This document provides an overview of child abuse and battered baby syndrome. It defines various types of child abuse according to the WHO, including physical abuse, sexual abuse, emotional abuse, and neglect. It also describes the signs and impacts of each type of abuse. The document then discusses battered child syndrome, also known as Caffey syndrome, which refers to injuries that appear to be intentionally inflicted by caregivers. Overall, the document covers the key definitions, classifications, indicators, and consequences of different forms of child abuse and neglect.

1. A PROJECT ON CHILD ABUSE AND BATTERED
BABY SYNDROME
BY- VINIT OHDAR
( 2ND
YEAR )

2. CONTENT
-ACKNOWLEDGEMENT
-DEFINITION
-HOW ‘WHO’ DEFINE IT
-VIOLENCE AGAINST CHILDREN
-TYPES
-PHYSICAL ABUSE
-SEXUAL ABUSE
-EMOTIONAL ABUSE
- NEGLECT
-BATTERED CHILD SYNDROME
-CONCLUSION
-REFRENCES

3. ACKNOWLEDGEMENT
I would like to express my special thanks of gratitude to my teachers of forensic medicine
department ,who gave me the golden opportunity to do this wonderful project on the topic –
CHILD ABUSE AND BATTERED BABY SYNDROME , which also helped me in doing a lot
of Research and i came to know about so many new things I am really thankful to them.
Secondly i would also like to thank my parents and friends who helped me a lot in finalizing this
project within the limited time frame.

4. CHILD ABUSE-
Child abuse or child maltreatment is physical, sexual,
and/or psychological maltreatment or neglect of a child or
children, especially by a parent or a caregiver.
Child abuse may include any act or failure to act by a parent or a
caregiver that results in actual or potential harm to a child and can
occur in a child's home, or in the organizations, schools, or
communities the child interacts with.

5. HOW ‘WHO’ DEFINE IT
The World Health Organization (WHO) defines child
abuse and child maltreatment as "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."
The WHO also says, "Violence against children includes
all forms of violence against people under 18 years old,
whether perpetrated by parents or other caregivers, peers,
romantic partners, or strangers."

6. VIOLENCE AGAINST CHILDREN:
Globally, it is estimated that one
out of two children aged 2–17 years
experience some form of violence each
year. One third of students aged 11–15
years worldwide have been bullied
by their peers in the past months, and
120 million girls are estimated to have
suffered some form of forced sexual
contact before the age of 20 years.
Emotional violence affects one in three
children, and worldwide one in four
children live with a mother who is
the victim of intimate partner violence.
Violence can result in death, injuries and
disabilities. Over the course of their lifetime,
children exposed to violence are
at increased risk of mental illness and anxiety
disorders; high-risk behaviours like alcohol and
drug abuse, smoking
and unsafe sex; chronic diseases such as cancers,
diabetes and heart disease; infectious diseases like
HIV; and social problems including educational
underattainment, further involvement in violence,
and crime.

7. TYPES (According to ‘WHO’ 2006)
Four types of child abuse:
1. physical abuse;
2. sexual abuse;
3.emotional (or psychological) abuse
4.neglect.

8. PHYSICAL ABUSE
Intentional use of physical force against the child that results in –
or has a high likelihood of resulting in – harm for the child's
health, survival, development, or dignity. This includes hitting,
beating, kicking, shaking, biting, strangling, scalding, burning,
poisoning, and suffocating. Much physical violence against
children in the home is inflicted with the object of punishing.
IMPACT-Physical abuse as a child can lead to physical and mental
difficulties in the future, including re-victimization, personality disorders,
post-traumatic stress disorder, dissociative disorders, depression, anxiety,
suicidal ideation, eating disorders, substance use disorders, and
aggression. Physical abuse in childhood has also been linked to
homelessness in adulthood.

9. Signs of physical abuse
Bumps and bruises don't always mean a child is being
physically abused. All children have accidents, trips and
falls. And there isn't just one sign or symptom to look out
for. But it's important to be aware of the signs.
If a child regularly has injuries, there seems to be a pattern
to the injuries or the explanation doesn't match the injuries,
then this should be reported.

13. CHILD LABOUR
The term “child labour” is often defined as work that deprives
children of their childhood, their potential and their dignity, and
that is harmful to physical and mental development. It refers
to work that:
 is mentally, physically, socially or morally dangerous and
harmful to children; and/or
 interferes with their schooling by: depriving them of the
opportunity to attend school; obliging them to leave school
prematurely; or requiring them to attempt to combine
school attendance with excessively long and heavy work.

