Child Abuse Dr. Mansour Alqurashi Session Objectives At the end of this session, participants will be able to: 1. To detail the epidemiology and long term effects of child abuse and neglect 2. To review the role of pediatrics in the primary prevention of child abuse and neglect 3. To learn specific office based strategies for the primary prevention of child abuse and neglect Child Abuse Abuse is a violation of an individuals human
and civil rights by any other person or persons Abuse and neglect are forms of maltreatment of a child.Somebody may abuse or neglect a child by inflicting harm, or by failing to act to prevent harm. Children may be abused in a family or in an institutional or community setting, by those known to them or, more rarely, by a stranger.They may be abused by an adult or adults, or another child or children. Children Rights There is clear evidence that child abuse is a global problem. It occurs in a variety of forms and is deeply rooted in cultural, economic and social practices. Before defining child abuse its crucial to get informed about childrens rights in the first place. RIGHTS BASED APPROACH
Non-discrimination Best interests of the child Life, survival and development Respect of the views of the child PRIORITIES Right to Education
Access to quality, free, compulsory primary education. Non-Discrimination in access to education (gender gap). Right to leisure, recreation and cultural activities. Right to Health Access to quality health services
Rights of children with disabilities Adolescents and reproductive health knowledge Right to benefit from social security Right to an adequate standard of living Right to Special Protection
Protection from all forms of exploitation (economic, sexual). Violence against children (physical, psychological & sexual). Female Genital Mutilation & early marriage. Torture and deprivation of liberty for juvenile in conflict with the law Hazardous occupations. Smoking, substance abuse, and trafficking. Street children. Child Abuse Definition:
Mental or emotional injury affecting growth, development, or psychological function Causing or permitting the child to be in a situation in which the child sustains injury or increases the risk for injury Failure to make a reasonable effort to prevent harm Harmful sexual conduct Failure to prevent harmful sexual conduct Encouraging the child to engage in such conduct Child abuse Definition:
Placing a child or failing to remove a child from a harmful environment Failure to seek appropriate care Failure to provide appropriate care Failure to arrange appropriate care when returning home Another Definition Any behavior directed toward a child that endangers or impairs a childs physical or emotional health and development How to help Report Believe children Screening? Prevention Role of Physician in Child Abuse
Protect Suspect Inspect Collect Respect Protect... Patient/family and team safety are paramount.
Protect the life of the patient as well as as much evidence as possible. Suspect... Does the history fit what you are seeing- either injury or illness? Is this a repeat patient or family member of a repeat patient? Is there a history of family violence? Collect... Collect as much evidence as possible, including
physical and trace evidence information Respect... Respect the right to refuse Respect diversity
Respect privacy Abuse is not always obvious
Difficulties and Challenges Abuse is not always obvious - Perpetrators may not admit, acknowledge or recognise - Victims may not disclose (or recognise) - Professionals may not notice Different and changing views about what constitutes Abuse Privacy and Family Life Interference or Protection General considerations
Suspect abuse with any unusual physical or psychological complaint Is the injury consistent with the history? Identify signs and symptoms of suspected abuse Maintain a safe environment for the child Understand legal requirements for reporting suspected child abuse General considerations (cont)
Case management should be a team approach Physicians and nurses Social services Law enforcement agencies Document, document Types of Abuse Physical Abuse Physical abuse is any non-accidental injury to a child under the age of 18 by a parent or caretaker.These injuries may include beatings, shaking, burns, human bites, strangulation, or immersion in scalding water or others, with resulting bruises and welts, fractures, scars, burns, internal injuries or any other injuries. Physical Abuse (cont.) The term battered child syndrome was coined to characterize the clinical manifestations of serious physical abuse in young children. This term is generally applied to children showing repeated and devastating injury to the skin, skeletal system or nervous system. It includes children with multiple fractures of different ages, head trauma and severe visceral trauma, with evidence of repeated infliction. Another form is the The shaken infant. Shaking is a prevalent form of abuse seen in very young children (less than 1 year). Most perpetrators of such abuse are males. Intracranial haemorrhages, retinal haemorrhages and chip fractures of the childs extremities can result from very rapid shaking of an infant. Corporal Punishment Corporal punishment of children --- in the form of hitting, punching, kicking or beating --- is socially and legally accepted in most countries. In many, it is a significant phenomenon in schools and other institutions and in penal systems for young offenders. Rates of harsh or moderate forms of physical punishment (WHO) WORLD REPORT ON VIOLENCE AND HEALTH (2002) Rates of verbal or psychological punishment (WHO) WORLD REPORT ON VIOLENCE AND HEALTH (2002) Identifying Physical Abuse... By the Doctor
Normal childhood development Conditions that may be confused with abuse Unintentional vs intentional injury Conditions that Mimic Child Abuse
Bruising Mongolian spots Congenital coagulopathy Birth trauma Accidental trauma Fractures Osteogenisis Imperfecta Rickets Scurvy Syphilis Copper Deficiency- Menkes kinky hair syndrome Recognizing Abuse Injuries...
Skin Injuries TEARS Human Bite Marks Hair Loss Falls Head, facial, oral injuries Shaken baby Syndrome Skin Marking Normal Trauma Protected areas
Extensor surfaces to arms and legs Protruding bony surfaces of face Protected areas Inner arms Throat Abdomen Lower back Inner thighs Skin Marking Dating Bruises?
Depth, skin color, location, amount of bleeding in the tissue Fresh: red/purple -> blue -> brown -> yellow/green Cannot effectively date bruises. Document location, size, shape, color Bruises Generally speaking:
fresh injury is red to blue 1-3 days deep black or purple 3-6 days color changes to green and then brown 6-15 days: green to tan to yellow to faded, then disappears The younger the child the quicker the color resolves. Bruises Common to all children
Accidental injuries typically occur on the forehead and extremities Bruising can occur secondary to medical conditions Leukemias Idiopathic thrombocytopenia purpura (ITP) Coagulopathies (bleeding disorders) Suspicious injuries Occur in different planes of the body Different stages of healing Central distribution Injuries to the back Pattern injuries If youre not old enough to cruise, youre not old enough to bruise
Bruising and other soft tissue injury is extremely uncommon in children younger than 6 months of age and increases in frequency as children becomes older and more mobile Any bruising on an infant