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
Smoking, substance abuse, and trafficking.
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
“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
“Any behavior directed toward a child that endangers or impairs a child’s physical or emotional health and development”
Types of Child Abuse
Physical abuse is any non-accidental injury to 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.
Physical Abuse (cont.)
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 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 Definition
Psychological Neglect - the consistent failure of a parent or caretaker to provide a child with appropriate support, attention, and affection.
Psychological Abuse - a chronic pattern of behaviors such as belittling, humiliating, and ridiculing a child.
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 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 Definition
Child sexual abuse is the exploitation of a child or
adolescent for the sexual gratification of another
-Girls more frequently abused at older age vs. boys
The Extent of the Problem
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.
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
Survey in Egypt showed: lying, disrespect, disobedience, low performance in school and destroying property are the main reasons for punishment (Youseff and Kamel, 1998(
Health Consequences of Child Abuse
Health Consequences of Child Abuse (cont.)
Role of Family Physician in Child Abuse
Patient/family and team safety are paramount.
Protect the life of the patient as well as as much evidence as possible.
Does the history fit what you are seeing- either injury or illness?
Is this a repeat patient or family member of a repeat patient?