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Joshua Saxe is one of 25 volunteers statewide who are participating in a program that trains people to detect signs of child abuse or neglect. Volunteers include dentists, dental hygienists, nurses and social workers. Photo by Clint Karlsen. Click on the image for an enlargement. Graphic by Mike Johnson. For more information on the Panda program, call 775-684-5953. To report suspected child abuse, call the Clark County Child Protective Services child abuse hot line at 399-0081. SIGNS OF ABUSE What to look for: -- Unexplained bruises, welts, cuts or broken bones. -- Marks on the skin reflecting the shape of the item used to inflict the injury (hand prints, belt buckle, electric cord). -- Several bruises in different stages of healing. -- Bite marks. -- Cigar, cigarette or iron burns. -- Rope burns on arms, legs, neck or torso. -- Patches of hair missing or falling out. -- Any injuries that regularly appear on a child following a weekend, vacation or other absence. Source: The University of Nevada, Reno, Cooperative Extension Program STATISTICS Child abuse statistics for 1999 in the United States: -- Nearly 3 million children were reported to state agencies as possible victims of child abuse. -- More than half of the reports came from professionals, the rest came from family members or close friends of the child. -- The 1999 victimization rate of 11.8 per 1,000 children decreased from the 1998 rate of 12.6 per 1,000 children. -- Children ages 3 and under were victims of abuse more than children in any other age bracket. -- Girls were abused at a rate of 1.6 per 1,000 female children while boys were abused at a rate of 0.4 per 1,000 male children. -- 62 percent of abusers were women. -- An estimated 1,100 children died from abuse or neglect. Source: U.S. Department of Health and Human Services -- REVIEW-JOURNAL

Monday, April 23, 2001
Copyright © Las Vegas Review-Journal

Program sheds light on child abuse signs

Dentists take lead in reporting effort

Trained to detect signs of child abuse in the mouths of their pediatric patients, Las Vegas dentists Joshua and Michael Saxe have a mental checklist of suspicious wounds:

• The lips are ripped away from the gum.

• Tears crack the corners of the mouth.

• Bruises or blood blisters line the back of the throat or the soft palate.

The pair of dentist brothers are sage in child abuse detection and reporting.

Other local dentists, doctors, teachers, parents and child care workers soon will follow suit because of a new statewide program known as Prevent Abuse and Neglect through Dental Awareness, or Panda. The program, with affiliates in 44 states and six countries, initially began as a training ground for dentists but has expanded to include anyone who regularly works with children.

"There are certain types of abuse that can only be recognized by looking inside the mouth," Joshua Saxe said. "We need to be able to recognize it, document it and go to the right agencies to report it."

Mouth injuries in children can be the result of sexual abuse, face slapping or placing gags in the mouth.

The Panda program, coordinated by the state health division, includes 25 volunteers statewide who are now trained in the detection and reporting of child abuse. As of Tuesday, the volunteers, including Joshua Saxe, are available to train anyone else in the community to do the same.

The volunteers include local dentists, dental hygienists, nurses and social workers. They were all trained by the founder of the Panda program, Lynn Mouden, director for Arkansas' office of oral health.

Mouden started the program in 1992 in Missouri after reporting several suspected cases of child abuse in his dental practice. He soon realized colleagues were seeing similar suspicious injuries in their own patients, but either didn't recognize the wounds as abuse or didn't know who to report it to. Mouden has since trained hundreds of volunteers across the country to train thousands more in their respective communities.

"I'm working right now with Israel and Finland too and hope to get coalitions set up there as well," Mouden said. "I do a train the trainer program to create a cadre of local experts to train others."

Chris Forsch, health educator for the state health division, said she wants everyone in the community to know that child abuse classes and training sessions are now available via the 25 volunteers free of charge.

"Seventy-five percent of all abuse cases have a symptom in the head, neck or face region. It's something a teacher, child care worker or neighbor can easily see if they know what to look for," she said.

Forsch hopes to train day care workers, schoolteachers, school nurses and church groups. Clergy members are especially important because they report child abuse less than any other reporting source, even less than the victims themselves, according to statistics with the state health division.

In 1999, there were 13,384 reports of suspected child abuse in Nevada. Of those, the largest reporting source was school personnel, at nearly 20 percent. Other major reporting sources include law enforcement personnel, friends and neighbors and medical professionals. The lowest reporting sources include the clergy at 0.2 percent and victims at 0.7 percent.

According to Panda volunteer and dental hygienist Cathy Lytle, the program has made a difference in the way she approaches her patients. Lytle says if she had known just last year what she knows now about detecting child abuse, she probably would have reported a few cases she otherwise overlooked.

Reporting suspected child abuse usually entails simply contacting Clark County's Child Protective Services and allowing the agency to investigate. Of 7,932 reports of suspected abuse in 1999 in Clark County, 4,769 were unsubstantiated.

"The trick is learning the difference between a normal trip and fall and something else," Lytle said. "I had never had any specific training before and wanted to know more about asking children the right questions and documentation. Kids will tend to change their stories when you ask them about an injury and they will also be really afraid if they are being abused sexually. They will really freak out when anybody comes near their head or face."

Lytle said she recalls two children in the past year who she felt had suspicious injuries. One involved bite marks and another involved lesions in the throat.

Anyone working in the fields of medicine, social work, law, education, clergy and child care are required by law to report any signs of child abuse to authorities. The problem, however, is that many people in these fields aren't trained in what to look for and are often oblivious to warning signs, said Michele Belkin, senior specialist for Clark County Child Protective Services and a Panda-trained volunteer.

"I got involved with Panda because this is a resource that needs to be tapped into," Belkin said. "It isn't just for dentists. It's for churches, the PTA, therapists, parents and any medical personnel."

Joshua Saxe has been practicing in Las Vegas for a year and has yet to report any child abuse cases, but he's careful to document any injuries his patients may have each time they come for a visit.

"A lot of times kids are just being kids and they fall down and that's normal." Saxe said. "But, sometimes we see repeated types of injuries when the child comes back. Part of my protocol when I do an exam is to ask parents how an injury happened and I note it in my chart. The worst thing is not to say anything and allow a child to be put back into an environment where they will get more abuse."