By esraa eliwa Farah Anood

1. By esraaeliwa Farah Anood CHILD ABUSE

2. Outline • objectives • Definition of child abuse • Type of child abuse • Reporting of Abuse • Prevention • Summary • Conclusion • Reference • Article

3. Student will be able to : Define children abuse To recognize statistic of child abuse Mention three types of  child abuse Define each type of child abuse Mention examples for child abuse How we will diagnose child abuse ? How we will provide the prevention ?

5. Ask yourself… Who would ever want to hurt a child? “No one,” you say.

6. What is Child Abuse? • Can be defined as causing or permitting any harmful or offensive contact on a child's body; and, any communication or transaction of any kind which humiliates, shames, or frightens the child. • Any act or omission, which fails to nurture or in the upbringing of the children. • Defined as a variety of abnormal behaviors directed against children. • Child abuse in general is a psychological problem or perversion of the abuser. The abuser is referred to as the perpetrator of abuse. 

7. Statistics of Child Abuse:

8. Everyday, about four children die in the United States from child abuse.

9. Each year in the state of Georgia, there are approximately 31,000 confirmed cases of abuse.

10. Of all abuse cases, 90% occur at home.

11. Sexual Physical There are four types of abuse... Neglect Emotional

12. Types of Child Abuse • Neglect – 63% • Physical – 19% • Sexual – 10% • Emotional – 8%

13. Physical Abuse An injury intentionally inflicted on a child by a caregiver, parents, or anyone residing in the child’s home.

15. Physical Abuse Behavioral indicators of physical abuse: wary of physical contact with adults, behavioral extremes (aggressive or withdrawn), frightened of parents, afraid to go home, cheating, stealing, lying (a sign that expectations in the home are too high), layered clothing. Physical indicators:unexplained bruises, burns, human bites, broken bones, missing hair, scratches. Definition: non-accidental injury of a child that leaves marks, scars, bruises, or broken bones.

16. Examples of Physical Abuse: • Hitting • Choking • Shaking • Kicking • Missing or loosened teeth • Biting • Burning • Slapping • Beating • Injuries inflicted with objects

18. 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 about SBS:-shaking is more likely to be done by a male, fathers make up 76% of all shakers .-If the shaker is female it’s more likely to be the babysitter.-About 70 % of the victims are killed , other 30 % live with severe permanent injuries. -One in four babies die as a result of SBS. Child Abuse

19. Three major components of child abuse Child + Care Giver + Stress = Child Abuse Child Abuse

20. Definition 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). Child Abuse

21. Diagnosis 1-Age of the child: Infants can be of any age, but the majority are under 2 years. It’s more likely to be male than female, unwanted or illegitimate child.2-Social class: Any social class can be involved , but the lower middle classes are the most at risk.3-Clinical findings: more common in the skin and the skeleton, Either:- evidence of injury as old or recent bruises, fractures, burns, scalds, bites, kicking, slapping..-Or evidence of neglect i.e. the child may be starved and dehydrated. Child Abuse

22. History • There is often:-A delay in 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. Child Abuse

23. Radiological evidence The most frequent sites of skeletal injury are -the extremities 77 %-the skull 34 %-the rib cage 19 %Epiphyseal-metaphyseal fractures of long bones of the arms and legs and the rib fractures exclusive for the new born period are considered specific for the child abuse.Multiple repetitive fractures of other areas are only suggestive of child abuse, but are not specific. Child Abuse

24. Causes of death 1-Head injuries: the most frequent cause of death , commonly subdural and subarachnoid hemorrhages.2-Injuries of the abdomen: -intestine: rupture-mesentery: tears-spleen: rupture-liver: laceration3-Burns or scalds: cause shock, dehydration and Infection. Child Abuse

25. Autopsy findings 1-Multiple bruises of various ages over the body2-Cigarette burns on the body.3-Multiple fractures by X-ray.4-Injuries to the head, in the first year of life.5-Abdominal injuries. Child Abuse

27. Sexual Abuse The use of a child for sexual gratification or financial gain, by an adult,older child, or adolescent, whether by physical force, coercion, or persuasion.

28. Sexual Abuse • Definition: any inappropriate sexual exposure or touch by an adult to a child or an older child to a younger child. • Physical indicators of sexual abuse: difficulty in walking or sitting, torn, stained, or bloody underclothing, pain or itching in genital area, bruises or bleeding in rectal/genital area, venereal disease. • Behavioral indicators of sexual abuse: age-inappropriate sexual knowledge/sexual touch, abrupt change in personality, withdrawn, poor peer relationships, unwilling to change for gym or participate in physical activities, promiscuous behavior/seductive behavior, drop in school performance/decline in school interest, sleep disturbances, regressive behavior (i.e., bed wetting).

29. Examples of Sexual Abuse: • Fondling • Indecent exposure • Showing pornographic materials • Touching sexual organs • (of the child or the adult) • Attempted or actual sexual intercourse • Child prostitution • Incest

30. Emotional or psychological abuse Verbal abuse or excessive demands on the child that result In impaired growth, negative self-image, and disturbed child behavior.

