Child abuse and neglect

1. CHILD ABUSE AND
NEGLECT
Student- Dr. Swati M. Phulpagar.
Guide- Dr. Pradeep Pazare Sir.

2. • The maltreatment (abuse and neglect) of
children is a pervasive problem in nations
throughout the world with short and long term
physical and mental health and social
consequences to the child, family, community
and society at large.

3. • “The United Nations Convention on the Rights of the
Child defines child as –“ human being below the age of
18 years unless under the law applicable to the child,
majority is attained earlier.”
• This is ratified by 192 of 194 member countries.
• In US immigration law, a child refers to anyone who is
under the age of 21.”

4. Global education monitoring report
2005
• India- 3rd of world’s illiterate population.
• Literacy scale- 106/127.
• 42.6% population- children.
• 110 million children are out of school.
• Immunization status of 100% out of school
children is unknown.
• Children living in poverty are deprived of their
rights to survival, health, nutrition, education,
participation and protection from harm exploitation
and discrimination.

5. Continued…
• 147million kids lives in kuccha houses.
• 77million don’t have drinking water from a tap/ hand pump.
• 273millions have no access to toilet.
• 85million are not immunized.
• 276million are severely underweight.
• 103million have no access to information via T.V.
• 33million have never been to school.
• 5million children <5years die every year because hunger
leaves their bodies too weak to resist the disease.

6. DEFINITIONS
• Abuse- acts of commission.
• U.S. government- any recent act or failure to act on
the part of the parent or caretaker, which results in
death, serious physical or emotional harm, sexual
abuse or exploitation, or an act or failure to act which
presents an imminent risk of serious harm.
• Neglect- acts of omission.
• Neglect refers to omission in care, resulting in actual
or potential harm.
• Omission include inadequate healthcare, education,
supervision, protection from hazards in environment
and unmet physical needs and emotional support.

7. ETIOLOGY
• Child maltreatment seldom has single cause.
• Multiple and interacting bio-psychosocial risk factors
are causative usually at 4 levels-
1. Individual level- child’s disability or parent’s
depression or substance abuse.
2. Familial level- family conflicts and domestic
violence.
3. Influential community factors- stressors such as
dangerous neighborhoods or lack of recreational
facilities.
4. Broad societal factors- poverty and associated
burdens.

8. Continued…
Child producing stresses Parent producing stresses Socio-cultural factors
1. Mentally retarded,
physically handicapped or
deformed.
2. Hyperactive or
behaviorally different.
3. Temperamental.
4. Too many children, girl
babies, premature infants,
foster child.
1. Low self esteem.
2. Depression.
3. Unhappy childhood
experiences, neglect/
abuse as child,
emotionally deprived.
4. Parental substance abuse.
5. Character disorder/
substance abuse.
6. Disappointment over the
sex of the infant.
7. Ignorance of child rearing,
unrealistic expectations.
8. Violence among adult
family members.
1. Values and norms-
concerning violence and
force against children.
2. Family structure- no. of
family members, joint/
nuclear family,
socioeconomic status.
3. Family and situational
stresses- poverty,
unemployment, alcohol
abuse, isolation, poor
housing.
4. Parent child relationship-
punitive child rearing style,
excess/ unwanted
children, role reversal.

9. PREDICTORS
The child The parents Social factors
1. Unwanted.
2. Was separated from
mother at birth.
3. Newborn is
disappointing.
4. Hyperactive by day but
cries through whole
night disturbing
mother’s sleep and
rest.
5. Difficult because of
illness.
6. Is different from the
rest of the family
especially the children.
1. Young mother age<=
18years.
2. Were abused/
experienced family
disruption in their
childhood.
3. Lack family support
and unreasonably
fearful of caring of their
own child.
4. Have unreasonable of
their baby and treat
him/her as a much
older child.
5. Have poor impulse
control.
6. Rigid/ authoritarian.
7. Psychiatrically ill.
1. Crises relating to
housing/ disconnection
of services.
2. Loss of work, chronic
unemployment.
3. Poverty and crises
relating to the use of
money.
4. Loneliness/ isolation of
mothers when partners
have left/ working
away from home.
5. Marital crises and new
liaisons, step children.
6. Unwanted pregnancy.

