared and not give any further information.

However, if the adult responds, "I see, what happened?" the child is able to reveal the reason, which may, or may not arouse suspicion.

An abused child wants two things:

• to be believed
• for the abuse to stop

If a child confides in you about abuse

• Acknowledge the child's feelings and praise them for having the courage to come and tell you.
• Tell the child it is not his or her fault. Do not blame or accuse the child, even if they did not report the abuse when it started - the abuser is the one at fault.
• Do not ask the child to "forgive" "forget" or "adjust"
• Do not confront the alleged abuser - it may give them an opportunity to silence, confuse or threaten the child about speaking out. It may also place the child in danger.
• Tell the child that you would like to take the help of other trusted adults (eg. close family members, child welfare services, medical professionals or police) to help, with the child's permission. 
• Do not tell other people who are not directly required to help and support the child.

Childline has a national toll-free number - 1098 - which an adult who is concerned about a child, or children in distress, can call for help and advice.

In Bangalore, 3 new Collaborative Child Response Units (CCRU) have recently been set up at M.S. Ramaiah Hospital, Bangalore Baptist Hospital and KIMS Hospital. They liaise between children, their families, doctors and other authorities to provide medical, psycho-social and legal assistance. More CCRU's are to be set up in other districts of Karnataka.

It is possible to contact the CCRU's directly, but they also receive referrals from the police, child welfare services and Childline.

Due to the recent "Protection of Children from Sexual Offences Act - 2012"  it has become mandatory for any person having knowledge of a child being sexually abused to report the same to the Special Juvenile Police Unit or local police. A child need never go to a police station, police will come in plain clothes to visit the child and record the statement in the child's own words.

Protecting children is every adult's responsibility.

In the next section, we will discuss guidelines for keeping children safe in various situations, both at home and outside. 

Protecting our children from abuse - Part 1

In this blog, we are going to cover a non-dental issue, because it is one that is important for us all to be aware of.


It is an issue which people do not like to discuss or even think about, but child abuse is alarmingly common in India and around the world.  As adults, we have a responsibility to protect not just our own, but all children from abuse. 



What is child abuse?
Child abuse is the term used when an adult, or another child, harms a young person under the age of 18. There are many types of abuse -  physical, emotional, sexual, neglect and specific offences such as child trafficking.

In this article we will concentrate on child sexual abuse (CSA), but many of the principles can also be used to protect children from other forms of abuse. 

How common is child sexual abuse in India?
Children from all social classes and backgrounds are susceptible to abuse. It is impossible to know the true incidence of CSA as the vast majority of those abused do not tell anyone. Social stigma in Indian society often prevents people from coming out in the open and talking about abuse. 

A goverment study published in 2007 (http://wcd.nic.in/childabuse.pdf), found that 53% of the children surveyed reported having faced sexual abuse, 21% serious sexual abuse. In the majority of cases the abuser was someone known to the child, or in a position of trust and responsibilty. Most of those abused had not reported it to anyone. With statistics like these, it is not an issue that we can afford to ignore.

How can I keep my child safe?
Parenting is challenging, and the issues are different for babies and small children than for older children who are starting to become independent. Childhood should be a carefree time and we don't want to worry our children, but we need to give them some guidelines on keeping safe. 

We tend to be concerned about our children when they are out and about but, as the majority of abusers are known to the child, we also need to consider keeping our children safe at home, school, when visiting relatives and friends or participating in other activities or using the internet. In a future article, we will look at safety issues for various situations. 

Good Communication

Good communication with your child is the key, both to listen to their concerns and so that they will listen to you when you give advice and rules on keeping safe. 

As the quote says, this needs to start when your child is young. Listening to your child, at a time when you are not rushed or distracted is important. Put down your phone, and make eye contact with your child. 

Find the best times to talk and listen, maybe at bath-time or bedtime, going to and from school, while in the car or walking together. If your child wants to talk when you are busy, assure them that you will make time as soon as possible. Ask your child about their feelings and emotional well-being. The art of listening builds trust. Your child may also have other adults, such as grandparents, who they trust and can talk to.



