Dr. Pothana

2. SCRIPTURE
• Jeremiah 1:4-8
• I Samuel 1:27-28
• Amos 5:24
• Micah 6:6-8
• Matthew 18:5
• Ecclesiastes 4:9-12
• Luke 2:22ff

3. Jeremiah 1:4-8
4 The word of the LORD came to me, saying, 5 "Before I formed you in the womb I
knew [a] you, before you were born I set you apart; I appointed you as a prophet to the
nations." 6 "Ah, Sovereign LORD," I said, "I do not know how to speak; I am only a
child." 7 But the LORD said to me, "Do not say, 'I am only a child.' You must go to
everyone I send you to and say whatever I command you. 8 Do not be afraid of them,
for I am with you and will rescue you," declares the LORD.

4. 1 Samuel 1:27-28
27 I prayed for this child, and the LORD
has granted me what I asked of him.
28 So now I give him to the LORD. For
his whole life he will be given over to
the LORD." And he worshiped the
LORD there.

5. Amos 5:2424 But let justice roll on like a river,
righteousness like a never-failing stream!
6 With what shall I come before the LORD and bow down before the
exalted God? Shall I come before him with burnt offerings, with calves a
year old?
7 Will the LORD be pleased with thousands of rams, with ten thousand
rivers of oil? Shall I offer my firstborn for my transgression, the fruit of my
body for the sin of my soul?
8 He has showed you, O man, what is good. And what does the LORD
require of you? To act justly and to love mercy and to walk humbly with
your God.
Micah 6:6-8

6. Matthew 18:5
5 And whoever welcomes a little child
like this in my name welcomes me.

7. Ecclesiastes 4:9-12
9 Two are better than one, because they have a good
return for their work: 10 If one falls down, his friend can
help him up. But pity the man who falls and has no one to
help him up! 11 Also, if two lie down together, they will
keep warm. But how can one keep warm alone? 12
Though one may be overpowered, two can defend
themselves. A cord of three strands is not quickly broken.

8. Luke 2:22
22 When the time of their purification
according to the Law of Moses had
been completed, Joseph and Mary
took him to Jerusalem to present him
to the Lord

9. REALITY CHECK

10. Numbers
(B 15; G 13)
• 1 child every 10 seconds is abused
• 1 out of 6 boys and 1 out of 3 girls will be
sexually assaulted before the age of 18.
• Half of reported sexual misconduct at
worship centers is perpetrated by
volunteers
Can you wrap your mind around
these numbers?

11. CHILD ABUSE IS…
Child abuse is generally categorized into five
major forms:
1. Physical Abuse
2. Emotional Abuse
3. Neglect
4. Sexual Abuse
5. Ritual Abuse

12. Abuse is Costly
• Victims?
• Financial?
• Ministry?

13. SCARY BUT TRUE STORIES

14. The New Reality
1. Many cases of abuse
2. The church is not exempt
3. There are many costs

15. MEET WESLEY
• WHO ARE THE ABUSERS?
• HOW DO YOU RECOGNIZE THEM?
• WHO ARE THE VICTIMS?

16. Local Church
Response

17. Cyber Safety

18. Safe Practices for Emerging
Technology
• Internet security in the workplace.
– Computer Visibility
– Firewall Protection/Filters
– Passwords
• Cyber Safety For Families

19. Safe Practices for Emerging
Technology
• Online Social Networking
– MySpace, Facebook, Xanga, Friendster, Virb,
MyYearbook, etc.
– Policy for appropriate conduct/boundaries
between volunteers and students
-- Training for parents and students

20. Safe Practices for Emerging
Technology
• Cell Phone Policies
– Picture/Video Capabilities
– Picture Messaging

21. Best Practices
Mentoring Students
1. On Campus and/or Off Campus
two-adult rule
appropriate adult/student boundaries
2. Parental Notification
online communication between
adults/students
guidelines

22. • Childhood should be a care-free time filled with love, and the joy of
discovering new things and experiences.
• However, it is a dream for many children.
• Child abuse and neglect is an increasing social problem.
• The effects of child abuse and neglect are not limited to childhood but
cascade throughout life, with significant consequences for victims (on
all aspects of human functioning), their families, and society.

23. • Child abuse : words or overt actions that cause harm, potential harm,
or threat of harm to a child.
• Child neglect can be conceptualized in a broad sense as harmful acts of
omission or the failure to provide for a child's basic physical,
emotional, or educational needs or to protect a child from harm or
potential harm.

24. DEFINITION
• Child abuse, as defined by Gill (1968)
“nonaccidental physical injury, minimal or fatal, inflicted
upon children by persons caring for them.”

25. PREVALENCE
• 2006: US dept of Health and Human Services:
– 65% of child maltreatment encompasses neglect
– 16% involves physical abuse
– 9% involves sexual abuse
– 7% involves emotional abuse
– >2% involves medical neglect
• Average age of identification of maltreatment victims: 7.4
years
• Infants -2 years : Most often victims of child neglect

26. PREVALENCE IN INDIA
• India has largest number of children in the world (375 million),
nearly 40% of its population.
• 69% of Indian children are victims of physical, emotional, or
sexual abuse.
• New Delhi, has an over 83% abuse rate.
• 89% of the crimes are committed by family members.
• Boys face more abuse (>72%) than girls (65%).
• More than 70% of cases go unreported and unshared even
with parents/ family.

27. PREVALENCE
Summary report of ‘Workshop on International Epidemiological
Studies’ : XIXth ISPCAN International Congress on Child Abuse
and Neglect, Sept 2012
• 25-50% of children around the world suffer from physical abuse.
• 5-10% of boys and 20% of girls experience sexual abuse.

