Dr. Nwagbo (Resident Doctor)

Child abuse is the one deliberate maltreatment of the child either through direct physical “assault”, neglect, emotional abuse, sexual exploitation, etc. it also includes fabrication of illness such that the child is exposed to the pain and discomfort of unnecessary physical investigations e.g. lumbar puncture, needle pricks, etc.

FORMS OF CHILD ABUSE

1. Physical abuse (non-accidental injury)
2. Emotional Abuse
3. Sexual Abuse.

Sexual abuse refers to the involvement of children in sexual activities which they do not fully comprehend and to which they cannot give informed consent. This violates generally accepted cultural rules and also covers some activities like posing for pornographic  photographs or films.

Emotional abuse refers to persistent neglect or rejection of the child and this affects his development. This comes in form of frequent belittling or sarcastic remarks about a child from the parents.

Physical abuse is a term used when serious physical injuries are inflicted by adults on a child.

CAUSES OF CHILD ABUSE

Some risk factors are usually identified either in the abuser, the abused or in     both.

1. Sexually deviant behavior in the abuser.
2. Lack of moral conscience in the abuser
3. Lack of cultural restraint by the environment
4. Excessive fear of adults in the child
5. Ignorance that sex is wrong for a child in the abused
6. Presence of mental illness in the abuser or parents of the child
7. Poor parenting skills
8. Lack of awareness of child’s abuse status by parents
9. Presence of a stranger in the home
10. Lack of home supervision especially from nuclear family members
11. Mentally retarded child
12. Criminal behavior in people living around the child
13. Persistently sick children

The Abused Child

Most the abused children are between 4 months to 18 years of age whist children of about 12 years are mostly involved. Most of the brutally beaten kids of about 3-4 years are abnormal children who may need medical attention.

HOW TO PREVENT CHILD ABUSE

By the community

The first part of treating child abuse is to ensure the child’s safety and well being. This often requires admission to hospital. Subsequently, some children can be managed at home, but some need foster care.

1. If help is feasible, it should be intensive and should probably focus on changing patterns of parenting skill to improve parental function.
2. Diminish the social or environmental stress on family if possible.
3. Reduce the adverse physchological effects of social problems on the parents through counseling groups, religious activities.
4. Reduce the demands on the child’s smother to a bearable level through day care placement of the child or provision of a house keeper or baby sitter among others
5. Provision of emotional support for the child
6. Ensure effective home supervision.

By the health team

To prevent child abuse, clinicians must identify those families at high risk and intervene before a child becomes a victim. Once high risk families have been identified, a comprehensive program should include psychiatric monitoring of the families including the identified high risk child. Families can be educated to recognize when they are being neglectful or abusive and alternative coping strategies can be suggested.

In general, child abuse prevention and treatment programs should try to prevent the separation of parents and children if possible, prevent the placement of school in institutions, encourage parental attainment of self care status and encourage the families’ attainment of self-sufficiency.

The outcome of treatment

The outcome of child abuse depends on the severity, duration and nature of the abuse, parents’ readiness to help child and the child’s vulnerability. It could be a success story if the community, the health workers and child’s caregivers are ready to monitor progress consistently. Children who already suffer from mental retardation, psychiatric problems, physical disability, disruptive behavior and attention deficit problems are likely to have a poorer outcome than children who are unhampered by mental or physical problems. Children who have been subjected to physical abuse are at high risk of further problems, for example, the risk of further severe injury, mental problems, delay in development, learning difficulty and sometimes development of criminal behavior.