Child Abuse and Neglect

Notes

## Basic introductiona,d

  • Children abuse and neglect is maltreatment of children or adolescents by parents, guardians, or other care-givers
  • The WHO Consultation on Child Abuse Prevention’sd defines child abuse and neglect as “Child abuse or maltreatment constitutes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power”
  • Often, the approach to child abuse need to consider different standards and expectations for parenting behaviour in various cultures globally

## Statisticsa,b,c

  • About 90% of child abusers are caregivers who are:

_Stressed

_Lonely

_Angry

_Unhappy

  • About 20% of women and 5-10% of men globally suffered sexual abuse in their childhood
  • >130 million children 6-11years old globally are not in school (60% being girls)
  • In Kenya, levels of violence prior to age 18 as reported by 18 -24 year olds (lifetime experiences) indicate that during childhoodc:

_32% of females and 18% of males experience sexual violence

_66% of females and 73% of males experienced physical violence

_26% of females and 32% of males experience any violence as children

_13% of females and 9% of males experienced all three types of violence during childhood

_< 10% of females and males who experienced sexual, physical or emotional violence as children received some form of professional help

## Types of child-abusea

  • Physical abuse

_This is the most common type of child-abuse

_The evidence of physical child abuse may include the following:

  ||| Bruises

  ||| Burns

  ||| Bone fractures

  ||| Head injury

  ||| Maiming

  ||| Internal injuries

  • Sexual abuse

_This is the least reported form of child-abuse

_Most of the cases of this type of child-abuse are meted out by close relatives or caregivers

_Sub-types of sexual abuse include:

  ||| Molestation

  ||| Sexual intercourse

  ||| Rape

  ||| Sexual talk and correspondences

  ||| Child prostitution

  ||| Child pornography

  ||| Exhibtionism

  • Emotional abuse

_This form of abuse is not easy to prove

_It may include:

  ||| Lack of nurturing

  ||| Destructive criticisms

  ||| Verbal abuse

  ||| Cruel punishment

  ||| Brainwashing

  ||| Exploitation

  ||| Extreme rejection

  • Nutritional neglect or deliberate underfeeding

_It is characterized by failure to thrive (FTT)

  • Neglect of medical care
  • Intentional drugging or poisoning

## Risk factors for child abuse and neglecta,b

  • Young children are more at risk of physical abuse than older children
  • Children who have reached puberty or adolescence have the highest rates of sexual abuse
  • Boys are more exposed to physical abuse (such as beatings)
  • Girls are more exposed to:

_Educational neglect

_Forced prostitution

_Infanticide

_Nutritional neglect

_Sexual abuse

  • Single parenthood
  • Overcrowding homestead
  • Poverty
  • Chronic illness
  • Disabilities
  • Behavioral difficulties
  • History of abuse of the caregiver
  • Chronic illness of caregiver
  • Psychiatric disorder of caregiver
  • Blended family
  • Poor parenting skills
  • Substance abuse by the caregiver
Symptoms
  • Inconsistent injuries such as bruises, burns, fractures and other injuries
  • Injuries manifested by delays in seeking medical assistance
  • Sexual abuses tend to be concealed mainly as a result of fear of reprisal by the perpetrators
  • Sexual abuses manifest mainly as:

_Vaginal bleeding

_UTIs

_STIs

_Acute stress

_Enuresis (involuntary urination, mainly at night)

_Encopresis (which is fecal incontinence in a toilet-trained child) in absence of organic disorder

_Pregnancy

  • Failure to thrive
  • Unkempt child
  • Child avoids eye-to-eye contact
  • Symptoms of malnutrition
  • Other consequences of child abuse includeb:

_Alcohol and drug abuse

_Delay in development in speech

_Delinquent, violent and other risk-taking behaviors

_Depression and anxiety

_Eating and sleep disorders

_Poor relationships

_Poor school performance

_Post-traumatic stress disorder

_Reproductive health problems

_Suicidal behaviour

Diagnosis
  • Early diagnosis (or recognition) is important for effective intervention
  • Comprehensive clinical review that include:

_Family history

_Physical examination that may include X-ray of various body parts

_For suspected cases of rape and sexual abuse

||| Swabbing the vagina, urethra, throat, and rectum for microscopy and cultures for Neisseria gonorrhoeae and Chlamydia trachomatis

||| Swabbing the vagina and cervix for sperm microscopy

||| X-rays, CT or MRI scans may be required.

||| Scarring as one sign of the sexual abuse.

||| Blood sample for testing for syphilis and HIV (the tests are repeated after 3 months)

Differential
  • Not applicable
Prevention
  • Alleviation of poverty
  • Training in parenting
  • Community support of families
  • Stable housing
Reference
  1. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf
  2. http://www.who.int/violence_injury_prevention/violence/world_report/factsheets/en/childabusefacts.pdf?ua=1Campbell, J. C. (1993).
  3. Violence against children in Kenya: Findings from a 2010 national survey. Summary report on the prevalence of sexual physical and emotional violence context of sexual violence and health and behavioral consequences of violence experienced in childhood. RESPONSE, 14(3), 18-24.
  4. World Health Organization. (1999). Report of the Consultation on Child Abuse Prevention, 29-31 March 1999, WHO, Geneva.
Management
  • For the rape victim,

_Start by treatment of life-threatening emergencies.

_Forensic examination then follows together with collection of evidence (including samples) that can be used to identify and prosecute the perpetrator

_Victims with abrasions are immunized for tetanus

_Initiate prophylactic treatment for:

||| Vaginitis

||| Gonorrhea,

||| Trichomoniasis

||| Chlamydia

_HIV PEP regime (see the details under “HIV” in this publication)

­_If the assailant is apprehended collect the necessary specimen such as hair, blood etc.

_The rape victims need to be followed for some few months

_Constructive surgery may be required

_Tranquilizers such as:

 ||| Tabs Diazepam 0.1 – 0.25mg TID

 ||| Tabs Phenobarbitone 5-8mg/kg/day

  • A social support staff is then made available to provide psychological care. A long-term psychiatric care may be required
  • It may be necessary to admit the child for the following reasons:

_Further medical attention

_Short-term provision of safety

_Further involvement of police and social worker

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