As difficult as it may seem, it is better to give your child some guidelines on keeping safe, rather than waiting until until you have a concern. This should be done in a way that is appropriate for your child's age and understanding. A good tip is not to treat it like a lecture, it's much better to find easy ways to have comfortable chats, little and often. Adding simple conversations into your day or routine about staying safe will help prevent your child from feeling like it's a big deal, unusual or weird.

The UK charity NSPCC has developed The Underwear, or P.A.N.T.S rule as a simple way of talking to your child without using scary words or mentioning sex. You can click on the above link for details, but in summary:-

Privates parts are private
Always remember your body belongs to you
No means no
Talk about secrets that upset you
Speak up, someone can help



In India, Enfold Proactive Health Trust, based in Bangalore, are involved in education and training to protect children from sexual abuse.

In the next blog, we will discuss signs that may raise concern and what to do if you suspect abuse or a child tells you they have been abused. 

Are Baby Teeth Important?

Are baby teeth Important? What if your child gets cavities in their baby teeth? Is it really necessary to get them treated if they are not having any toothache? Surely the baby teeth will fall out after a while anyway?

Though you lose them early in life, your primary teeth, also called baby teeth or milk teeth, are essential in the development and placement of your permanent teeth. They also help in speech development. The permanent teeth develop close to the roots of the primary teeth. 

Untreated infection in baby teeth can affect the normal development of the permanent tooth. Primary teeth also maintain the spaces where permanent teeth will erupt. If baby teeth are lost too early other teeth may tilt into or take up the vacant space, forcing permanent teeth to come in crooked. 

Although baby teeth start to fall out around 6 years old, some will remain until 12 years or even later. By taking your child for regular check-ups any problems with the baby teeth can be seen early and treated or prevented from progressing. This way more complex treatment, which may be more expensive and require more cooperation from the child, can be avoided. If your child is taught to look after their baby teeth, they are much less likely to have problems once their permanent teeth come through. 

Which foods cause tooth decay?

Your child's diet is one of the most important factors in developing dental decay and small changes can make a big difference. 

In the previous blog post we looked at how foods containing sugar combine with bacteria in plaque to produce acid. If the teeth are subjected to frequent or long periods of acid attack, decay becomes likely to occur.

Most people are aware that children who eat too many sweets and candies are likely to get cavities. However, any foods that are are high in refined carbohydrates (starch), such as crackers and chips, can cause decay if the foods remain stuck to the teeth for long periods of time, as the starch breaks down into sugar. In fact, one good way to determine if a snack is good for a child is to check their teeth 20 minutes after consumption. If the teeth are still filled with food, the risk for dental decay will be higher. These foods should be eaten only rarely and teeth should be brushed afterwards.

There are a lot of "hidden sugars" in processed food. If you read the ingredients, they may be labelled as sucrose, glucose, lactose, or fructose - these are all types of sugar. In addition to containing high levels of sugar, many children's breakfast cereals also stick onto the teeth. Even diet soda drinks and concentrated fruit juices can cause decay as they are acidic.

It is not realistic to ban your child from eating sweets. altogether. Instead, limit consumption of sweets and candy to maximum of once a day, preferably at the end of a meal. Those treats that dissolve and clear from the mouth quickly eg. a milk chocolate bar, are better than hard candies, lollipops or sticky caramels. Sweets should be eaten in one go, rather than continually snacking on them.

Children do get hungry and need to snack. Choose healthy snacks such as fresh fruit and vegetables, nuts, cheese. For drinks in between meals go for water or milk without added sugar.

What causes dental cavities?

When you consume any food or drink containing carbohydrate, or sugar, the bacteria in the plaque on your teeth metabolise it, producing an acid attack which lasts for at least 20 minutes. The acid dissolves the outer surface layer of the teeth (enamel).

The acid attack will be much longer if the food remains stuck onto the teeth, or if snacking continues over a period of time, eg. eating a bag of sweets one by one, or continuously licking a lollipop. Also, If babies or toddlers fall asleep with a bottle, or whilst nursing, the milk will remain on their teeth for a longer period of time.

