Child Neglect, Emotional And Sexual Abuse
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  • 1. Child Neglect, Emotional and Sexual Abuse By Shatish Raj Shatish Raj
  • 2. 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
  • 3.
    • 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
  • 4. EMOTIONAL ABUSE
    • Includes
      • Withdrawal of love by rejecting the child
      • Malicious critism threats and ridicule
      • Scapegoating
    Shatish Raj
  • 5.
    • 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
  • 6. 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
  • 7.
    • 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
  • 8.
    • 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
  • 9.
    • 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
  • 10.
    • 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
  • 11. 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
  • 12.
    • 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
  • 13. If sex abuse is suspected, local safeguarding children committee should be followed:- Shatish Raj
  • 14.
    • Interview of child jointly with physician, social worker, and experienced police officer
    • Post Traumatic stress disorder
    • Thank You
    Shatish Raj
  • 15. 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