Battered child syndrome (BCS)

Introduction
Battered child syndrome refers to non-accidental injuries sustained by a child as a physical
abuse, usually inflicted by an adult caregiver. Battered child syndrome is any act of physical,
sexual or psychological aggression, negligence or intentional neglect a minor.

Incidence
According to one estimation; approximately 2.9 million cases of child abuse are reported each
year worldwide, in 2012 ,80% of these committing the abuse were parents .Occasionally
abused kill one or both of their parents which is known as parricide. The total abuse rate of
children is 25.5 per 1000 children, with physical abuse accounting for 5.7 per 1000, sexual
abuse 2.5 per 1000, emotional abuse 3.4 per 1000 and neglect accounting 15.9 per 1000
children.

Causes/risk factor
 Lower income
 Psychological condition of parents
 Incessant crying and whining
 Perceived excessive fussiness and disobedient
 A toddler failed toilet training
 culture tradition
 absused child
 single parenthood
 lack of education
 alcoholism and other drug addiction

Sign and symptoms

Physical signs
 Bruises that match the shape of hand, fist or belt
 Cigarette burns; scald marks; black eyes
 Unconsciousness
 Lash marks; bruises or choke marks around necks; circle marks around wrists or ankles
(indicating twisting)
 Separated sutures; unexplained unconsciousness ; and a bulging fontanel in small
infants
 Poor performance in school
  Lose weight or fail to gain weight appropriate to age
Emotional/psychological signs
 A poor self-image
 Sexual acting out
 An inability to love or trust others
 Aggressive, disruptive or illegal behavior
 Anger more quickly ,cry more often
 Show signs of clinginess
 Anxiety, panic, and irritability
 Self- destructive or self-abusive behavior
 Suicidal thoughts
 Passive or withdrawal behavior
 Fear of entering into a new relationships or activities
 Sadness or other problems of depression
 Flashbacks or nightmares
 Drugs or alcohol abuse

Diagnosis
 Delayed visit to the emergency room with an injured child
 An implausible explanation of the cause of the child’s injury
 Repeated hospital visit and absurd complains by parents
 Physical examination
 X-ray, MRI ,CT,USG

Treatment
 Medical treatment will vary according to the types of injury
 Counseling and the implementation of an interventions plan
 Placement of the child with an outside caregiver or returning the child to the home
 Physical and psychological therapy
 interventions counseling and training in good parenting skills
Pre hospital care
  The initial statement of the mechanism of injury should be carefully documented.
 In case of abuse ,the family may change the story and the initial history may become
critical
 Observation and concern should be conveyed to the hospital personnel and Detail
description report should be written

Most importantly the emergency service provider must report to child protective services
when the abuse is suspected

Emergency department care

 The initial medical treatment of the physically abused child in the emergency
department should proceed no differently from treatment of any injured child.
 Initial assessment and treatment of the seriously physically abused child should
proceed according to established guidelines such as Advanced Life Support .Intra cranial
lesions should prompt neurosurgical consultation for management and decision for the
need of surgery. Such interventions should be guided by clinical examination CT scan
,and other investigations
Blunt abdominal trauma from child abuse should be identified quickly and treated
aggressively because of its attendant high mortality
 All patients with suspected head injury should be kept in cervical precautions until the
spine is cleared
 Documentation of the history and findings and report to the authorities

Policies for child protection

 UNICEF works to improve the policies and service that protects all children. It aims to
make the world a safe place for children to thrive. The child protection programme aims
at preventing and responding to violence, exploitation, abuse and neglect of children,
including in emergency contexts.
The major results of the protection programme are given below;
 Child protection system strengthening
State institutions and other partners have increases capacity to legislate, plan and
budget to prevent and respond to child protection concerns including during
humanitarian situations.
 Prevention of violence and exploitation
Children, families/care givers, teachers, communities and state institutions have
improved knowledge, skills and capacity to prevent and respond to violence (violent
discipline, gender-based violence and child marriage)and exploitation .
 Justice for child
 Justice/security professionals and gender sensitive services to protect children in
contact with the justice system.
Achievement of these results will be measures through;
 Less use of violent discipline(physical or psychological)
 Less children engaged in child labor.
 Less children living in residential care institution
 More cases of violence against children reported to the police
 More justice and security personnel capacitated on child friendly and gender sensitive
justice for children.
 More community groups members trained on measures to prevent and respond to
violence and exploitation(violent discipline, child labor child trafficking and child
marriage)