Child Abuse

Dr. Rasha Salama

PhD Community Medicine
Suez Canal University
Egypt
“So long as little children are
allowed to suffer, there is no
true love in this world”
Duncan
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 “children’s rights” in the first
place.

 According to the National Council for Childhood

and Motherhood (NCCM) in Egypt, Egyptian
children are a national priority.
NCCM’S RIGHTS’ BASED APPROACH
(Convention on the Rights of the Child)

 Non-discrimination (article 2)
 Best interests of the child (article 3)
 Life, survival and development (article 6)
 Respect of the views of the child (article 12)
PRIORITIES
Right to Education
 Access to quality, free, compulsory primary
education.
 Non-Discrimination in access to education
(gender gap).
(Aims of Education: art. 29)
 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
In 1999, the WHO Consultation on Child Abuse
Prevention compared definitions of abuse from 58
countries and drafted the following definition:

‘‘Child abuse or maltreatment 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.’’
Definition of Child Abuse

“The physical or mental injury, sexual

abuse or exploitation, negligent treatment,
or maltreatment of a child under the age of
18 by a person who is responsible for the
child’s welfare under circumstances which
indicate that the child’s health or welfare is
harmed or threatened.”
Child Welfare Act
Another Definition

“Any behavior directed toward a child

that endangers or impairs a child’s
physical or emotional health and
development”
 Types of Child Abuse
 physical abuse
 sexual abuse
 emotional abuse
 neglect
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 child’s 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.
PSYCHOLOGICAL MALTREATMENT
Definition

 Psychological Neglect - the consistent failure of a

parent or caretaker to provide a child with
appropriate support, attention, and affection.

 Psychological Abuse - a chronic pattern of

behaviors such as belittling, humiliating, and
ridiculing a child.
 Emotional Abuse
 Emotional abuse includes the failure of a
caregiver to provide an appropriate and
supportive environment, and includes acts that
have an adverse effect on the emotional health
and development of a child.

 Such acts include restricting a child’s

movements, denigration, ridicule, threats and
intimidation, discrimination, rejection and
other nonphysical forms of hostile treatment.
Neglect
 Neglect refers to the failure of a parent to provide
for the development of the child – where the
parent is in a position to do so – in one or more of
the following areas: health, education, emotional
development, nutrition, shelter and safe living
conditions.

 Neglect is thus distinguished from circumstances

of poverty in that neglect can occur only in cases
where reasonable resources are available to the
family or caregiver.
CHILD SEXUAL ABUSE
Definition

Child sexual abuse is the exploitation of a child or

adolescent for the sexual gratification of another
person.
SEXUALLY ABUSIVE BEHAVIORS

 Voyeurism  Sodomy

 Fondling  Oral-genital stimulation

 Child prostitution  Verbal stimulation

 Child pornography
 Exhibitionism
 Intercourse
Three Major Components
of Child Abuse

Child
+
Care Giver
+
Stress
=
Child Abuse
Who are at Risk

-Abuse most common in children < 1 yr. old

-Girls more frequently abused at older age vs. boys
TABLE 2
Risk Factors for Child Abuse

Community/societal Parent-related (continued)

• High crime rate • Lack of social support
• Lack of or few social services • Domestic violence
• High poverty rate • Lack of parenting skills
• High unemployment rate • Lack of preparation for the extreme stress of
having a new infant
Parent-related • History of depression or other mental health
• Personal history of physical or sexual problems
abuse as a child • Multiple young children
• Teenage parents • Unwanted pregnancy
• Single parent • Denial of pregnancy
• Emotional immaturity
• Poor coping skills Child-related
• Low self-esteem • Prematurity
• Personal history of substance abuse • Low birth weight
• Known history of child abuse • Handicap
 The Extent of the Problem
 Fatal abuse
 According to the World Health Organization, there were
an estimated 570 000 deaths attributed to homicide
among children under 15 years of age in 2000 around the
world. Global estimates of child homicide suggest that
infants and very young children are at greatest risk, and
those who live in developing countries.

 Non-fatal abuse
 According to the “WORLD REPORT ON VIOLENCE
AND HEALTH” by WHO among children in Egypt,
37% reported being beaten or tied up by their parents and
16% reported physical injuries such as fractures, loss of
consciousness or permanent disability as a result of being
beaten or tied up.
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)
Parental beliefs and reasons for punishment

 Survey in Egypt showed: lying,

disrespect, disobedience, low performance
in school and destroying property are the
main reasons for punishment (Youseff and
Kamel, 1998(
Health Consequences of Child Abuse
Health Consequences of Child Abuse
(cont.)
Role of Family 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
The Cycle of Abuse...
 Family violence
 Abuser-to abuser
cycle
 Factors in altering
the cycle of
violence
Responsibilities to Report...
 Who must report…
 Deciding to report…

A report of suspected child abuse is a

responsible attempt to protect a child.