14. worst forms of child labour as defined by Article
3 of ILO (international labour organisation) :
 all forms of slavery or practices similar to slavery, such as the sale
and trafficking of children, debt bondage and serfdom and forced or
compulsory labour, including forced or compulsory recruitment of
children for use in armed conflict;
 the use, procuring or offering of a child for prostitution, for the
production of pornography or for pornographic performances;
 the use, procuring or offering of a child for illicit activities, in
particular for the production and trafficking of drugs as defined in
the relevant international treaties;
 work which, by its nature or the circumstances in which it is carried
out, is likely to harm the health, safety or morals of children.

17. Child Labour (Prohibition & Regulation) Amendment
Act, 2016
Government has enacted the Child Labour (Prohibition & Regulation)
Amendment Act, 2016 which came into force on 1.9.2016. The
Amendment Act completely prohibits the employment of children below
14 years. The amendment also prohibits the employment of adolescents
in the age group of 14 to 18 years in hazardous occupations and processes
and regulates their working conditions where they are not prohibited. The
amendment also provides stricter punishment for employers for violation
of the Act and making the offence of employing any child or adolescent
in contravention of the Act by an employer as cognizable.
In order to achieve effective enforcement of the provisions of the Act, the
amendment empowers the appropriate Government to confer such powers
and impose such duties on a District Magistrate as may be necessary.
Further, the State Action Plan has been circulated to all the States/UTs for
ensuring effective implementation of the Act.

18. PREVENTION
A child who is being physically abused might not realise what’s
happening is wrong. And they might even blame themselves. If a
child talks to you about physical abuse it’s important to:
 listen carefully to what they're saying
 let them know they've done the right thing by telling you
 tell them it's not their fault
 say you'll take them seriously
 don't confront the alleged abuser
 explain what you'll do next
 report what the child has told you as soon as possible.

19. SEXUAL ABUSE
Sexual abuse refers to the participation of a child in a sexual act
aimed toward the physical gratification or the financial profit of
the person committing the act.
Child sexual abuse (CSA) is a form of child abuse in which an
adult or older adolescent abuses a child for sexual stimulation.
Forms of CSA include asking or pressuring a child to engage in
sexual activities (regardless of the outcome), indecent
exposure of the genitals to a child, displaying pornography to a
child, actual sexual contact with a child, physical contact with the
child's genitals, viewing of the child's genitalia without physical
contact, or using a child to produce child pornography. Selling the
sexual services of children may be viewed and treated as child
abuse rather than simple incarceration.

20. Warning signs of sexual abuse in children
The child may:
 Have trouble walking or sitting.
 Display knowledge of sexual acts inappropriate for their
age, or even exhibit seductive behavior.
 Make strong efforts to avoid a specific person, without an
obvious reason.
 Not want to change clothes in front of others or participate
in physical activities.
 Have an STD or pregnancy, especially if they’re under the
age of 14.
 Try to run away from home.

21. SEXUAL ABUSE
Effects of child sexual abuse on the victim(s) include guilt and self
blame, flashbacks, nightmares, insomnia, fear of things associated with
the abuse (including objects, smells, places, doctor's visits, etc.), self-
esteem difficulties, sexual dysfunction, chronic pain, addiction, self-
injury, suicidal ideation, depression, post-traumatic stress
disorder, anxiety, other mental illnesses including borderline personality
disorder and dissociative identity disorder, propensity to re-
victimization in adulthood, bulimia nervosa, and physical injury to the
child, among other problems. Children who are the victims are also at an
increased risk of sexually transmitted infections due to their immature
immune systems and a high potential for mucosal tears during forced
sexual contact. Sexual victimization at a young age has been correlated
with several risk factors for contracting HIV including decreased
knowledge of sexual topics, increased prevalence of HIV, engagement in
risky sexual practices, condom avoidance, lower knowledge of safe sex
practices, frequent changing of sexual partners, and more years of sexual
activity.

22. Child Sexual Abuse: Management and Prevention, and Protection of
Children from Sexual Offences (POCSO) Act-
Examination
The elements of physical examination include particular attention to the
following
• calming the child during examination
• positioning for optimal exposure of prepubertal genital structures: frog-
leg supine position, knee-chest or left lateral decubitus position
• general observation and inspection of the anogenital area, looking for
signs of injury or infection and noting the child’s emotional status.
• examination of mons pubis, labia majora and minora, clitoris, urethral
meatus, hymen, posterior fourchette, and fossa navicularis.

23. • visualization of the more recessed genital structures, using handheld
magnification or colposcopy as necessary.
• collection of specimens for sexually transmitted disease (STD)
screening and forensic evidence collection.
It is important realize that physical examination in CSA is very likely to
be within normal limits in most cases. The absence of abnormal findings
can be explained by several factors. Many forms of sexual abuse do not
cause physical injury. Thus, sexual abuse may be non-penetrating
contact and may involve fondling, oral-genital, genital or anal contact, as
well as genital-genital contact without penetration. Mucosal tissue is
elastic and may be stretched without injury, and superficial abrasions
and fissures can heal within a few days.
CHILDLINE 1098
.Management
Emergency medical care must be provided in a case of CSA. Police or magisterial
requisition is not required for that purpose. The management of CSA includes the
following:
• Treatment of sexually transmitted diseases (STDs) is carried out with appropriate
medications.
• In post-menarchal girls, the likelihood of pregnancy and the need for emergency
contraception is considered.
• Emotional support is provided.
• CSA, whether confirmed or strongly suspected, must be reported to the appropriate
authorities.