31. Emotional Abuse Definition: parental behavior, such as rejecting, terrorizing, ignoring, or isolating a child. • Physical indicators of emotional abuse: speech disorders, lags in physical development, failure to thrive. • Behavioral indicators of emotional abuse: habit disorders (sucking, biting, rocking), conduct disorders (withdrawal, destructiveness, cruelty), sleep disorders or inhibition of play, behavior extremes (aggressive or passive).

32. Examples of Emotional Abuse • Ignores child’s physical/emotional needs • Rejection/withdrawal of love • Terrorizes/threatens child • Cruel, bizarre/inconsistent punishment • Isolates/restricts child for long periods • Denies child food, shelter, or sleep as a punishment • Corrupts child by encouraging antisocial/unacceptable behavior

33. Neglect Acts or omissions by the perpetrator that fail to meet the child’s needs for basic living, including food, hygiene, medical care, clothing, and a safe warm environment.

34. Neglect Definition: failure of parents or caretakers to provide needed, age appropriate care including food, clothing, shelter, protection from harm, hygiene, and medical care. • Physical indicators of neglect:constant hunger, poor hygiene, excessive sleepiness, lack of appropriate supervision, unattended physical problems or medical needs, abandonment, inappropriate clothing for weather conditions. • Behavioral indicators of neglect:begging or stealing food, frequent sleepiness, lack of appropriate supervision, unattended physical problem or medical needs, abandonment, inappropriate clothing for weather conditions.

35. Parental Characteristic- • Violence, • Poverty, • Parental history of abuse, • Socially isolated, • Low self esteem, • Less adequate maternal functioning.

36. Characteristic of Child - • No. of children’s, • Child's temperament, • Position in the family, • Additional physical needs if ill or disabled, • Activity level or degree of sensitivity to parental needs. • Occasionally the abused child is ill e.g. it is mate, unwanted, brain damaged, hyper active or physically disabled.

37. Who get abused the most? • Behavior problems • Medical problems • Prematurity • Disability • Non-biological relationship to caretaker

38. Environmental Characteristics - • Chronic stress, • Problem of divorce, • Poverty, • Unemployment, • Poor housing, • Frequent relocation, • Alcoholism, • Drug addiction.

39. Who Abuses Children?Where Does it Happen? • Most often, the abuser is someone the child knows, such as a parent, neighbor, someone work at home or relative. • Child abuse usually happens in the child’s home. Sometimes it happens in other settings, such as child-care centers and even schools. National Figures • 74 % Natural Parent • 10% Step-parent or de facto • 7% Other relative or sibling • 5% Friend or neighbors • 4 % Others (including strangers)

40. WHY THEY DO THAT?: • Abused as a child • Single parent • Spouse is gone much of the time • Family conflicts • Divorce • Alcohol or other drugs • Emotional immaturity • Postpartum depression • Unrealistic expectations • Stress of unemployment • Mental illness • Low self-esteem

41. Characteristic of Abuse • Repetitive pattern of injury • Injuries not consistent with story • Presence of other signs of abuse • Unusual behavior of parent • Incidental discovery of injury

42. Method of examination • Differential diagnosis SIDS • Skin disorders • Blood dyscrasia • Fractures due to osteogenesisimperfecta, osteoporosis • Failure to thrive due to disease process

43. Distinguishing Accidents From Abuse Location of the injury • Common accidental injury locations include knees, elbows, shins and forehead. Suspicious locations are the protected body parts and soft tissue area (the face, back, thighs, genital areas, buttocks, or the backs of legs.

44. Approximately 30% of all childhood fractures are inflicted. In children younger than 1 year, 75% of fractures are likely to be inflicted.

45. Accidental injuries have a reasonable explanation. Abuse injuries may not match their explanation.

46. The 5 R’s • Raise the issue • Reach out to kids and parents in your community • Remember the risk factors • Recognize the warning signs • Report suspected abuse or neglect

47. Reporting of Abuse • Approximately 3 million reports of possible maltreatment are made to child protective service agencies each year. • The actual incidence of abuse and neglect is estimated to the three times greater than the number reported to authorities.

48. What to do… • Don’t try to conduct an investigation, yourself. • If the child tells you of the sexual abuse immediately after it occurred, DO NOT bathe the child, or wash or change his or her clothes. • Let the child talk as much as he or she wishes. • Understand that the child is probably having mixed feelings. • Believe the child. • Explain what you will do next to help them.

49. Prevention • Never discipline your child when your anger is out of control. • Participate in your child’s activities and get to know your child’s friends. • Never leave your child unattended, especially in the car. • Teach your child the difference between “good touches” and “bad touches.” • When your child tells you he or she doesn’t want to be with someone, this could be a red flag. Listen to them and believe what they say. • Be aware of changes in your child’s behavior or attitude. • Teach your child what to do if you and your child become separated while away from home. • Pay attention when someone shows greater than normal interest in your child. • Make certain your child’s school or day care center will release him/her only to you or someone you officially designate.

50. Reference • Essentials of psychiatric mental health nursing concept of care in evidence based practice