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Article about Child Abuse.
21 Aug 2017

Over three million cases of child abuse and neglect are reported globally, a rate of 68 per 1000 children. More than 1000 fatalities from abuse were estimated in 1996, 76% of these involving children under four years. There was a 67% increase in abuse and neglect cases documented between 1986 and 2016 globally. This may be, in part, due to community professionals reporting suspected abuse more vigorously, but this increase is also thought to reflect a real rise in incidence of abuse and neglect. Of course these data do not include the actual number of abuse cases that are unreported. The lasting effects of abuse on victims and society are far reaching. Children who were sexually abused are more likely to be arrested for prostitution in adult life. Abused children also have higher rates of adolescent suicide, depression, psychiatric disorders, violent behaviour, drug and alcohol abuse, and developmental disabilities.
Child abuse has been documented in various forms since the beginning of recorded history. Unfortunately, little public attention was given to it until a little over a century ago. In fact, in the United States, the first organized society addressing child abuse issues was the Society for the Prevention of Cruelty to Children, created in 1874 when New York citizens found an abused child in a church. The only resource they could find to help the girl was the Society for the Prevention of Cruelty to Animals. The Society intervened on the child’s behalf under the premise that children are also animals and, therefore, should be protected against abusive acts.
Data published by the Kerala Police Department recently painted a grim and sordid picture as it revealed an alarming rate of growth in violence against children, including sexual abuse, in Kerala.
Almost 57% growth was reported in cases registered under Protection of Children from Sexual Offences (POSCO) Act between 2013 and 2015. Child abuse is also on the rise. In 2013, as many as 1002 cases of sexual assault were reported while it increased to 1569 in 2015. The data reveals that 219 rape cases were reported in the state until July 2016.
This year, till July, 1156 cases were registered under POSCO. Malappuram district leads the list with the highest number of cases of violence against children registered since 2008. Kidnapping and abduction follow rape with a total 29 cases registered till July 2016. Also, 1024 cases were registered in 2013. However, the cases of violence against children registered in 2015 were 1406. Though there is an increase in the number of cases, the actual convictions in such cases are very low. The report also revealed that only 53 accused were convicted during November 2012 - 2015.Sometimes it is difficult to understand exactly what child abuse and neglect are. Child abuse is any mistreatment of a child (someone under 18) by a parent or caregiver that results in harm or injury.


Child abuse includes:

Physical Abuse: an injury to a child that is not an accident; for example, hurting a child by hitting, burning, biting or shaking. Causes or threatens to cause a non-accidental physical or mental injury.
Physical Neglect: neglects or refuses to provide the child food, clothing, medical care, shelter or supervision. This includes abandoning child, or failing to provide adequate supervision in relation to the child’s age and developmental level.
Sexual Abuse: any sexual contact or exploitation of a child. This includes committing or allowing being committed any illegal sexual act upon a child, such as incest, rape, fondling, indecent exposure, child prostitution or allows a child to be used in any sexually explicit material.
Emotional  Abuse and Neglect: an abusive parent may scare a child by threatening to leave him or her, or by being severely critical. A neglectful parent may not spend any time with the child or may never show the child any affection.

Manifestations of Child Abuse and Neglect

Injuries inflicted by a caregiver on a child can take many forms. Serious damage or death in abused children is most often the consequence of a head injury or injury to the internal organs. Head trauma as a result of abuse is the most common cause of death in young children, with children in the first two years of life being the most vulnerable. Because force applied to the body passes through the skin, patterns of injury to the skin can provide clear signs of abuse. The skeletal manifestations of abuse include multiple fractures at different stages of healing, fractures of bones that are very rarely broken under normal circumstances, and characteristic fractures of the ribs and long bones.

The Shaken Infant

Shaking is a prevalent form of abuse seen in very young children. The majority of shaken children are less than nine months old. Most perpetrators of such abuse are male, though this may be more a reflection of the fact that men, being on average stronger than women, tend to apply greater force, rather than that they are more likely to shake children than women.
Intracranial haemorrhages, retinal haemorrhages and small ‘‘chip’’ fractures at the major joints of the child’s extremities can result from very rapid shaking of an infant. They can also follow from a combination of shaking and the head hitting a surface. There is evidence that about one-third of severely shaken infants die and that the majority of the survivors suffer long-term consequences such as mental retardation, cerebral palsy or blindness

The Battered Child

One of the syndromes of child abuse is the ‘‘battered child’’. This term is generally applied to children showing repeated and devastating injury to the skin, skeletal system or nervous system (Table 0.1). It includes children with multiple fractures of different ages, head trauma and severe visceral trauma, with evidence of repeated infliction. Fortunately, though the cases are tragic, this pattern is rare.
Indicators of Child Abuse
    >Showing wariness and distrust of adults
    >Rocking, sucking or biting excessively
    >Bedwetting or soiling
    >Demanding or aggressive behaviour
    >Sleeping difficulties, often being tired and falling asleep
    >Low self-esteem
    >Difficulty relating to adults and peers
    >Abusing alcohol or drugs
    >Being seemingly accident
    >Having broken bones or unexplained bruising, burns or welts in different stages of healing
    >Being unable to explain an injury, or providing explanations that are inconsistent, vague or unbelievable
    >Feeling suicidal or attempting suicide
    >Having difficulty concentrating
    >Being withdrawn or overly obedient
    >Being reluctant to go home
    >Creating stories, poems or art work about abuse.


Sexual Abuse

Children are brought to professional attention following
Physical or behavioural abnormalities that, on further investigation, turn out to result from sexual abuse. It is not uncommon for children who have been sexually abused to exhibit symptoms of infection, genital injury, abdominal pain, constipation, chronic or recurrent urinary tract infections or behavioural problems. To be able to detect child sexual abuse requires a high index of suspicion and familiarity with the verbal, behavioural and physical indicators of abuse.


Neglect

There exist many manifestations of child neglect, including non-compliance with health care recommendations, failure to seek appropriate health care, deprivation of food resulting in hunger, and the failure of a child physically to thrive. In addition, abandonment, inadequate supervision, poor hygiene and being deprived of an education have all been considered as evidence of neglect.

Indicators of Neglect

    >Malnutrition, begging, stealing or hoarding food
    >Poor hygiene, matted hair, dirty skin or body odour
    >Unattended physical or medical problems
    >Comments from a child that no one is at home to provide care
    >Being constantly tired
    >Frequent lateness or absence from school
    >Inappropriate clothing, especially inadequate clothing in winter
    >Frequent illness, infections or sores
    >Being left unsupervised for long periods.

Author:

Dr. K .V. Prasanth, M. D. (Accident and Emergency Medicine), Rajagiri Hospital.



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