24. • Detailed, well-documented medical records must be kept, since these are crucial in
legal proceedings, which may take place after a lapse of long periods.
• Referral to a mental health specialist should be made in all cases, which is required
for evaluation and treatment of acute stress reaction, and subsequently posttraumatic
stress disorder (PTSD). Referral to other specialists should be made as required.

31. EMOTIONAL ABUSE
Emotional abuse, which is sometimes called psychological abuse, is a
pattern of behavior that damages a child's sense of self worth and
negatively impacts their emotional development. In addition to
withholding love and support, the person emotionally abusing the child
also may reject, criticize, threaten, demean, and berate the child. They also
may humiliate the child, engage in name-calling, and insult them.
Emotional abuse can occur in conjunction with physical abuse, sexual
abuse, or neglect and is one the hardest forms of abuse to recognize.
Like other forms of abuse, emotional child abuse is about power and
control. The perpetrator manipulates and controls the child by using words
and actions that are emotionally hurtful and damaging.

32. Identifying Emotional Abuse
Although an emotionally abused child might not end up in the
hospital with a broken bone or a concussion, the effects of
emotional abuse can be damaging and long-lasting.
A child who is being emotionally abused may demonstrate
behaviors that can be signs of abuse, including:
 Anxiety
 Attempts to avoid certain situations (such as going to an
activity or another person’s house)
 Declining performance at school
 Delayed emotional development
 Depression
 Desire to hurt themselves or other people on purpose
 Desperately seeks affection from other adults
 Developmental regression (for example bedwetting or
soiling after previously mastering bladder and bowel
control)
 Frequent complaints of headaches, stomachaches, or other
somatic symptoms with no known cause
 Loss of interest in social activities or other interests
 Low self-esteem

33. Impact of Emotional Abuse
A child often believes that they are responsible for the abuse and that it
means they are unloved, unlovable, and unwanted.
 Attachment issues: Emotional abuse can interfere with a child’s
ability to form and maintain healthy attachments. Attachment
issues in early childhood have been linked to insecure attachments
in adulthood. Children also might be at an increased risk for poor
peer relations, trouble with intimacy, difficulty with conflict
resolution, and relational aggression
 .
 Behavioral and social problems: Emotional abuse in childhood also
has been linked to delinquency and sexually aggressive behavior in
young adults.

 Repeating the cycle of abuse: Without appropriate intervention,
people who were abused as children are more likely to abuse their
kids than people who did not experience abuse.

 Suicide and mental illness: Teens who experienced emotional
abuse as children are more likely to be diagnosed with at least one
mental illness, such as depression or anxiety, which can persist into
adulthood.6 People with a history of emotional abuse are also at an
increased risk of attempting suicide.
Emotional abuse doesn't just have a negative effect on individuals and
families; it also strains society as a whole.

34. Treatment for Emotional Abuse
If a child is being emotionally abused, the first course of action is to ensure the
child’s safety. Then, appropriate treatment can begin. The perpetrator might
require treatment—especially if it’s a parent. Examples of treatment can include
individual therapy, parenting classes, and social services.
Those who have experienced emotional abuse can benefit from therapy with a
licensed mental health professional. Once they have processed what they went
through emotionally, they can learn healthy coping mechanisms, social skills, and
conflict resolution.

35. CHILD NEGLECT-
Neglect—a very common type of child abuse—is a pattern of failing to provide for
a child’s basic needs, which include adequate food, clothing, hygiene, or
supervision.
Child neglect is not always easy to spot. Sometimes, a parent might become
physically or mentally unable to care for a child, such as in cases of serious illness
or injury, or untreated depression or anxiety. Other times, alcohol or drug abuse may
seriously impair judgment and the ability to keep a child safe.

36. Warning signs of child neglect
The child may:
 Wear ill-fitting, filthy, or inappropriate clothing for the weather.
 Have consistently bad hygiene (unbathed, matted and unwashed
hair, noticeable body odor).
 Have untreated illnesses and physical injuries.
 Be frequently unsupervised or left alone or allowed to play in
unsafe situations.
 Be frequently late or missing from school.


