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Child abuse and Neglect.

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[author image=”” ]Saadia Khan A paediatric resident at the Children’s Hospital and Institute of Child Health, Multan, she has a keen interest in preventative paediatric medicine and community work, and tweets as@drkhanchc ([/author]

Child abuse and neglect are the important social problems that are taken for granted .This term covers the physical abuse, emotional abuse, sexual abuse and neglect. Poverty, parental relationship disharmony, depression, substance abuse, domestic problems and violence are risk factors for all this.

 Being a pediatrician we often come across these cases of child abuse and neglect. Salman 5 year  child who had  just bones and skin, broken incisors and multiple bruises over body was brought to stabilization centre for malnourished children and when evaluated he was  the  case of physical child abuse by his step mother with whom he lived. Similarly 3 years boy landed to intensive care with unconsciousness because of intracranial hemorrhage after slapped by his uncle over his ear. Zain 2 year old neglected and malnourished child of broken family was also the victim of child abuse. Many children come to hospital with conversion reaction, when we probe history most of them belong to Mudarsa or badly beaten by Molvi sahib or teachers.

Kiran, 5 year girl was brought to OPD for consultation regarding encorpresis (fecal soiling). she told that she felt very alone at school ,no one is ready to make friendship with her and all girls in school make  fun of her complexion as she has a dark complexion. Her mother told that she is very good at studies and always stands first in class, but she is very depressed and people attitude hurts her a lot as people are more interested in making fun of her complexion rather to appreciate her and to encourage her intelligence. 

Physical abuse by parents is very common. Mothers have often great contribution and committed this mostly during toilet training of child or while teaching them but severe injuries are gifted by fathers :Head trauma, abdominal trauma, bruises over body by sticks,  slap marks ,burns by cigarettes ,match sticks ,irons and boiled water are commonly seen.

History provided by parents does not match with the pattern of injuries and there is delay in seeking medical attention. Child suffering from chronic physical abuse often has injuries of multiple ages. Schools are notorious for physical abuse: Face slapping, beating with rulers especially steel, prolong standing, standing over chair, expelling out of class and to make them stand in sun in summer or in cold and harsh weather in winter. Memories cannot easily be suppressed. Physical abuse affects the development of child and child finds it very difficult to cope with physical trauma and their traumatizing memories.

Emotional abuse has become the hallmark of our society. Child just after delivery is on the hit list of people .Comments on his /her complexion, weight and features start from early age and people continue to abuse this baby emotionally throughout life. Children with low IQ, poor school performance and poor grades are often emotionally abuse by parents, teachers and relatives.

Sexual abuse in children may be a single incident or may be chronically affected and perpetrators are males in most of the cases and that are known and very close to children. Mostly they are near relatives, teachers  and family close friends and in some cases Parents .Girls are victims in most of the cases but boys are mostly under recognized.

 Unwanted pregnancy, not a preferred gender and appearance, complexion of child, fussy excessive crying babies, fussy eaters, developmental delay children, very active toddlers, poverty financial crisis, unemployment of parents, domestic violence are the risk factors for child abuse and neglect.

Consequences of child abuse and neglect are anxiety, depression, dissociation, difficulty in concentration, academic problems, sleeping issues, nutritional issues,

Bipolar disorder, increased suicidal tendency, aggression, violence, criminal behaviours, eating disorder and obesity, self harming behaviours, failed marital relationships, job issues and poor social interaction.

Meta-analysis of 24 studies has shown that child abusers are at a risk of diabetes, gastro-intestinal problems, arthritis, headaches, gynaecological problems, stroke, hepatitis, heart diseases.

Meaning of parents is synonym to someone who provide safety, security, love, and one who nurture and support. Ones environment is changed or if good and timely family and community support is available child can overcome the effects of trauma and can go to heal and thrive. To fight with child abuse everyone has to take start from own home, stop making your children victims of this issue that can spoil all his personality and psychology. Take care of your children, should educate them about good and bad and develop a habit of problem sharing with your children so that you can anticipitate if there is anything wrong to them.


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