Child Abuse

Reference :
1. Nelson textbook of pediatrics
2. A study on child abuse in india 2007

Dr Ruturaj Deshmukh
Right for First to get aid in
disaster
“So long as little children are
allowed to suffer, there is no
true love in this world”
Duncan
Definition :
 “any recent act or failure to act on the part of
a parent or caretaker, which results in death,
serious physical or emotional harm, sexual
abuse or exploitation.” (nelson)

 “Child abuse constitutes all forms of physical and/or

emotional ill treatment 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”.
(WHO)
Who are at Risk

-Abuse most common in children < 1 yr. old

-Girls more frequently abused at older age vs.
boys
WHY Critical Concerns IN INDIA:
 Every fifth child in the world lives in India
 Every third malnourished child in the world lives in India

 Every second Indian child is underweight

 Three out of four children in India are anaemic

 Decline in female/male ratio is maximum in 0-6 years: 914

females per 1000 males

 Birth registration is just 62% (RGI-2004)

 Retention rate at Primary level is 71.01% (Elementary Education in

India Progress towards UEE NUEPA Flash

 Statistics DISE 2005-2006)

 Girls' enrolment in schools at primary level is 47.79% (Elementary

Education in India Progress towards UEE

 NUEPA Flash Statistics DISE 2005-2006)

 1104 lakh child labour in the country (SRO 2000)

Types:
 physical abuse
 sexual abuse
 emotional abuse
 neglect
1.Physical abuse
“Physical abuse is any non-accidental injury to a child
under the age of 18 by a parent or caretaker. ”
These includes- beatings, shaking, burns, human
bites, strangulation, or immersion in scalding water or
others,
Which may results in:
1. Bruises and welts 2. fractures
3. Scars 4. burns
5. Internal injuries or any other injuries.
BRUISE:
When to suspect it is inflicted abuse:
(1) bruising in a preambulatory infant ,
(2) bruising of padded and less exposed areas
(buttocks, cheeks, under the chin, genitalia),
(3) patterned bruising or burns conforming to shape of
an object or ligatures around the wrists
(4) multiple bruises, especially if clearly of different
ages.
Before confirming it we must rule out:
(1) birthmarks and Mongolian spots
(2) blood dyscrasias or connective tissue disorders
(hemophilia,Ehlers- Danlos).
(3) Henoch-Schonlein purpura
(4) coagulopathy
(5) Cultural practices
Bruises
Bites:
 characteristic pattern- “1 or 2 opposing arches with
multiple bruises.”
 child bites: < 8 yr primary teeth typically have a distance of
less than 2.5 cm between the canines.
 Animal bites: usually have narrower arches than human
bites and are often deep.
 Self-inflicted bites are on accessible areas, particularly the
hands.
 Adult bites: canine distance
>2.5 cm and has broader arch.
 Multiple bites by another child
suggest inadequate supervision
and neglect.
Fractures:
 When to suspect abuse:
◦ Multiple fractures in various stages of healing.
◦ classic metaphyseal lesions
◦ posterior rib fractures,
◦ fractures of the scapula, sternum, and spinous processes, especially in
young children.
 Non abused #:
◦ Clavicle, femoral, supracondylar humeral, and distal extremity fractures in
children older than 2 yr are most likely noninflicted unless they are multiple
or accompanied by other signs of abuse
Differential diagnosis includes conditions that increase
susceptibility to fractures, such as osteopenia and
osteogenesis imperfecta, metabolic and nutritional disorders
(e.g., scurvy, rickets), renal osteodystrophy, osteomyelitis,
congenital syphilis, and neoplasia
A, Metaphyseal fracture of the distal tibia in a 3 mo old infant
admitted to the hospital with severe head injury
Burns:
 When to suspect as abuse:
◦ it shows clear delineation between the burned and healthy
skin
◦ has uniform depth.
◦ mainly sock or glove distribution
◦ absent Splash marks.
◦ Symmetrical burns (especially suggestive of abuse as
are burns of the buttocks and perineum).
◦ pattern Burn (hot objects such as curling
irons, radiators, steam irons, metal grids,hot knives, and
cigarettes.)
Burns
Medical terms
1. ‘‘battered child syndrome’’: serious physical abuse
repeated and devastating injury to the skin, skeletal system or
nervous system causing multiple fractures of different ages, head
trauma and severe visceral trauma, with evidence of repeated
infliction.

