Child Abuse

Child Abuse
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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

  1. Physical
  2. Emotional
  3. Sexual
  4. 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


  • 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


  • Age-inappropriate sexual knowledge
  • Changes in personality
  • Sleep disturbances
  • Drop in school performance


  • 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?

  1. Protect- Protect the life of the patient, patient/family safety is paramount
  2. 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?
  3. Collect-collect as much evidence as possible including physical and trace evidence and information

Any solutions to child abuse?

  1.  Guidance and counseling/psychotherapy for the older children
  2.  Skilling and empowering the children-skills and knowledge to protect themselves
  3.  Parental education/sensitization
  4.  Having better structures and more institutions (like orphanages)-child protection desks/refuge centers
  5.  Enforcement of the law.


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