37. Indian legislation for child protection
1. Furthering the vision of the UNCRC, the Juvenile Justice (Care and
Protection of Children) Act, 2015 is India’s fundamental law in dealing
with children in need of care and protection. It caters to their needs
through care, protection, development, treatment, social reintegration,
through its child-friendly approach by addressing matters in the best
interest of children.
2. The Protection of Children from Sexual Offences Act (POCSO), 2012 is
one of the Indian government’s most progressive laws, to combat sexual
violence against children. POCSO qualifies penetrative sexual assault on
a child below the age of 12 as aggravated penetrative sexual assault, a
crime punishable with a fine and a minimum term of rigorous
imprisonment for 10 years, which can be extended to life imprisonment.
3. The Criminal Law (Amendment) Act, 2013’s introduction of several
new sexual offences under the Indian Penal Act, such as Section 376(2)(i),
IPC, which punishes rape of a female under 16 years is considered an
aggravated form of rape punishable with a fine and a minimum term of
rigorous imprisonment for 10 years, which can be extended to life
imprisonment.
Battered child syndrome(=CAFFEY SYNDROME):

38. BATTERED CHILD SYNDROME is a term used by us to characterized
a clinical condition in young children who have received serious
physical abuse, generally from a parent or foster parent. The condition
has also been described as “unrecognized trauma” by radiologist,
orthopedics’ pediatricians, and social service workers.it is significant
cause of child disability and death. Unfortunately it is not recognized or
if diagnosed is inadequately handled by physician because of hesitation
to bring the case to attention of proper authority.
CAUSES
1.Stress , including the
- Stress of caring for children
-stress of caring a children with special needs
-special needs
-difficult behavior
2.Lack of nurturing qualities needed for child care
3.Immaturity
4.difficult controling anger.
5.history of being abused
6.alcohol or drug abuse
7.mental health problem
8.personal problems etc…

39. INJURIES ASSOCIATED
1. Unexplained bruises
2. Welts, human bite marks, bald spots
3. Unexplained burns especially cigarette burns
4. Unexplained fractures, lacerations, abrasions
5. Swollen areas
6. Evidence for delayed or inappropriate treatment for injuries
7. Soft tissue injury
8. CNS injury
9. Eye injuries
10. Visceral injury
11. Skeletal Injuries.
DIAGNOSIS-
1. Nature of injury
2. Delay in seeking medical treatment(reason)
3. Recurrent injuries
4. Radiological manifestations.

40. BRUISES
bruises
ABDOMINAL TRAUMA

41. BROKEN TEETH
MOUTH TRAUMA
SCALD(HOT LIQUID) BURNS
EYE TRAUMA

42. Ten Things You Can Do to Prevent Child Abuse
 Volunteer your time. Get involved with other parents in your community.
...
 Discipline your children thoughtfully. ...
 Examine your behavior. ...
 Educate yourself and others. ...
 Teach children their rights. ...
 Support prevention programs. ...
 Know what child abuse is. ...
 Know the signs.
 Report abuse
 Invest in kids.

44.  Conclusion
Preventing child abuse is not simply a matter of parents doing a better
job, but rather it is about creating a context in which “doing better” is
easier. Enlightened public policy and the replication of high-quality
publicly supported interventions are only part of what is needed to
successfully combat child abuse. It remains important to remind the
public that child abuse and neglect are serious threats to a child’s
healthy development and that overt violence toward children and a
persistent lack of attention to their care and supervision are
unacceptable. Individuals have the ability to accept personal
responsibility for reducing acts of child abuse and neglect by providing
support to each other and offering protection to all children within their
family and their community
NGOs are tirelessly working for the protection of children pushed into
child labour, children facing abuse in the community, children trafficked,
children affected by a calamity or emergency situations. It rescues them
from children facing various kinds of harms – abuse, neglect,
exploitation, physical danger and violence. Executing programmes in
India’s remotest parts, the NGO is driven by the premise of ensuring
happy and safe childhoods for all children. Towards this goal, he partners
with civil society organisations, child-led initiatives, governments and
other key stakeholders.

45. REFRENCES
-Modern Medical Toxicology by V.V Pillay
-The essentials of Forensic Medicine and Toxicology
-https://www.aap.org/en-us/advocacy-and-policy/aap-
health-initiatives/Pages/Child-Abuse-Prevention.aspx
-https://www.dcyf.wa.gov/safety/prevent-child-abuse
-http://www.healthofchildren.com/B/Battered-Child-
Syndrome.html
-https://www.ilo.org/ipec/facts/lang--en/index.htm
-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614596/
-https://www.naaree.com/domestic-violence-helplines-india/
-https://www.indianpediatrics.net/nov2017/nov-949-953.htm
-https://labour.gov.in/childlabour/child-labour-acts-and-
rules
-
https://scholar.google.co.in/scholar?q=physical+child+abuse
&hl=en&as_sdt=0&as_vis=1&oi=scholar