The document discusses child abuse, defining it as physical, emotional, and sexual maltreatment affecting children's health, survival, and development. It outlines factors contributing to abuse, its various forms, and the long-term consequences for victims, along with nursing diagnoses and prevention strategies. Additionally, it describes the Protection of Children from Sexual Offences Act, 2012, emphasizing the importance of safeguarding children's rights and punishing offenders.

1. CHILD ABUSE
BY PIYUSH PARASHAR
BSC.(HONS) NURSING

2. INTRODUCTION
• Child abuse is as state of physical, emotional and sexual ill- treatment,
neglect or negligent behavior that a child below the age of 18 years is
subjected to in the society causing harm to survival, health and development.
• According to WHO, child abuse is most prevalent in children aged 0-4 years.
• An estimated 40 million children suffering from child neglect and abuse
require social healthcare.
• In 2005, National crime Report Bureau, India reported 14,975 crime cases
against children. These included child marriage and genital mutilation in the
name of traditional practices and economic exploitation.

3. DEFINITION
• The term child abuse has come to mean any intentional act of physical,
emotional or sexual abuse, including acts of negligence, committed by a
person responsible for the care of the child.
• It 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.

4. UNICEF
• According to ‘UNICEF’ violence against children can be “physical and mental
abuse and injury, neglect or negligent treatment, exploitation and sexual
abuse. Violence may take place in homes, schools, orphanages, residential
care facilities, on the streets, in the workplace, in prisons and in places of
detention.” such violence can affect the normal development of the child
impairing their mental, physical and social well being.
• In extreme cases the abuse of a child can result in death.

5. FACTORS AFFECTING CHILD ABUSE
• PARENTAL FACTORS:
Parent has already abused a child.
Pregnancy was not wanted
Young, unsupported mother often with low education.
Parents have unrealistic expectations of the child and lack parenting
knowledge.
Parent is isolated and has few supporters.
Parent has a mental illness or is abusing drugs or alcohol.

6. • ENVIRONMENTAL FACTORS:
Overcrowding in the house.
Poverty or lack of opportunity to improve the family’s resources.
Family violence is present.
A non biological adult living in the house.
Family is experiencing multiple stresses.

7. • CHILD FACTORS:
Baby is sickly, or unwanted.
Child has a physical or developmental disability.
Child is the product of abusive relationship.
Lack of attachment between child and parent.

8. EFFECTS THE FAMILY
• Child abuse has long term as well as immediate effects.
• The abused child may be hyperactive; may exhibit angry, anti- social
behavior; or may be especially withdrawn.
• When the child abuse is suspected or confirmed, the child may be removed
from the home or separated from the family for protection.
• Abusive parents often were abused themselves as children; thus the problem
of child abuse continues in a cyclical fashion from generation to generation.

9. FORMS OF CHILD ABUSE
• Child abuse has many forms:
Physical
Emotional
Sexual
Neglect
any of these that are potentially or actually harmful to a child’s health,
survival, dignity and development are abuse.

10. PHYSICALABUSE
• Physical abuse may occur when the caregivers unfamiliar with normal child
behavior. Inexperienced caregivers may not know what is normal behavior for
the child and become frustrated when the child does not respond in the way
they expect.
• Physical abuse is when a child has been physically harm due to some
interaction or lack of interaction by another person, which could have been
prevented by any person in a position of responsibility, trust or power.

11. SHAKEN BABY SYNDROME
• It occurs when a small child is shaken by the arms or shoulders in a
repetitive, violent manner.
• When the child is shaken, a whiplash type injury occurs to the neck. In
addition, the child may have edema to the brain stem and retinal or brain
haemorrhage. Loss of vision, mental retardation, or even death may occur in
these children.
Clinical manifestations: Lethargy, irritability, vomiting, seizures, but this type of
child abuse does not have easily noted signs and can be missed on
examination of the child.
Internal symptoms are detected by the use of the computed tomography (CT)
and magnetic resonance imaging.

13. MUNCHAUSEN SYNDROME BY PROXY
• In this, one person either fabricates or induces illness in another to get the
attention.
• When a caregiver has this syndrome, he or she frequently brings the child to
a health care facility and reports symptoms of illness when the child is
actually well.
• Child’s illness fabricated or induced by the parent ( usually the mother).
Mother develops a dependent relationship with her child’s doctor/ medical
staff.

14. • This situation is frustrating for health care personnel
because it is difficult to catch the suspect in the act of
endangering the child.
• Close observation of the caregiver’s is necessary .
• If episodes of apnea occur only in the presence of the
care giver , be alert for this syndrome.
• The caregiver who suffers from this syndrome must
receive psychiatric help.

16. EMOTIONALABUSE
• Injury from the emotional abuse can be just as serious and lasting as that
from physical abuse, but it is much more difficult to identify.
• Injury from emotional abuse can be just as serious and lasting as that from
physical abuse, but it is much more difficult to identify..
• Emotional abuse can be seen as failure to provide a supportive environment
and primary attachment figure for a child so that they may develop a full and
healthy range of emotional abilities.

