32511 - Child Abuse Child Dr. Rasha Salama PhD Community...

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Unformatted text preview: Child Abuse Child Dr. Rasha Salama PhD Community Medicine Suez Canal University Egypt So long as little children are“ allowed to suffer, there is no ”true love in this world Duncan Children Rights Children There is clear evidence that child abuse is a global There problem. It occurs in a variety of forms and is deeply rooted in cultural, economic and social practices. practices. Before defining “child abuse” its crucial to get Before informed about “children’s rights” in the first place. place. According to the National Council for Childhood According and Motherhood (NCCM) in Egypt, Egyptian children are a national priority. children NCCM’S RIGHTS’ BASED APPROACH ((Convention on the Rights of the Child Non-discrimination (article 2) Best interests of the child (article 3) Life, survival and development (article 6) Respect of the views of the child (article 12) PRIORITIES Right to Education Access to quality, free, compulsory primary education. Non-Discrimination in access to education (gender gap). (Aims of Education: art. 29) Right to leisure, recreation and cultural activities. Right to Health Access to quality health services Rights of children with disabilities Adolescents and reproductive health knowledge Right to benefit from social security Right to an adequate standard of living Right to Special Protection Protection from all forms of exploitation (economic, sexual). Violence against children (physical, psychological & sexual). Female Genital Mutilation & early marriage. Torture and deprivation of liberty for juvenile in conflict with the law Hazardous occupations. Smoking, substance abuse, and trafficking. Street children. Child Abuse Child In 1999, the WHO Consultation on Child Abuse Prevention compared definitions of abuse from 58 countries and drafted the following definition: ‘‘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.’’ Definition of Child Abuse Definition “The physical or mental injury, sexual abuse or exploitation, negligent treatment, or maltreatment of a child under the age of 18 by a person who is responsible for the child’s welfare under circumstances which indicate that the child’s health or welfare is harmed or threatened.” Child Welfare Act Another Definition Another “Any behavior directed toward a child Any that endangers or impairs a child’s that physical or emotional health and development” development Types of Child Abuse Types physical abuse sexual abuse emotional abuse neglect Physical Abuse Physical Physical abuse is any non-accidental injury to Physical a child under the age of 18 by a parent or caretaker. These injuries may include beatings, shaking, burns, human bites, strangulation, or immersion in scalding water or others, with resulting bruises and welts, fractures, scars, burns, internal injuries or any other injuries. internal .(Physical Abuse (cont Physical The term ‘‘battered child syndrome’’ was coined to characterize the clinical manifestations of serious physical abuse in young children. This term is generally applied to children showing repeated and devastating injury to the skin, skeletal system or nervous system. It includes children with multiple fractures of different ages, head trauma and severe visceral trauma, with evidence of repeated infliction. Another form is the “The shaken infant”. Shaking is a prevalent form of abuse seen in very young children (less than 1 year). Most perpetrators of such abuse are males. Intracranial haemorrhages, retinal haemorrhages and chip fractures of the child’s extremities can result from very rapid shaking of an infant. Corporal Punishment • Corporal punishment of children --- in the form of hitting, punching, kicking or beating --- is socially and legally accepted in most countries. In many, it is a significant phenomenon in schools and other institutions and in penal systems for young offenders. PSYCHOLOGICAL MALTREATMENT PSYCHOLOGICAL Definition Psychological Neglect - the consistent failure of a parent or caretaker to provide a child with appropriate support, attention, and affection. appropriate Psychological Abuse - a chronic pattern of behaviors such as belittling, humiliating, and ridiculing a child. ridiculing Emotional Abuse Emotional Emotional abuse includes the failure of a caregiver to provide an appropriate and supportive environment, and includes acts that have an adverse effect on the emotional health and development of a child. Such acts include restricting a child’s movements, denigration, ridicule, threats and intimidation, discrimination, rejection and other nonphysical forms of hostile treatment. Neglect Neglect Neglect refers to the failure of a parent to provide for the development of the child – where the parent is in a position to do so – in one or more of the following areas: health, education, emotional development, nutrition, shelter and safe living conditions. Neglect is thus distinguished from circumstances of poverty in that neglect can occur only in cases where reasonable resources are available to the family or caregiver. CHILD SEXUAL ABUSE CHILD Definition Child sexual abuse is the exploitation of a child or Child adolescent for the sexual gratification of another person. person. SEXUALLY ABUSIVE BEHAVIORS Voyeurism Sodomy Fondling Oral-genital stimulation Verbal stimulation Exhibitionism Child prostitution Child pornography Intercourse Three Major Components Three of Child Abuse Child + Care Giver + Stress = Child Abuse Who are at Risk Who Abuse most common in children < 1 yr. oldGirls more frequently abused at older age vs. boys- TABLE 2 Risk Factors for Child Abuse Community/societal • High crime rate • Lack of or few social services • High poverty rate • High unemployment rate Parent-related • Personal history of physical or sexual