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Sujeewa Amarasena
Child Abuse
Original Definition
Prevalence
Child Abuse
Usually caused by
A related care-giver
Sex abuse usually by males, rarely
by females
Physical abuse/Sexual abuse also by
females
Common
When the father is unemployed,
Drug addict or Alcoholic
A male friend of the mother
Abuser
Parents/ Care givers
Young parents>older parents
Both in physical abuse and neglect
Sexual abuse men>women
Poisoning, suffocation and Munchausen
by proxy
mother
No mental illness usually
Personality traits
Predisposing to violent behavior or
inappropriate sexual behavior
All layers of society but more in poor
Inter generational transmission
Child Abuse
Prevalent in
Physical abuse
Nutritional neglect
Sexual abuse
Intentional drugging / Poisoning
Munchausen syndrome by proxy
Neglect
Emotional abuse
Child labour & Conscription of children
in war
Physical abuse
Importance
Influence childs future
Life vs death
Permanent handicap
Emotional abuse
Deprivation will cause progressive
and permanent damage to personality
esp older children
Diagnostic features
1.
2.
3.
Physical abuse
Definition
Physical abuse may involve hitting, shaking,
throwing, poisoning, burning or scalding,
drowning, suffocating, or otherwise causing
Physical harm to a child. Physical harm may
also be caused when a parent or carer feigns
the symptoms of, or deliberately causes, ill
health to a child whom they are looking after
this situation is commonly described using
terms such as factitious illness by proxy or
Munchausen syndrome by proxy
Single injury
Multiple injuries
Patterns of injuries
Accidental vs intentional
History- story
Discrepancy
Scale and severity
Conceal
No medical treatment
Indicators
Bite marks
X-rays
X-rays
X-rays
Emotional abuse
Definition
Emotional abuse is the persistent emotional ill
treatment of a child such as to cause severe and
persistent adverse effects on the child's emotional
development. It may involve conveying to children that
they are worthless or unloved, inadequate, or valued
only insofar as they meet the needs of another person.
It may feature age or developmentally inappropriate
expectations being imposed on children. It may
involve causing children frequently to feel frightened or
in danger, or the exploitation or corruption of children.
Some level of emotional abuse is involved in all types
of ill- treatment of a child , though it may occur alone.
Indicators
Sexual abuse
Definition
Sexual abuse involves forcing or enticing a
child or young person to take part in sexual
activities , whether or not the child is aware of
what is happening. The activities may involve
physical contact, including penetrative (eg: rape or
buggery) or non-penetrative acts. They may
include non contact activities, such as involving
children in looking at , or in the production of ,
pornographic materials or watching sexual
activities, or encouraging children to behave in
sexually inappropriate ways.
Indicators
Hardly seen
Domestic sexual
abuse of boys
Iceberg phenomenon
Sexual Abuse
Conclusions
Commonly Prevalent
Common among relatives, Incest
In lower social classes, the
incidence of sexual abuse is high
Neglect
Definition
Indicators
Measurable deficits
Eg: polio
Vs CAN
Developmental delay
Personality problems
Conduct disorder
Psychiatric illnesses
eg: Depression
Sexual disorders
sexual dysfunction, sexualized behaviour,
prostitution, self mutilation
Eating disorders
Childhood
experience
Possible outcome
Understimulation
Developmental delay
Emotional neglect
Emotional abuse
Excessive
punitiveness
Family violence
Conduct disorders
Sexual abuse
Sexualized behaviour
self mutilation
Eating disorders
Depression
Child Labour
Definition
Child labour
Sending
Community
4076 families
1022 children employed
Estate, rural, armed conflict, inner
city slums
Estate 51.8%
Agriculture 19.2%
Labour 11.2%
Other
Child labour
8% in Galle
4% in admissions
2.5% (<14 years) 7574 children
(NCPA indirect survey)
Child labour
Working children
Management
Rehabilitation / follow up
Care plan
Judiciary
case conference
Police, Judicial Medical officer
probation, Paediatrician , Psychiatrist
Average
Hospital admissions
Paediatrics ward
Surgery ward
Gynecology
Obstetrics &
wards.
Attendance
Paediatrician
AJMO/ JMO
Probation officer
Police officer
Psychiatry registrar or written
opinion
Paediatric
Registrar/Registrars/House officer
Parents, guardian , some times child
One medical student
Detail discussion
Probation report
Decisions in the best interest of
the child
50% within 4 weeks in 2002
Placement
Follow up
Childrens home
Relatively easy
Home
Difficult
Compliance poor
Ground realities & logistics
difficult
CRPO / PO
Access difficult
Workload heavy
6 PO
20 now
better
Three wheelers
Motor bicycles
STD Follow up
1.
2.
3.
VDRL positive
1 case
Gonococcus
1 case
Herpes
1 case
Over 8 years rare.
Education follow up
Childrens home
Birth certificate
Leaving certificate
PO / CRPO need to attend
Principal give it to the guardian
Court orders are needed
Case story
Teacher with 3 children
Father ran away to Italy. Sold the house
Big - National school .
Did not give the leaving certificate
Court order
children
Monitoring
Children's homes
ROLE OF POLICE
OFFICERS
1. AS A
POLICE OFFICER
2. AS A PARENT
3. AS A CITIZEN
AS A police officer
HAVE PRINCIPLES
CANNOT TAKE A SIDE
DO NOT TAKE PART IN
UNETHICAL CONDUCT
BE FREE OF PERSONAL ,
POLITICAL BIASES
AS A PARENT
AS A CITICIZEN
WHAT WILL YOU DO
Reality
Case detection
1996 - Personal intervention
A 13 yr old boy sexually abused by 2
adults.
Paid Rs. 20/-,
I took him to police station in my
car
Severe anal trauma, VDRL
positive.
Evidence in courts, Fined Rs 1500/=
2002 School
teacher
Drawing of a child ,
CRPO
Referred to police by
me.
I reported to
police. Pending
on 19/3/2007
2006 - Community
A child physically abused by the
father
Head hit on the wall
Neighbor intervened
Father cut the penis.
The child ran bleeding and
collapsed.
Estate watcher picked up & ES
drove to
hospital
E.g.: 06.03.2007
Provision of support
Case : A 13 yr old girl with RAP in a medical
ward.
Referred to me due to P/H CSA.2002 at 8 y
Handled by us.