If food and drinks containing sugar are limited to mealtimes, with sugar free snacks and drinks in between, the teeth can recover from these short periods of acid attacks. In the early stages of decay (before a cavity is formed), the enamel can repair itself by taking in minerals from saliva. Fluoride also helps to strengthen the enamel in this process.

However, with frequent snacks and drinks containing sugar, cavities become much more likely to occur.

Once the enamel layer crumbles, a cavity is formed, bacteria enter and the decay process spreads rapidly.

To prevent dental decay, the aim should be to reduce the amount of time that any food containing sugar is present in the mouth. Drinking water or rinsing after eating can help. Try to make snacks and drinks, between meals, sugar free as far as possible. 

 

Regular, thorough brushing to remove plaque build-up from the teeth will also help but, as it is not possible to prevent plaque from building up again after brushing, diet is of extreme importance in preventing cavities.

Top Toothbrushing Tips

Tooth brushing is an important healthy habit to establish early on. 

For babies, you can use a clean, moist cloth to wipe the gums and the teeth once they start to erupt. Change to a soft brush or finger brush once they have at least two teeth. 

Finger brush

Parents should be in charge of brushing until their child reaches the age of 6 or 7, and older children will still need encouragement and supervision.

For children up to 3 or 4 years it is easier to see and brush their teeth if they lie down with their head on your lap. Try to make brushing fun - maybe by singing a song as you brush.

For children under 2 years, toothpaste is not advised. Once you start using toothpaste, use a small pea sized amount and encourage your child to spit it out. If your child is unable to spit out after brushing you can use a non-fluoridated toothpaste. Whilst fluoride is useful for preventing cavities, swallowing too much can cause fluorosis and staining of the developing adult teeth. Even after they learn to spit, young children will still swallow some paste so a toothpaste with a lower fluoride content is advised until around 7 years old. Ask your dentist for advice on which toothpaste is best for your child. 

Tooth brushing at twice a day should become part of the child's daily routine.  Let your child see you brushing. Small children love to copy what their parent or older sibling is doing. If your child sees you brushing regularly, it will set them a good example to follow.

It takes two minutes to brush teeth well. It may help to get a timer, or use one on your mobile phone. Make sure that all tooth surfaces are brushed.

Toothbrushes should be changed every three to four months, or sooner if they show signs of wear. Although not essential, a toothbrush with a favourite cartoon character on it may help motivate your child. You can use an electric toothbrush, if you find it easier, as long as it is one designed for children.

If you sometimes forget or your child is reluctant, you could use a reward chart, on which you place a star or smiley face, each time the child has their teeth brushed.

It's never too early to start preventing tooth decay

Young children can start to develop dental caries as soon as their first teeth enter the mouth. As a parent, awareness and prevention can never start too early.

It may be difficult to see all your child's teeth, especially the back molars, and so many children develop cavities before their parents realise there is a problem. By the time a child gets toothache the cavity will already be quite deep. It is best to take your child for a check-up at the dentist at around 1 year old.

An early check-up enables the dentist to assess the risk factors for your child developing dental decay and give personalised preventive advice. Also, if early signs of dental decay are seen, it may be possible to prevent it progressing to become a cavity. 

In future blogs we will be focusing on what you can do at home to keep your child's teeth healthy. 

Every Child Deserves a Beautiful Smile

Every child deserves a beautiful smile

The anterior teeth in children have two very important function .
1) It helps in speech development
2) Aesthetics

Now a days with increased exposure to electronic media the kids are becoming more aware of the way they look at a much earlier age. Hence, It becomes very important we as parents understand their concept of self image and help them built their confidence.



The anterior or the front teeth in children can gat damaged and look un aesthetic due to one of these reasons
1) Decay especially Early childhood caries
2) Fall or fracture of the teeth
3) Crooked or missing teeth

All these can be corrected by a simple visit to the pediatric dentist. Few of the general treatment options are

1) Composite restorations
2) Strip crowns
3) Removable dentures
4) Pre formed crowns

Final treatment plan for a child is custom designed based on the childs oral health. After all every child surely deserves a beautiful and healthy smile.