17. • Several types of emotional abuse can occur, including:
VERBAL ABUSE, such as humiliation, scapegoating, unrealistic expectation
with belittling and erratic discipline.
Emotional unavailability when caregivers are absorbed in their own problems.
Insufficient or poor nurturing, or threatening to leave the child or otherwise
end the relationship.
Role reversal in which the child must take on the role parenting the parent
and is blamed for parent’s problem.

18. SEXUALABUSE
• It is engaging a child in any sexual activity that he/she does not understand or
cannot give informed consent for or is not physically, mentally or emotionally
prepared for.
• Abuse can be conducted by an adult or another child who is developmentally
superior to victim.
• This includes using a child for pornography , sexual materials, prostitution
and unlawful sexual practices.

19. • The Federal Child Abuse Prevention Treatment Act defines sexual abuse as “
the employment, use , persuasion, inducement, enticement or coercion of any
child to engage in, or assist any other person to engage in, any sexually
explicit conduct.”

20. NEGLECT
• Neglect or negligent treatment is purposeful omission of some or all
developmental needs of the child by a caregiver with the intention of harming
the child. This includes the failure of the protecting the child from a harmful
situation or environment when feasible.
• Child neglect is failure to provide adequate hygiene, health care, nutrition,
love, nurturing and supervision needed for growth and development.

21. TYPES OF NEGLECT
• Neglect takes many forms and can be classified broadly as physical or
emotional maltreatment.
 PHYSICAL NEGLECT, involves the deprivation of necessities, such as food,
clothing, shelter, supervision, medical care and education.
EMOTIONAL NEGLECT generally refers to the failure to meet the child’s
needs for attention, affection and emotional nurturance.

22. HEALTH CONSEQUENCES OF CHILD ABUSE
• Physical consequences: Bruises/welts, fractures, scalds/ burns, laceration,
ocular injuries, poisoning, asphyxia.
• Sexual consequences: STD, HIV/AIDS, unwanted pregnancy
• Emotional consequences: Hyperactivity, depression, poor school
performance, somatic disorders, poor self esteem, eating disorders, drug/
alcohol abuse.
• Long- term consequences: Depression, eating disorders, developmental
effects, risk taking behavior, self- destructive behavior, violent behavior,
disability, infertility.
• Fatal consequences: HIV/AIDS, infanticide, homicide, suicide.

23. NURSING DIAGNOSIS
• Anxiety related to history of abuse .
• Ineffective coping by the parent related to fear of violence from abusive
partner or feelings of powerlessness.
• Impaired parenting related to situational stressors or poor coping skills.
• Disabled Family Coping related to unrealistic expectations of the child by the
parent.

24. PREVENTION OF CHILD ABUSE
• Prevention of child abuse is categorized into three groups:
 Primary prevention: It attempts to stop occurrence of abuse at the community
level by educating the population about good parenting.
Secondary prevention: this includes targeting of high risk groups e.g.
providing good parenting education to young parents who were abused in
their childhood.
Tertiary prevention: This consists of providing protection to children who have
undergone abuse and therapeutic care to parents who abuse their children.

25. PRIMARY PREVENTION
• Promoting good parenting practices.
• Public awareness activities ( media, campaigns).
• Community education programs
• Prenatal, perinatal and early childhood health care that improves pregnancy
outcomes.
• Availability and accessibility of social services, supports and networks.
• School- based activities towards non- violence

26. SECONDARY PREVENTION
• Family support, e.g. home visiting.
• Community based, family centered support, assistance and network.
• Perinatal and ongoing identification of at risk children and families.
• Substance abuse treatment programs.
• Clearly established referral system of support services.
• Schools based social services for hifh stress.
• Environment information available about community resources and safety
planning.

27. TERTIARY PREVENTION
• Early diagnosis
• Reintegration in a child friendly community/ school.
• Proper interdisciplinary services to ensure: treatment, care and counseling,
management and support of families/ victim.
• Adequate child protection law and child friendly courts.

28. PROTECTION OF CHILDREN FROM SEXUAL
OFFENCES ACT, 2012( POCSO)
• The Protection of Children from Sexual Offenses Act, 2012 was formulated
against sexual abuse and sexual exploitation of children from less than 18
years of age.
• The act regards the well- being of the child of the paramount importance and
ensures a healthy emotional, physical, social and intellectual development of
a child.
 It classified sexual abuse into different categories : penetrative sexual
assault, non- penetrative sexual assault, sexual assault and pornography.
It deems a sexual assault to be “ aggravated” under certain circumstances,
such as when the abused child is mentally ill or when the abuse is committed
by the person in a position of trust or authority vis-a – vis the child, like family
member, police officer , teacher or doctor.

29.  people who traffic children for sexual purposes are
also punishable under the provision of relating to
abetment in the act.
The Act prescribes stringent punishment graded as
per the gravity of offence, with a maximum term of
rigorous imprisonment for life, and fine.
Under the act, it is mandatory to report any sexual
offense against children.