Child Neglect, Emotional and Sexual Abuse By Shatish Raj Shatish Raj

CHILD NEGLECT Needs adequate food, shelter, affection and stimulation Without these developmental needs -> NEGLECT Development affected by neglect Common among mothers who themselves are unloved and and depressed Shatish Raj

Needs adequate food, shelter, affection and stimulation

Without these developmental needs -> NEGLECT

Development affected by neglect

Common among mothers who themselves are unloved and and depressed

Presents as Failure To Thrive (Non organic FTT) Inadequate hygiene including severe nappy rash pr infestation Poor development of emotional attachment to the childs caregiver Delay in developmental and speech and language Poor attendance for immunizations and school Shatish Raj

Presents as

Failure To Thrive (Non organic FTT)

Inadequate hygiene including severe nappy rash pr infestation

Poor development of emotional attachment to the childs caregiver

Delay in developmental and speech and language

Poor attendance for immunizations and school

EMOTIONAL ABUSE Includes Withdrawal of love by rejecting the child Malicious critism threats and ridicule Scapegoating Shatish Raj

Includes

Withdrawal of love by rejecting the child

Malicious critism threats and ridicule

Scapegoating

Presents with emotional and behavioral disturbance May have excessive compliance or aggressive defiance, poor self esteem, poor ability to enjoy things or sustain self occupation, or may exhibit pseudomature behavior Associated with physical and sexual abuse Includes bullying Shatish Raj

Presents with emotional and behavioral disturbance

May have excessive compliance or aggressive defiance, poor self esteem, poor ability to enjoy things or sustain self occupation, or may exhibit pseudomature behavior

Associated with physical and sexual abuse

Includes bullying

SEXUAL ABUSE ‘ Involvement of dependent, developmentally immature children and adolescents in sexual activities they do not fully comprehend, are unable to give informed consent to and that violates social taboos of family roles’ Shatish Raj

‘ Involvement of dependent, developmentally immature children and adolescents in sexual activities they do not fully comprehend, are unable to give informed consent to and that violates social taboos of family roles’

Includes Genital exposure Fondling Genital, anal or oral sexual activity or intercourse including rape Involvement in pornography Encouraging a child to look at pornography or sexual acts is also sexual abuse. Shatish Raj

Includes

Genital exposure

Fondling

Genital, anal or oral sexual activity or intercourse including rape

Involvement in pornography

Encouraging a child to look at pornography or sexual acts is also sexual abuse.

Victims are of any age and any sex (girls>boys) Family risk factors for child sex abuse Poor parental sexual relationship Maternal depression and physical illness Mother sexually abused as a child Father/abuser either inadequate or aggressive Family chaotic, disorganized or socially isolated Parentified daughter who has taken over mothers role Shatish Raj

Victims are of any age and any sex (girls>boys)

Family risk factors for child sex abuse

Poor parental sexual relationship

Maternal depression and physical illness

Mother sexually abused as a child

Father/abuser either inadequate or aggressive

Family chaotic, disorganized or socially isolated

Parentified daughter who has taken over mothers role

Most abusers are male, but females are increasingly being recognized Abuser/Pedophiles may be Someone in the family Trusted adult (ex baby sitter) Someone outside the family (less common) Part of a organized group Shatish Raj

Most abusers are male, but females are increasingly being recognized

Abuser/Pedophiles may be

Someone in the family

Trusted adult (ex baby sitter)

Someone outside the family (less common)

Part of a organized group

Presents as Incidental allegation either spontaneous to a trusted adult or after a crisis (run away, overdose) Genital trauma, infections STD High sexualized behavior towards adults or children Unexplained pregnancy Inexplicable change in behavior or school work Shatish Raj

Presents as

Incidental allegation either spontaneous to a trusted adult or after a crisis (run away, overdose)

Genital trauma, infections

STD

High sexualized behavior towards adults or children

Unexplained pregnancy

Inexplicable change in behavior or school work

Examination of a suspected sexual abused child.. Done by skilled pediatrician Less than 30% have significant clinical abnormalities. Done under consent of parent or court and adolescent. And accompanied by trusted adult Privacy, non threatening environment. Always remember to do assessment of growth and development, photograph findings by colposcope and take forensic swabs if < 72hrs Shatish Raj

Done by skilled pediatrician

Less than 30% have significant clinical abnormalities.

Done under consent of parent or court and adolescent. And accompanied by trusted adult

Privacy, non threatening environment.

Always remember to do assessment of growth and development, photograph findings by colposcope and take forensic swabs if < 72hrs

Genitalia only detailed inspection and not internal examination Clinical Features pain, itching, bruising or bleeding in the genital or anal areas Bruising around thighs, genitalia, anus, perineum, buttocks and lower abdomen Tears and abrasions of female genitalia (esp hymen) Tears and abrasions to male genitalia Anal fissures (rule out constipation) Reflex anal dilatation:- buttocks parted for 30-45s and positive if anus opens and rectum can be seen due to incompetance of anal sphincter (rule out constipation) Shatish Raj

Genitalia only detailed inspection and not internal examination

Clinical Features

pain, itching, bruising or bleeding in the genital or anal areas

Bruising around thighs, genitalia, anus, perineum, buttocks and lower abdomen

Tears and abrasions of female genitalia (esp hymen)

Tears and abrasions to male genitalia

Anal fissures (rule out constipation)

Reflex anal dilatation:- buttocks parted for 30-45s and positive if anus opens and rectum can be seen due to incompetance of anal sphincter (rule out constipation)

If sex abuse is suspected, local safeguarding children committee should be followed:- Shatish Raj

Interview of child jointly with physician, social worker, and experienced police officer Post Traumatic stress disorder Thank You Shatish Raj

Interview of child jointly with physician, social worker, and experienced police officer

Post Traumatic stress disorder

Thank You

Reference… Miall L, Rudolph M, Levene M (2003) Pediatrics At A Glance , United Kingdom, Blackwell Science Ltd Lissauer T, Clayden G (2001) Illustrated Textbook of Pediatrics 3 RD edition , United Kingdom, Mosby El Sevier www.nspcc.org.uk Shatish Raj

Miall L, Rudolph M, Levene M (2003) Pediatrics At A Glance , United Kingdom, Blackwell Science Ltd

Lissauer T, Clayden G (2001) Illustrated Textbook of Pediatrics 3 RD edition , United Kingdom, Mosby El Sevier

www.nspcc.org.uk