abuse as a child • Teenage parents • Single parent • Emotional immaturity • Poor coping skills • Low self -esteem • Personal history of substance abuse • Known history of child abuse Parent-related (continued( • Lack of social support • Domestic violence • Lack of parenting skills • Lack of preparation for the extreme stress of having a new infant • History of depression or other mental health problems • Multiple young children • Unwanted pregnancy • Denial of pregnancy Child-related • Prematurity • Low birth weight • Handicap The Extent of the Problem The Fatal abuse According to the World Health Organization, there were an estimated 570 000 deaths attributed to homicide among children under 15 years of age in 2000 around the world. Global estimates of child homicide suggest that infants and very young children are at greatest risk, and those who live in developing countries. Non-fatal abuse According to the “WORLD REPORT ON VIOLENCE AND HEALTH” by WHO among children in Egypt, 37% reported being beaten or tied up by their parents and 16% reported physical injuries such as fractures, loss of consciousness or permanent disability as a result of being beaten or tied up. Rates of harsh or moderate forms of physical punishment ((WHO) WORLD REPORT ON VIOLENCE AND HEALTH (2002 Rates of verbal or psychological punishment ((WHO) WORLD REPORT ON VIOLENCE AND HEALTH (2002 Parental beliefs and reasons for punishment Parental Survey in Egypt showed: lying, Egypt disrespect, disobedience, low performance in school and destroying property are the main reasons for punishment (Youseff and Kamel, 1998( Kamel, Health Consequences of Child Abuse Health Health Consequences of Child Abuse Health .((cont Role of Family Physician in Child Abuse Child Protect Suspect Inspect Collect Respect ...Protect Protect   Patient/family and Patient/family team safety are paramount. paramount. Protect the life of the Protect patient as well as as much evidence as possible. possible. ...Suspect Suspect    Does the history fit Does what you are seeingeither injury or illness? illness? Is this a repeat patient Is or family member of a repeat patient? repeat Is there a history of Is family violence? family Collect... Collect...  Collect as much Collect evidence as possible, including… including physical and trace physical evidence evidence information Respect... Respect...    Respect the right to Respect refuse refuse Respect diversity Respect privacy The Cycle of Abuse... The Family violence  Abuser-to abuser Abuser-to cycle cycle  Factors in altering Factors the cycle of violence violence  Responsibilities to Report... Responsibilities Who must report…  Deciding to report…  A report of suspected child abuse is a responsible attempt to protect a child. responsible Identifying Physical Abuse... By the Family Doctor Family  Normal childhood development  Conditions that may be confused with abuse  Unintentional vs intentional injury Recognizing Abuse Injuries... Recognizing  Skin Injuries  TEARS Human Bite Marks  Hair Loss  Falls  Head, facial, oral injuries  Shaken baby Syndrome  Human Bites Human Strongly suggest abuse  Easily overlooked Easily  Location of bite marks on infants differ Location from sites on older children from  Bruises Bruises  Generally speaking: fresh injury is red to blue  1-3 days deep black or purple  3-6 days color changes to green and then brown  6-15 days: green to tan to yellow to faded, then 6-15 disappears disappears   The younger the child the quicker the color The resolves. resolves. Bruises Bruises Burns Burns  Abusive Burn Patterns Scald: Immersion & Splash Burns  Flexion Burns  Contact Burns   “Pseudoabusive” Burns Burns Burns Suspicious Fractures Suspicious Falls Falls In most cases, falls cause a minor injury.  If a child is reported to have had a routine If fall but has what appear to be severe injuries, the inconsistency of the history with the injury indicates child abuse. with  Head, Facial, Oral Injuries Head, Head is a common area of injury.  Approx. 50 % of physical abuse patients Approx. have head or facial injuries. have  Injuries to the sides of the face, ears, Injuries cheeks, and temple area are highly suspicious for abuse. suspicious  Mouth/lip/teeth injuries Mouth/lip/teeth  (Indicators of Child Abuse (Discovered by Family Doctor Indicators Type of Abuse Physical Indicators Behavioral Indicators Physical Physical Unexplained bruises, welts, burns, Unexplained fractures, or bald patches on scalp fractures, Wary of adult contact, frightened of Wary parents or afraid to go home, withdrawn or aggressive, moves uncomfortably, wears inappropriate clothing for weather clothing Sexual Difficulty walking or sitting; torn or Difficulty stained/blood underclothes; pain, itching, bruises, swelling in genital area; frequent urinary or yeast infections infections Advanced sexual knowledge, Advanced promiscuity, sudden school difficulties, self-imposed social isolation, avoidance of physical contact or closeness, depression contact Emotional Speech or communicative disorder, Speech delayed physical development, exacerbation of existing conditions, substance abuse substance Habit disorders, antisocial or Habit destructive behaviors, neurotic traits, behavior extremes, developmental delays delays Neglect Consistent hunger, poor hygiene, Consistent inappropriate dress, unattended medical problems, underweight, failure to thrive failure Self-destructive behaviors, begging or Self-destructive stealing food, constant fatigue, assuming adult responsibilities or concerns, frequently absent or tardy, states no caretaker in home states Common Features of Successful Child Abuse Preve...
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This note was uploaded on 02/26/2012 for the course PHARM 210 taught by Professor Staff during the Fall '10 term at Rutgers.

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