10. • Protective factors-
1. Family support.
2. Mother’s concern for her child.

11. Forms of child abuse and neglect
1. Physical abuse- intentional, no accidental use of
physical force on the part of parent or other
caretaker interacting with a child in his care
aimed at hurting, injuring or destroying the
child, these injuries may be caused by striking,
shaking, burning, squeezing and assault with a
weapon.
Physical symptoms including-
• Bruises/welts, different ages, buttocks and
thighs
• Thumbs and finger prints, arms, forceful gasping

12. • Choke marks, burns and scalds, fractures,
sprains and dislocations
• Bruising of upper lip and frenulum, forceful
feeding
• Bruising of mouth in older children who have
been hit
• Eye damage- acute hyphemia, dislocated lens,
detached retina, retinal hemorrhage
• Laceration and abrasion
• Coma and convulsion- subdural hematoma,
common cause of death in battered baby
syndrome, caused by violent shaking

13. • Recurrent vomiting, abdominal distention and
absence of bowel sound/ local tenderness-
abdominal visceral injuries, punch/ crushing
forces, second most cause of death in
battered children
• Poisoning
• Vicarious Munchausen’s syndrome- inducing
symptoms in child in an attempt to bring out
unnecessary medical treatment and even
surgery.

14. 2. Nutritional abuse- due to non-availability of food
to the newborn infant or child due to neglect or
intentional starvation excluding causes due to
poverty or diseases in child e.g.-abandoned
newborn or infant, drug addict mother.
3. Sexual abuse-any sexual misuse of the child by a
caretaker or family related adult.
• Sexual abuse include- incest, rape, oral genital
contact, sodomy, molestation, digital
manipulation, touching, fondling of genitalia of
the child/ forcing the child to do the same for
adult, forced exposure to pornography,
prostitution, exhibitionism.

15. • Physical signs-presence of STD, pregnancy,
vaginal/anal bleeding/discharge.
• Behavioral signs-
• Nonspecific signs- sudden change in
behavior/temperament, sleep disorder,
constant complaint of headache/abdominal
pain, difficulty at school, serious difficulties in
relating to peers/adults, self destructive
behaviors, persistent habit disorders,
excessive concern about physical privacy,
reluctant to go home.

16. 4. Behavioral abuse-
• Single behavioral sign
• Repeated occurrence of one sign or
combination of several signs.
• Signs- wariness of adult contact, wearing
inappropriate clothing in attempt to cover
injuries, apprehension when other children/
adult cry/shout, aggressiveness/ withdrawal,
fear of parents, prefer to stay away from
home, attaching too readily to strangers,
frequent absenteeism and unwillingness to go
to school.

17. 5. Emotional abuse-
• Most difficult to diagnose and even harder to
prove
• observed and reported by friends, neighbors/
members of extended family
• Only diagnosed in association with other forms of
abuse
• Few physical signs
• Signs- extremely low self esteem, depression,
high constant anxiety, poor social and
interpersonal skill, delayed development,
persistent habit disorder, unexplained academic
delay.

18. 6. Drug abuse- deliberate drugging of children by adult
caretaker with sedatives intended for use by adults or by
sharing narcotics and alcoholic drinks with them.
7. Abandonment- prominent form of abuse and neglect.
8. Substance abuse
9. Medical abuse
Munchausen’s syndrome by proxy-
• Fabricated or induced illness by a parent, guardian or a
caretaker in a child to mimic symptoms of real illness
• To attract attention of medical services and gain sympathy
• Triad- deceived doctor, fabricating parent and harmed kid
• Caretaker- psychiatric illness
• Mortality- 10%
• Increased risk of unexplained death in sibling of children
identified as having fabricated illness
.

19. 10. Child exploitation- children are used for
economic contribution i.e.
• Child labor
• For entertainment- circus, camel races
• For sexual pleasure- prostitution and
pornography
• Political purposes
• Sold for- slavery, prostitution
• For earning money- by begging
• Kidnapped and used for- antisocial activities
• As care taker of domestic as well as non
domestic animals.