28. CONSEQUENCES OF CHILD ABUSE
AND NEGLECT
“Sensitive period” is a broad term that can apply to the effects of
extraordinarily strong experiences on the brain during a limited period in
development.
Critical periods are a special set of sensitive periods that result in irreversible
changes in brain function.

29. CONSEQUENCES OF CHILD ABUSE
AND NEGLECT
• All aspects of development are affected including brain, cognitive, and
social development.
• Characteristics of a child’s exposure to abuse or neglect—including
timing, chronicity, severity, and type of abuse—influence the risk for
problematic outcomes.
PSYCHOLOGICAL NEUROBIOLOGICAL

30. PSYCHIATRIC CONSEQUENCES OF CAN
• Psychiatric problems: Mood and anxiety disorders, Unipolar
depression, bipolar disorder, panic attacks, phobias and post-
traumatic stress disorder. (Agid et al 1999, Famulrao et al 1992, Heim
and Nemeroff 2001, Hill 2003, Kendler et al 2000).
• Increased risk of schizophrenia, reactive attachment disorder, eating
disorders and personality disorders. (Ackard and Neumark-Sztainer
2003, Agid et al 1999, Felitte et al 1998, Saunders et al 1992, Zeanah
et al 2004)
• Link between child abuse and later substance abuse : Briere and
Wow 1991, Burnam et al 1988, Kendler et al 2000)
• Childhood trauma: increases the risk for later suicide attempts.

31. NEUROBIOLOGICAL CONSEQUENCES
OF CAN
• Seymour Levine : manipulation of neonatal rate, such as handling or
mild shock, permanently alters behaviour as well as corticosteroid
responsiveness to later stressors. (Levine 1967)
• Early life stress produces effects on developing brain, leading to adult
phenotype with vulnerability to stress, depression and anxiety.
• Cause: long term disturbance of hypothalamic-pituitary axis. (Heim et
al 2000, Newport et al 2001.)

32. SENSITIVE PERIODS
• Maercker et al. (2004) found that age of traumatization predicted
risk for depression versus PTSD in young women.
• A study by Andersen et al. (2008) was the first to provide evidence
for differential effects of early trauma on regional brain volumes in
26 young adult women aged 18–22 years as a function of timing of
sexual abuse.
• Hippocampal volume was reduced in association with childhood
sexual abuse experienced at ages 3–5 years and ages 11–13 years,
and frontal cortex was attenuated in subjects with childhood sexual
abuse at ages 14–16 years.

33. HISTORICAL BACKGROUND
• First documented and reported case of CA/CN occurred in 1874 with a
child named, Mary Ellen.
• Late 19th century: ‘House of Refuge’ movement (safe place for
abandoned children)
• 1870s: New York society for Prevention of Cruelty to Children
established to work in coherence with “House of Refuge”
• 1946: Medical discovery of child abuse was documented by Caffey on
observing children with multiple bone fractures and children with
trauma unsubstantiated by parents.
• 1962: Term ‘Battered child syndrome’ by Henry Kempe
• 1972: Kempe founded ‘Kempe Centre’
• 1974: Child Abuse Prevention and Treatment Act
• 1978: Mclain: coined CAN: Child abuse and neglect

34. PREDISPOSING FACTORS
PARENTAL CHARACTERISTICS
CHILD CHARACTERISTICS
ENVIRONMENTAL CHARACTERISTICS

35. PARENTAL CHARACTERISTICS
• Violence,
• Poverty,
• Parental history of abuse,
• Socially isolated,
• Low self esteem,
• Less adequate maternal functioning.

36. CHILD CHARACTERISTCS
• Unwanted or unplanned child
• No. of children in the family,
• Child's temperament,
• Position in the family,
• Additional physical needs if ill or disabled,
• Activity level or degree of sensitivity to parental needs.

37. ENVIRONMENTAL CHARACTERISTICS
• Chronic stress,
• Problem of divorce,
• Poverty,
• Unemployment,
• Poor housing,
• Frequent relocation,
• Alcoholism,
• Drug addiction.

38. TYPES OF ABUSE
• Physical abuse
– Shaken Baby Syndrome
– Munchausen syndrome of proxy
• Sexual abuse
• Emotional abuse
• Child Neglect

40. PHYSICAL ABUSE
INCLUDES:
• SHAKING
• HITTING
• BURNING/ SCALDING
• FEMALE GENITAL MUTILATION
• FABRICATED AND INDUCEDILLNESS
• DROWNING
• SUFFOCATING

41. • Most easily recognizable form of maltreatment.
• Battered child syndrome:
– Initially described by Dr C Henry Kempe and colleagues in 1962
– Elaborated further by Kempe and Helfer in 1972
– Clinical picture of physical trauma in which the explanation of
injury was not consistent with the severity and type of injury
observed.
PHYSICAL ABUSE

42. IDENTIFYING PHYSICAL ABUSE IN
CHILDREN
• Often, the abuse stems from an angry response of caretaker to punish
the child for misbehaviour.
• Most commonly recognized by clinical findings, but history is a helpful
tool when child reports with non-descriptive findings.
• Identifying factors elucidated in history and clinical examination.

43. HISTORY
• Correct questions to be asked.
• Eyewitness history:
– Child states that injury is caused by parent.
– Parent accepts that one of the many injuries is caused by him but not all.
– One parent accuses the other about the injury.
• Unexplained injury
– Denial
– Vague explanation
– No explanation
– Inconsistent explanation
– Alleged self-inflicted injury
• Delay in seeking medical care

44. CLINICAL FINDINGS
• BRUISES
• MARKS
• BURNS
• LACERATIONS AND ABRASIONS
• FRACTURES AND DISLOCATIONS
• MUTILATION INJURIES