Child abuse, now selectively should be called as child maltreatment is quite common occurrence in society. One fourth of all adults report having been physically abused as children, no matter how much severe. Sexual abuse also is reported as one in five women and one in thirteen men.
Child maltreatment is the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other exploitation, which results 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. Exposure to intimate partner Violence is also sometimes included as a form of child maltreatment. (WHO)
Problem Statement: The problem is universal whether the country is developed or developing, peaceful or civil war involving. Most of the time under reporting is seen due to social, political and religious issues .in spite of ,many surveys ,sufficient and reliable data is still lacking in many countries.
Estimates depend on:
- Definitions of child maltreatment used;
- Type of child maltreatment studied;
- Coverage and quality of official statistics;
- Coverage and quality of surveys that request self-reports from victims, parents or caregivers.
Psychological, emotional or child neglect is another issue which is difficult to study. In emergency pediatric services, however we see tip of iceberg cases as presentation of child abuse and neglect. Every year, there are an estimated 41 000 homicide deaths in children under 15 years of age. This number underestimates the true extent of the problem, as a significant proportion of deaths due to child maltreatment are incorrectly attributed to falls, burns, drowning and other so called accidental causes. In areas where civil war or terrorist activities are going on, girls are particularly vulnerable to sexual violence by armed forces, extremists, members of communities and mafias.
Consequences of maltreatment: Child maltreatment causes suffering for child, family ,community and country .It poses long term consequences in most of the cases. Disruption in early brain development is one of the extensions of child or women abuse both. Stress can take toll on the development of the nervous and immune systems. Children with abuse are prone for depression,smoking,obesity,high-risk sexual behaviours,unintended pregnancy,alcohol and drug misuse.This at the end can contribute to behavioural and mental health consequences, maltreatment can contribute to heart disease, cancer, suicide and sexually transmitted infections. An economic impact for person and country, is also important and may include costs of hospitalization, mental health treatment, child welfare, and longer-term health costs
Risk factors: Risk factors are dependant on scenario and background,they may not be present in every case coming forth.
Child-Children are the victims and are never to blame for maltreatment.
A number of characteristics of an individual child may increase the likelihood of being maltreated: Some of them being unwanted, or failing to fulfil the expectations of parents others may be having special needs, crying persistently or having abnormal physical features.
Parent or caregiver- Parents may have difficulty bonding with a newborn, not able to nurture the child, were maltreated themselves as a child. Sometimes they are involved in criminal activity or experiencing financial difficulties. They may be lacking awareness of child development or having unrealistic expectations, or misusing alcohol or drugs, including during pregnancy.
Relationship- Relationships within families or among intimate partners, friends and peers may increase the risk of child maltreatment. These are physical, developmental or mental health problems of a family member ,family breakdown or violence between other family members, being isolated in the community or lacking a support network and a breakdown of support in child rearing from the extended family.
Community and societal factors- A number of characteristics of communities and societies may increase the risk of child maltreatment. They are gender and social inequality; lack of adequate housing or services to support families and institutions; high levels of unemployment or poverty; the easy availability of alcohol and drugs; inadequate policies and programmes to prevent child maltreatment, child pornography, child prostitution and child labor; social and cultural norms that promote or glorify violence towards others, support the use of corporal punishment, demand rigid gender roles, or diminish the status of the child in parent–child relationships; and social, economic, health and education policies that lead to poor living standards, or to socioeconomic inequality or instability.
Prevention: Preventing child maltreatment requires a multisectoral approach. Support to parents and teaching positive parenting skills are most important parts of prevention. These include:
Programmes to prevent child sexual abuse-These are usually delivered in schools and media and teach children about body ownership, the difference between good and bad touch. Children are taught to recognize abusive situations , to say “no” when suspicion and to disclose abuse to a trusted adult.
To maximize the effects of prevention and care, WHO recommends that interventions are delivered as part of a four-step public health approach:
- Defining the problem;
- Identifying causes and risk factors;
- Designing and testing interventions aimed at minimizing the risk factors;
- Disseminating information about the effectiveness of interventions and increasing the scale of proven effective interventions.
Issue: October-December 2018 [Volume 7.4]