2. “The shaken infant”: (mainly < 1yr of age)

Intracranial haemorrhages, retinal haemorrhages and chip fractures
of the child’s extremities result from very rapid shaking of an infant
Neglect: M.C form of abuse
 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.
 When to suspect :
• Begs for or hoards food
• States frequent/continual absence of parent or guardian
• Frequently dirty or not bathed
• Has unattended physical problems
• Shows extreme dependence or detachment
• Frequently hungry or inappropriately dressed
• Engages in delinquent behavior, such as like stealing
CHILD SEXUAL ABUSE:
Child sexual abuse is the exploitation of a child or
adolescent for the sexual gratification of another
person.

IT INCLUDS:

Oral-genital stimulation
Sodomy Verbal stimulation
Exhibitionism Voyeurism
Fondlin Child
prostitution
Child pornography Intercourse
WHEN TO SUPECT:
 Difficulty walking or sitting

 Demonstrates unusual sexual knowledge/behavior above developmental level

 Shows extreme compliance or defiance

 Sudden reluctance to change near others (for activities such as gym)

 Reported nightmares or bedwetting

 Sudden change in appetite

 Suddenly avoids a certain adult(s)

 Experiences pain when urinating

 Signs of eating disorders

 Indicators of Child Abuse (Discovered by Family
Type of Abuse Physical Indicators
Doctor) Behavioral Indicators
Physical Unexplained bruises, welts, burns, Wary of adult contact, frightened of
fractures, or bald patches on scalp parents or afraid to go home,
withdrawn or aggressive, moves
uncomfortably, wears inappropriate
clothing for weather

Sexual Difficulty walking or sitting; torn or Advanced sexual knowledge,

stained/blood underclothes; pain, promiscuity, sudden school
itching, bruises, swelling in genital difficulties, self-imposed social
area; frequent urinary or yeast isolation, avoidance of physical
infections contact or closeness, depression

Emotional Speech or communicative disorder, Habit disorders, antisocial or

delayed physical development, destructive behaviors, neurotic traits,
exacerbation of existing conditions, behavior extremes, developmental
substance abuse delays

Neglect Consistent hunger, poor hygiene, Self-destructive behaviors, begging or

inappropriate dress, unattended stealing food, constant fatigue,
medical problems, underweight, assuming adult responsibilities or
failure to thrive concerns, frequently absent or tardy,
states no caretaker in home
Do’s and Don’ts of Responding to child

Do DON’T
• Panic or show that you are shocked.
Immediately tell the child you believe REMAIN CALM!
them. • Never give the impression that you might
Tell them they were right to tell you, and blame the child. Don’t ask: “Why did you
were brave to do so. let him?”, “what were you doing there
• Acknowledge that it is difficult talk about anyways?” or “why didn’t you tell me
this before?”.
• Tell the child that they are not responsible • Don’t promise that you won’t tell anyone if
and did not deserve it the child asks you to keep it a secret
• Ensure that the child feels safe following • Don’t ask intrusive questions. Listen but
disclosure don’t push for more answers.
General Principles for Assessing Possible Abuse (nelson)

 Consultation with a physician expert in child maltreatment is recommended.

 A thorough history should be obtained from the parent(s) optimally via separate
interviews.
  children should be interviewed separately, in a developmentally appropriate
manner.
  A thorough physical examination is necessary.
 Careful documentation of the history and physical is essential.

   •    For abuse: What is the evidence for concluding abuse? Have other
diagnoses been ruled out? What is the likely mechanism of the injury? When did
the injury likely occur?
   •    For neglect: Do the circumstances indicate that the child's needs have not
been adequately met? Is there evidence of actual harm? Is there evidence of
potential harm and on what basis? What is the nature of the neglect? Is there a
pattern of neglect
   •    What is contributing to the maltreatment? Consider the factors listed under
the section on etiology.
General Principles for Addressing
Child Maltreatment
 Treat any medical problems.
   •    Help ensure the child's safety, often in conjunction with CPS; this is a
priority.
 Avoid blaming. It is natural to feel anger or pain towards parents of
maltreated children, but they need support and deserve respect
 Know your national and state laws and/or local CPS policies on reporting
child maltreatment
 address contributory factors, prioritizing those most important and
amenable to being remedied
 Establish specific objectives, with measurable outcomes. Similarly, advice
should be specific and limited to a few reasonable steps. A written contract
can be very helpful.
   •    Engage the family in developing the plan, solicit their input and
agreement.
   •    Build on strengths; there are always some. These provide a valuable
way to engage parents.
  