Identifying Physical Abuse... By the
Family Doctor

 Normal childhood development

 Conditions that may be confused with abuse

 Unintentional vs intentional injury

Recognizing Abuse Injuries...
 Skin Injuries
 TEARS
 Human Bite Marks
 Hair Loss

 Falls

 Head, facial, oral injuries

 Shaken baby Syndrome

Human Bites

 Strongly suggest abuse

 Easily overlooked

 Location of bite marks on infants differ

from sites on older children

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
Burns
 Abusive Burn Patterns
 Scald: Immersion & Splash Burns
 Flexion Burns

 Contact Burns

 “Pseudoabusive” Burns
Burns
Suspicious Fractures
 Falls

 In most cases, falls cause a minor injury.

 If a child is reported to have had a routine
fall but has what appear to be severe
injuries, the inconsistency of the history
with the injury indicates child abuse.
 Head, Facial, Oral Injuries

 Head is a common area of injury.

 Approx. 50 % of physical abuse patients
have head or facial injuries.
 Injuries to the sides of the face, ears,
cheeks, and temple area are highly
suspicious for abuse.
 Mouth/lip/teeth injuries
Indicators of Child Abuse (Discovered by Family Doctor)
Type of Abuse Physical Indicators Behavioral Indicators
Physical Unexplained bruises, welts, burns, Wary of adult contact, frightened of
fractures, or bald patches on scalp parents or afraid to go home,
withdrawn or aggressive, moves
uncomfortably, wears inappropriate
clothing for weather

Sexual Difficulty walking or sitting; torn or Advanced sexual knowledge,

stained/blood underclothes; pain, promiscuity, sudden school
itching, bruises, swelling in genital difficulties, self-imposed social
area; frequent urinary or yeast isolation, avoidance of physical
infections contact or closeness, depression
Emotional Speech or communicative disorder, Habit disorders, antisocial or
delayed physical development, destructive behaviors, neurotic traits,
exacerbation of existing conditions, behavior extremes, developmental
substance abuse delays

Neglect Consistent hunger, poor hygiene, Self-destructive behaviors, begging or

inappropriate dress, unattended stealing food, constant fatigue,
medical problems, underweight, assuming adult responsibilities or
failure to thrive concerns, frequently absent or tardy,
states no caretaker in home
Common Features of Successful Child Abuse Prevention Programs 
_______________________________________
 Strengthen family and community connections and support.
 Treat parents as vital contributors to their children's growth
and development.
 Create opportunities for parents to feel empowered to act on
their own behalf.
 Respect the integrity of the family.
 Enhance parents' capability to foster the optimal development
of their children and themselves.
 Establish links with community support systems.
 Provide settings where parents and children can gather,
interact, support and learn from each other.
 Enhance coordination and integration of services needed by
families.
 Enhance community awareness of the importance of healthy
parenting practices.
 National Initiatives to Eliminate
Child Abuse
 PILOT PROJECTS
􀂄 “FGM Free Village Model” to eliminate the practice of FGM in 120
villages in Upper Egypt.
􀂄 “Protection and Rehabilitation of Child Labor” in selected
squatter areas.
􀂄 “Empowerment of Adolescent Girls” focusing on reproductive
health awareness and knowledge dissemination
􀂄 “Protection of Youth From Substance Abuse” to establish
demand-reduction units and increase social awareness.
􀂄 “Protection of Children Against Delinquency” to effectuate family
courts” and monitor its jurisdiction.
􀂄 “Protection of Street Children Against Drugs” through monitoring
protection institutions and building capacities of police officers and
social workers.
􀂄 “Promote the Culture of Child Rights” through raising awareness
of school teachers with the child rights.
FGM
NATIONAL PROGRAM FOR THE
ELIMINATION OF FGM

􀂄 Trigger behavioral change.

􀂄 Enhance rights of the girl child with a
focus on FGM.
􀂄 Create NGO and youth leaders advocacy
network.
􀂄 Incorporate regulatory provisions that
condemn FGM.
􀂄 Implement a social marketing campaign
and produce an FGM-Free Village model
toolkit.
 ‫أطفال‬
‫الشوارع‬
NATIONAL STRATEGY FOR PROTECTION, REHABILITATION
AND INTEGRATION OF STREET CHILDREN
Ensure all rights of street children through:
􀂄 Changing the community's negative perception.
􀂄 Building a comprehensive database.
􀂄 Capacity building for cadres dealing with street
children.
􀂄 Introducing legal amendments and
strengthening enforcement mechanisms.
􀂄 Supporting NGOs caring for street children
from drug abuse, violence and exploitation.
􀂄 Demonstrating vocational, health and
psychological rehabilitation services.
􀂄 Expanding the social net programs and direct
services for poor families to eradicate root causes
of the problem.
JUVENILE JUSTICE

􀂄 Ensure protection of rights of children in

conflict with the law.
􀂄 Define criminal responsibility and penalty in
proportion to child age.
􀂄 Initiate measures to protect children against
delinquency.
􀂄 Monitor juvenile courts effectiveness.
􀂄 Promote physical and psychological
rehabilitation
􀂄 Establish family friendly courts.
Thank You