Parents and Guardians
- The relationship a child has with their parents or guardians is the most primary
- When this primary relationship is full of betrayal and mistrust, the child and his or her psychological growth and development is impacted greatly
What is Child abuse?
- It is unexpected form of mistreatment of a child whereby the survival, safety, self-esteem, growth and development of the child are endangered
Types of Child Abuse
- Physical
- Emotional
- Sexual
- Neglect
- Child Discipline is an expected parental response to specific misbehavior or failure of a child to meet expectations
Risk Factors for Child Abuse
Parent related
- Personal history of physical or sexual abuse as a child
- Teenage parents
- Single parent
- Emotional immaturity
- Poor coping skills
- Low self esteem
- Personal history of substance abuse
- Known history of child abuse
Lack of social support
- Domestic violence
- Lack of parenting skills
- Lack of preparation for the extreme stress of having a new infant
- History of depression or other mental health problems
- Multiple young children
- Unwanted pregnancy
Sexual Abuse
- Its appropriate sexual exposure or touch by an adult to a child or an older child to young one
Examples of sexual abuse
- Fondling
- Indecent Exposure
- Showing/creating pornography
- Incest
- Actual intercourse
- Child prostitution
- WHO estimates that 36-62% of all sexual assault victims are aged below 15 years
Indicators of sexual abuse
Physical
- Difficulty in walking or sitting
- Torn, stained or bloody underclothing
- Pain or itching in the rectal/ genital area
- Bruises or bleeding in rectal/genital area
Behavioral
- Age-inappropriate sexual knowledge
- Changes in personality
- Sleep disturbances
- Drop in school performance
Neglect
- This is failure to provide sufficient food, clothing, shelter, medical care, education to the child
Physical indicators
- Constant hunger
- poor hygiene
- inappropriate clothing
Behavioral indicators
- Begging or stealing food
- Frequent sleepiness
Emotional/Verbal Abuse
- Its intentional verbal or behavioral acts that result in adverse emotional consequences as rejection, isolation, constant criticism
Physical indicators
- Speech disorders
- Lag in physical development
Behavioral indicators
- Conduct disorders(withdrawal, destructiveness)
- Behavioral extremes(aggressive or passive)
By far however, most of the abusive words used on and by the children in Kenya have sexual connotation
Cultural violence
- Forced Circumcision/Female Genital Mutilation(FGM)
- Early/child and forced marriages
They are grounded in traditions and custom, and which negate basic human rights as observed in the constitution of Kenya
- 1 in 3 girls worldwide are married before the age of 18, and 1 in 9 before the age of 15. Areas with the highest rates of child marriage are Sub-Saharan Africa and South Asia.
Shaken Baby Syndrome (SBS)
- Can be a fatal form of child abuse. Characterized by intracranial hemorrhage, retinal hemorrhage and loss of consciousness due to vigorous shaking of the infant
Facts on SBS
- Shaking is more likely to be done by a male, fathers make up 76% of all shakers
- If the shaker is female its more likely to be the baby sitter
- About 70% of the victims are killed, other 30% live with severe permanent injuries
- 1 in 4 babies die as a result of SBS
Battered Child
- It’s a clinical condition characterized by repeated intentional acts of trauma to a young child. Deprivation of food and water is a variant of this trauma. Also called child abuse syndrome or non-accidental injury.
Spectrum of injury
- Soft tissue injury
- Thermal injury
- Skeletal injury
- Internal injuries(brain, abdomen or eye)
Physical violence in Kenya
- In a study-Perpetrators-Teachers (24%), followed by school mates (19%) and lastly friends (14%), parents accounted for 20% of the mentions with mothers (at 11%)
- The most common-via use of a stick, rod, belt or plastic flip.
- Other forms include kicking, slapping, pinching, punching with more severe forms of physical abuse, like burning by pouring hot liquid or using a hot rod and cutting also existed
What are the consequences of child abuse?
- Affective and behavioral disorders
- Developmental delay and learning difficulties
- Failure to thrive and growth retardation
- Low self-esteem, multiple sexual partners
- Low enrollment in schools with multiple dropouts
- Predisposition to adult psychiatric disorders
- Death or disability in severe cases
- STDs, HIV and unwanted pregnancy from sexual assault
- Suicidal attempts
- Addictions e.g. Alcohol and other substances
- An increased risk of the abused becoming an abuser leading to Abuse cycle
History of Child abuse
- A delay n bringing the child to the hospital
- A significant discrepancy between the history given by parents and the clinical findings
- Unexplained malnutrition
- Inconsistent or vague explanation
- Reports by the patient of sexual activities with the parent
- Tearing, bruising and specific inflammation of the mouth or genitals
- Pregnancy and the girl is evasive in naming her partner
Why child abuse is often NOT reported?
- Culture- stigma for victim
- Victims are often young children
- Health professional unaware of signs and symptoms
- Health professionals unwilling to report
- The child-might be afraid, threatened, not hurt, did not feel like, forgave the perpetrator, think no one would believe them, thought they had made a mistake or did not know where to report
What is your role in child abuse?
- Protect- Protect the life of the patient, patient/family safety is paramount
- Suspect- Does the history fit what you are seeing either injury or illness? Is this a repeat patient or family member of repeat patient? Is there a history of family violence?
- Collect-collect as much evidence as possible including physical and trace evidence and information
Any solutions to child abuse?
- Guidance and counseling/psychotherapy for the older children
- Skilling and empowering the children-skills and knowledge to protect themselves
- Parental education/sensitization
- Having better structures and more institutions (like orphanages)-child protection desks/refuge centers
- Enforcement of the law.