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˜ Physical or psychological damage to a child

under the of 18 that is sustained as a result
of neglect or maltreatment usually by a
parent relative, caretaker ,baby sitter, or a
˜ „ccording to National Committee for the
Prevention of Child „buse:
˜ „bout 3 million cases of child abuse and
neglect were reported in 1994 each year in
the U.S.,
˜ child abuse and neglect cause 2000- 4000
deaths in each year
˜ 150,000 ±200,000 new cases of sexual
abuse are reported .
˜ „n estimated one of every three girls and
one of every seven boys will be sexually
assaulted by the age of 18 years.
˜ The actual occurrence rates are likely to be
higher than these estimates because many
maltreated children go unrecognized and
many are reluctant to report the abuse.
˜ Df these children who are physically
˜ 32% are less than 5years old, 27% are
between 5-9 years old, 27% are between 10-
14 years ,14% are between 15-18 years .
˜ Most child maltreatment is at the hands of
parents (75% ), other relatives (15% ) ,or an
unrelated caretaker (10% ).
˜ „busive parents have themselves been
victims of physical and sexual abuse and of
long term exposure to violent home lives of
pain which is a promoter of aggression
˜ „lso parents brought with harsh corporal
punishment and cruel treatment by their
own families may continue the abuse
tradition with their children.
˜ „dults believe that their methods are
acceptable ways of teaching discipline,
others are ambivalent about their methods
of abusive parenting but find themselves
without coping mechanisms and so fall into
behaviors similar to those of their own
˜ „buse occurs most often in the context of
volatile and dysfunctional interpersonal
relationships, violent marital relationships,
and heightened stress in the environment.
˜ Stressful living conditions such as
overcrowding and poverty, social isolation,
the lack of support system, and parental
substance abuse, unemployment, housing
problems, and lack of finances.
˜ Mental disorders can play a role as a
parent¶s judgment and thought processes
may be impaired.
˜ Parents who are depressed or psychotic,

or have severe personality disorders view

their children as bad or trying to drive them
crazy .
˜ Premature, mentally retarded, physically
disabled, and those who cry excessively or
are unusually demanding---- difficult child.
˜ The perpetrator of physical abuse is usually
the mother than the father.
˜ Dne parent is the active batterer and the
other passively accepts the battering.
˜ Men are the perpetrators in about 95% of
the cases of sexual abuse of the girls and
80% of cases of sexual abuse of boys.
˜ Perpetrators of sexual abuse are usually
known to the child and in many cases have
been victims of physical or sexual abuse.
˜ Physical abuse:
˜ Dbvious cases of abuse may present with bruises,
fracture, dislocation, burns, lacerations, signs of
intracranial bleeding, or abdominal injury.
˜ Malnutrition or dehydration may indicate water or
food deprivation.
˜ Physical abuse is also called (battered child
˜ Ms a form of child abuse in which caretaker
(usually the mother) brings the child with a
fabricated illness to medical attention.
˜ The caretaker may report nonexistent
symptoms in the child (apneic episodes),
alter a laboratory test (putting a blood in a
urine sample) or induce illness by various
methods (administering a symptom
inducing medication).
˜ Children are then subjected to unnecessary
medical work-ups and treatments.
˜ The diagnosis should be suspected in cases
involving children whose symptoms
disappears when separated from their
˜ There are a number of clues that suggest
that a child is or has been abused or
neglected, some of those are strongly
suggestive that sexual abuse has been
˜ „rrives at school early, leaves late.
˜ Nervous around adults, parent and males.
˜ Drug use.
˜ Withdrawal from social relationships.
˜ Deterioration in school performance.
˜ Poor peer relationships.
˜ „cts out aggressive feelings.
˜ Dverly complaints.
˜ Non participation in school activities.
˜ Running away from home.
˜ Regressive behavior.
˜ Suicidal feelings.
˜ Sleep changes, bedwetting, nightmares.
˜ Fears or phobias.
˜ Unusual sexual behavior, precociousness, or
˜ „ge inappropriate knowledge of sexual
˜ Seductiveness with males.
˜ Specific sexual problems, preoccupations,
avoidance, or behavior that is not age
appropriate .
˜ Somatic symptoms with sexual content (rare
but often specific).
˜ Excessive parental jealousy.
˜ Running away from home or childhood
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˜ „ father who is overly possessive.
˜ Favoritism towards the victim by father.
˜ Lack of intimacy in parental relationship.
˜ „ father or other male who is often alone
with his daughter for extended periods .
˜ Talking about sex with young children,
allowing children to witness sex between
adults are other forms of sexual abuse .
˜ 6rossly abnormal care can be the result of
conscious cruelty, lack of parenting skills or
unwanted parenthood.
˜ There is an increased incidence of emotional abuse
when the parents are mentally retarded.
˜ The most typical picture is failure to thrive in a
young child, the physician should look for
hypokinesis, apathy unhappy facial expression,
delayed responsiveness, malnutrition ,and
˜ Mnterviews should be conducted in a manner
that conveys respect and allows for utmost
˜ when interviewing a child ,do not suggest
answers, or press for accusatory responses.
˜ Do not display strong emotions to the child
gently ask the child to describe what
happened, drawing and dolls can be helpful.
˜ Tell the parents that they are required by
law to make a report to a child protective
service when abuse is confirmed or even
˜ When the parents suspect that another adult
has abused their child reassure the parents
that an honest , supportive and direct
approach with the child will lessen any
further emotional trauma.
˜ Use open ended questions with caretakers
such as: (How do you deal with the stress
of being a parent ?).
˜ (How is the child punished when he is