CHILD ABUSE AND NEGLECT

Increased morbidity and quality of life has decreased in infants and

children , because they are underprivileged, they lack food, shelter,
health, education and security. Even, right to live, social status are
hindered . These children lack love from parents and feeling of being
wanted persist in young child. Some are forced to work in organized
and unorganized sectors and suffer from exploitation and abuse. Few
engage in antisocial activities. How ever , children get abused
intentionally or unknowingly by their parents, and caretakers.

Who are prone for getting child abuse

Child abuse can be physical, sexual or emotional. The street children,

refugees, orphans of AIDS, prostitutes, disabled children and those
trapped in trafficking, sale and kidnapping are more prone to get
exploited.

Factors of high incedence of child abuse

 Poverty
 Unemployment,
 Overcrowding
 High rate of violence, teenage pregnancy, single parenthood and
drug abuse

 DEFINITION

The first term “Battered Baby Syndrome” used for child abuse . It
means chronic repetitive injuries due to abuse .

Then this term was changed to child abuse and neglect (CAN)
which means any problem resulting from lack of
reasonable care and protection of child and adolescents by their
parents, guardians or caretakers.
Different terms used for child abuse

1. “Child Abuse”,
2. “Child Neglect”,
3. “Child Maltreatment”,
4. “Physical Abuse”,
5. “Child Battering”,
6. “Silverman’s Syndrome”,
7. “Illegitimate
8. Child Syndrome”
9. “Parental Dysfunction”
10. Most recently “Non-Accidental Injury” (NAI)

FORMS OF CHILD ABUSE

There are various forms of child abuse like physical ,nutritional,

sexual, behavioural, emotional, substance abuse, and medical neglect .
various form in detail are described below

Physical:
 Cuts, bruises, hematoma, fracture, head injury, burns, eye
injury, trauma,
 injury due to slapping, pushing, squeezing, kicking, shaking,
“shaken baby syndrome”

Nutritional:

 Failure to thrive, marasmus, stunting

Sexual:

 Rape, fondling(touching ), pornography, prostitution,

  Exhibitionism ( exposing body infront of others) , female
feticide and infanticide, neglect of girl child
 Female discrimination in deprivation from food, education,
clothing, entertainment, love and social status and early girl
child marriage

Behavioral:

 Aggressiveness behaviour, crying shout , prefers to stay away

from home as much as possible, frequent absenteeism and
unwillingness to go to school, not reporting injury to parents or
giving inappropriate explanation of an injury

Emotional

 Depression, extremely low self esteem, passive, withdrawn,

tearful, high anxiety, poor social and interpersonal skills,
persistent habit disorders such as sucking, biting, or rocking,
self-destructive behaviour

• Substance abuse:

 Drugs which alleviate mood or create illusions, happiness, e.g.

Cocaine, marijuana, etc.and alcohol

Medical neglect:

Neglecting medical management of the child by professional is called

medical neglect , it could even lead to death.

Forms of Child Exploitation

Exploitation can be sexual, entertainment, social benefits, political,

social, kidnapping and trafficking of children
 1. Sexual: Children used for prostitution/sex related trade,
pornography and allied abuses-trafficked children, devdasis, etc.
2. Entertainment: Use of children as jockeys , street dancing and
street shows or games with non-domesticated animals, monkeys,
bears, elephants, camels, snakes, etc, rope walking, , for
religious celebrations, fire jumping, or fire swallowing in circus
3. Social benefits: Use of children by schools, orphanages, NGOs,
etc. for formal welcome programs. Making children to wait in
hot climates without drinking water, or going to toilet.
4. Political: For wars
5. Labor: in organized/unorganized sectors
6. Kidnapping: Use of kidnapped children for begging, for thefts,
stealing, and antisocial activities
7. Trafficking of children: For antisocial activities namely slavery,
prostitution, and sex, industrial labor, smuggling, entertainment,
etc.

CHILD NEGLECT

It means that child is deprived of basic physiologic needs like food,

protection, housing, education, health, and medical problems,
entertainment and most being loved, being wanted .

CLINICAL FEATURES

The signs and symptoms vary according to the type of abuse.

Physical abuse
1. Signs of battered baby syndrome (less than 4 years) are painful
swellings, restriction of movements due to fracture of long
bones.
2. Finger and thumb impressions of abuser in arms of child.
3. Body marks due to beating with belt, stick or ruler.
4. Bite marks ,it looks like crescent shaped .
 5. Slap marks over the cheeks.
6. Choke marks in neck may due to tying of strings or ropes.
7. “Black eye” and contusions over face or sides of the head .
8. Burn marks due to cigarette burns. Especially in buttocks or
thighs showing circular burns.
9. Blow injury over abdomen may cause tearing/rupturing of liver
or spleen.

Sexual abuse

1. Molestation, intercourse and rape are the three types of sexual

abuse manifestation found in skin, mouth, rectum and external
genitalia may show evidence of trauma.
2. A hymenal opening of over 5 mm.
3. Pedophilia refers to sexual abuse (attack) on children under 10
years of age.

Nonorganic failure-to-thrive (FTT)

1. Child is deprived of emotional stimulus and nutrition.

2. Manifestations include signs of nutritional deficiencies, and
diaper rash impetigo, scabies, unwashed skin, uncut nails, dirty
nails

Emotional abuse

1. Child is drowsy, unconscious or emotionally scared.

2. She is too shocked to reveal anything. Importantly, the injuries
are more serious than expected from the given history

DIAGNOSIS

When to suspect child abuse:

• Discrepancy with parents story
• Abnormal attitude of parents
• Gap between onset of symptoms an seeking medical advice
• Injuries in uncommon areas
Physical abuse
1. X-ray shows soft tissue swelling, linear fractures, hematoma .
2. Other investigations
.

Effects of Child Abuse and Neglect

The effects can be divides into short and longterm effects on

cognitive, socio-economic and behavioral
development.
• Short-term/immediate: Withdrawn behaviour, quiet, depressed,
excessive crying, frightful, non-communication with family members
, friends and schoolmates

• Long-term/delayed: It include low IQ, hyperactivity, physical

defects, less social responsibility, poor impulse control,
aggressiveness, marked anxiety, rebel behaviour,
More prone to do crime, drug abuse, poor social and marital
adjustment and sexual difficulties.

• Neglect: when compared to abused children, these neglected

children have more cognitive and academic deficits, may feel
worthless, social withdrawal, limited peer( same age group)
interactions.

MANAGEMENT

Management depends on type of drug abuse.

 Physical abuse needs appropriate treatment of the injuries.

 What ever be the type of abuse, inform immediately to
police/physician and caretaker.
  If the victims of sexual abuse go undetected or if they did not
reveal regarding child abuse because of social stigma, then
these abuse will repeated.
 Sex education in schools reduced the sexual abuse rate to a
greater extend.
 Child laborers require food, shelter, health care, education,
social stability and entertainment, which need to be provided by
employers, government, or NGOs.
 Economic help, rehabilitation with own family is always
preferable. Personal care is advisable wherever possible.
 Abandoned babies in orphanages need urgent and long-term
medical and health care, adoption.
 Long term rehabilitation should be given for kidnapped,
trafficked, refugees, HIV/AIDs affected, orphans, prostitutes.
They require comprehensive help and long term rehabilitation.
 There are several organisations working at national,state,district
level for protecting against child abuse.

CONCLUSION

This chapter dealt with child abuse, its definition, riskfactors, types
and forms of child abuse, forms of exploitation, diagnosis, clinical
features and management of child abuse and neglect.