20. • Trafficking of the children-
Trafficking- the recruitment, transportation,
transfer, harboring/ receipt, of persons by
means of the threat/ use of force/ other forms
of coercion, of abduction, of fraud, of
deception

21. 11. Neglect-
• Narrow margin between willful neglect and
abuse
• Physical signs- constant hunger, FTT/
malnutrition, poor hygiene, inappropriate
dress a/c to climate, unattended physical
problems/ medical needs, fad diets.
• Behavioral signs- stealing food, extending
stays at school, fatigue, listlessness/ falling
asleep in class, alcohol/ drug abuse, child
states that there is no caregiver, aggressive/
inappropriate behavior, isolation from peer
group.

22. 12. Social abuse-
• Results from acts that are detrimental to the
child’s proper development as a full and
functioning member of society
• Includes- discrimination and denials of rights
and privileges on the basis of sex, age,
illegitimacy, race, ethnicity/ family status.

23.  It’s worth knowing-
 Third largest form of organized crime- trafficking of children
 Nearly 2million children globally/year
 South Asia
 Globalization and induced poverty
 New development policies- change income, employment,
lifestyle patterns, displacement from their traditional
livelihood places
 In India-
 25% victims of sexual exploitation <18years
 5% are from Nepal and Bangladesh
 Most of them belongs to socially/ economically deprived
classes
 HIV/AIDS threat- demand for younger girls.

24. Diagnosis
• When to suspect child abuse- it is not an obvious
diagnosis at initial consultation.
• One should be suspect child abuse in all cases of
injuries at uncommon distribution sites or having unusual
pattern: suspected if the child victims and the parents’ is
at variance or if the features do not match with known
conditions/diseases/disorders.
• Clinical manifestations are bizarre and often
symmetrical.
• Child is drowsy, unconscious or emotionally scared.
He/she is too shocked to reveal anything.
• Importantly the injuries are more serious/ griveous than
expected from the given history.

25. Effects of CAN
• It can have severe and deleterious short and long term effects
on cognitive, socioeconomic and behavioral development.
• Short term/ immediate effects: often noticeable, withdrawn,
quite, depressed, excessive crying, frightful, non
communication with family members/ friends/ schoolmates.
• Long term/ delayed effects: unless correlated with past abuse,
these are difficult to prove. These includes low IQ, motor
problem, hyperactivity, physical defect, increased intensity to
reactions, less social responsibilities, poor impulse control,
aggressiveness, marked anxiety, feeling of rebellion, more
prone to later crime, drug abuse, poor social and marital
adjustment and sexual difficulties.
• Neglect: compared to abused children, more cognitive and
academic deficits, may feel worthless, social withdrawal,
limited peer interactions.

26. Management
• It depends on diagnosis and type of abuse.
• Physical abuse- needs appropriate treatment of the injuries . Proper
information should be relayed to the police/ physician/ caretaker.
• Sexual abuse- often go undetected because of social stigmata and
hence repeated offences are common. Prevention requires strong
need and advocacy sex education in school.
• Child labor- requires food, shelter, health care, education, social
stability and entertainment, which need to be provided by
employers, government and NGOs.
• Economic help, rehabilitation with own family is always preferable.
• Personal care- wherever possible.
• Abandoned babies- urgent and long term medical health care,
placements in promotive institutions or orphanages.
• Initiate and facilitate adoption.
• Children endangered situations require immediate comprehensive
help and long term rehabilitation.

27. CAPTA
• Child Abuse Prevention and Treatment Act which is the
federal law governing Child Protective Services
Programs across the country.
• Passed in 1974 and reauthorized in 2010
• The keeping children Safe Act of 2003 amended CAPTA
and was signed into law.

28. In India
• Before 2012:
• Goa Children’s Act 2003, was the only specific piece
of child abuse legislation before 2012 Act.
• Child sexual abuse was prosecuted under the
following sections of IPC:
• I.P.C.(1860) 375- Rape
• I.P.C.(1860) 354- outraging the modesty of woman
• I.P.C.(1860) 377- unnatural offences.
• The Parliament Of India passed the “Protection Of
Children Against Sexual Offences Bill, 2011.”

29. References
• IAP textbook of pediatrics.
• Child abuse- Robert M. Reece and Stephen
Ludwig
• Advances in pediatrics- A.K. Dutta.