Gen principle cont.....
 •    Encourage informal supports (e.g., family, friends;
invite fathers to office visits). This is where most people
get their support, not from professionals. Consider
support available through a family's religious affiliation.
   •    Consider children's specific needs. Too often,
maltreated children do not receive direct services.
   •    Be knowledgeable about community resources,
and facilitate appropriate referrals.
   •    Provide support, follow-up, review of progress,
and adjust the plan if needed.
   •    Recognize that maltreatment often requires long-
term intervention with ongoing support and monitoring.
National legislations for protection of child rights in
the country are:
Guardian and Wards Act, 1890
 Factories Act ,1954
 Hindu Adoption and Maintenance Act, 1956
 Probation of Offenders Act, 1958
 Bombay Prevention of Begging Act, 1959
 Orphanages and Other Charitable Homes (Supervision and Control) Act, 1960
 Bonded Labour System (Abolition) Act, 1976
 Immoral Traffic Prevention Act, 1986
 Child Labour (Prohibition and Regulation) Act,1986
 Prevention of Illicit Traffic in Narcotic Drugs and Psychotropic Substances Act,
1987
 Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act,
1994
 Persons with Disabilities (Equal Protection of Rights and Full Participation) Act,
2000
 Juvenile Justice (Care and Protection of Children) Act, 2000
 Commission for Protection of the Rights of the Child Act, 2005
I.P.C related to child abuse:
 Infanticide (Section 315)
 Abetment of Suicide: Abetment to commit suicide of minor (Section 305)
 Exposure and Abandonment: Crime against children by parents or others to expose or
to leave them with the intention of abandonment (Section 317)
 Kidnapping and Abduction: Kidnapping for extortion (Section 360)
Kidnapping from lawful guardianship (Section 361)
Kidnapping for ransom (Section 363 read with
Section 384),
Kidnapping for camel racing etc. (Section 363)
Kidnapping for begging (Section 363-A)
Kidnapping to compel for marriage (Section 366)
Kidnapping for slavery etc. (Section 367)
Kidnapping for stealing from its person: under 10 years of
age only
(Section 369)
 Procurement of minor girls by inducement or by force to seduce or
have illicit intercourse (Section 366-A) .
Selling of girls for prostitution (Section 372) h) Buying of girls for
prostitution (Section 373)
 Rape (Section 376)
 Unnatural Sex (Section 377).
SCHEMES AND PROGRAMMES ON CHILD PROTECTION
 A Programme for Juvenile Justice for children in need of care and
protection and children in conflict with law. The Government of India
provides financial assistance to the State Governments/UT Administrations
for establishment and maintenance of various homes, salary of staff, food,
clothing, etc. for children in need of care and protection and juveniles in
conflict with law. Financial assistance is based on proposals submitted by
States on a 50-50 cost sharing basis.
 An Integrated Programme for Street Children without homes and family
ties. Under the scheme NGOs are supported to run 24 hours drop-in
shelters and provide food, clothing, shelter, non-formal education,
recreation, counselling, guidance and referral services for children. The
other components of the scheme include enrolment in schools, vocational
training, occupational placement, mobilizing preventive health services
and reducing the incidence of drug and substance abuse, HIV/AIDS etc.
 CHILDLINE Service for children in distress, especially children in need of
care and protection so as to provide them medical services, shelter, rescue
from abuse, counseling, repatriation and rehabilitation. Under this
initiative, a telephone helpline, number 1098, runs in 74 urban and semi-
urban centres in the country.
 Shishu Greha Scheme for care and protection of
orphans/abandoned/destitute infants or children up to 6 years and
promote in-country adoption for rehabilitating them.
  Scheme for Working Children in Need of Care and Protection for children working as domestic workers, at roadside dhabas, mechanic shops, etc. The scheme provides for bridge education and vocational training, medicine, food, recreation and sports
equipments.

 Rajiv Gandhi National Creche Scheme for the Children of Working Mothers in the
age group of 0- 6 years. The scheme provides for comprehensive day-care
services including facilities like food, shelter, medical, recreation, etc. to children
below 6 years of age.

 Pilot Project to Combat the Trafficking of women and Children for Commercial
Sexual Exploitation in Source and Destination Areas for providing care and
protection to trafficked and sexually abused women and children. Components of
the scheme include networking with law enforcement agencies, rescue operation,
temporary shelter for the victims, repatriation to hometown and legal services.

 National Child Labour Project (NCLP) for the rehabilitation of child labour. Under
the scheme, Project Societies at the district level are fully funded for opening up of
Special Schools/Rehabilitation Centres for the rehabilitation of child labourers.
These Special Schools/Rehabilitation Centers provide non-formal education,
vocational training, supplementary nutrition and stipend to children withdrawn
from employment.

 INDO-US Child Labour Project (INDUS): The Ministry of Labour, Government of

India and the US Department of Labour have initiated a project aimed at
eliminating child labour in 10 hazardous sectors across 21 districts in five States
namely, Maharashtra, Madhya Pradesh, Tamil Nadu, Uttar Pradesh and NCT of
Delhi.
Thank you.....