P.A.N.D.A.

1. General physical assessment of the child. Although general physical examinations may not be appropriate in all settings, be aware of obvious physical traits that may indicate abuse or neglect (e.g. difficulty in walking or sitting, physical signs that may be consistent with the use of force).
   
   
2. Behavior assessment. Judge the child's behavior against the demeanor of children of similar maturity in similar situations.
   
   
3. Health histories. If you suspect child maltreatment, it can be useful to obtain more than one history, one from the child and one separately from the adult.
   
   
4. Orofacial examination. Look for signs of violence, such as multiple injuries or bruises, injuries in different stages of healing, or oral signs of sexually transmitted diseases.

1. Documentation. Carefully document any findings of suspected abuse or neglect in the patient's record.
   
   
2. Witness. Have another individual witness the examination, note and co-sign the records concerning suspected child abuse or neglect.
   
   
3. Report. Call the appropriate child protective services (CPS) or law enforcement agency in your area, consistent with state law. Make the report as soon as possible without compromising the child's dental care.
   
   
4. Necessary information. Have the following information available when you make the report:

• name and address of the child and parents or other persons having care and custody of the child
• child's age
• name(s) of any siblings
• nature of the child's condition, including any evidence of previous injuries or disabilities; and,
• any other information that you believe might be helpful in establishing the cause of such abuse or neglect and the identitiy of the person believed to have caused such abuse or neglect.