Parents and Guardians

• The relationship a child has with their parents or guardians is the most primary
• When this primary relationship is full of betrayal and mistrust, the child and his or her psychological growth and development is impacted greatly

What is Child abuse?

• It is unexpected form of mistreatment of a child whereby the survival, safety, self-esteem, growth and development of the child are endangered

Types of Child Abuse

1. Physical
2. Emotional
3. Sexual
4. Neglect

• Child Discipline is an expected parental response to specific misbehavior or failure of a child to meet expectations

Risk Factors for Child Abuse

Parent related

• Personal history of physical or sexual abuse as a child
• Teenage parents
• Single parent
• Emotional immaturity
• Poor coping skills
• Low self esteem
• Personal history of substance abuse
• Known history of child abuse

Lack of social support

• Domestic violence
• Lack of parenting skills
• Lack of preparation for the extreme stress of having a new infant
• History of depression or other mental health problems
• Multiple young children
• Unwanted pregnancy

Sexual Abuse

• Its appropriate sexual exposure or touch by an adult to a child or an older child to young one

Examples of sexual abuse

• Fondling
• Indecent Exposure
• Showing/creating pornography
• Incest
• Actual intercourse
• Child prostitution
• WHO estimates that 36-62% of all sexual assault victims are aged below 15 years

Indicators of sexual abuse

Physical

• Difficulty in walking or sitting
• Torn, stained or bloody underclothing
• Pain or itching in the rectal/ genital area
• Bruises or bleeding in rectal/genital area

Behavioral

• Age-inappropriate sexual knowledge
• Changes in personality
• Sleep disturbances
• Drop in school performance

Neglect

• This is failure to provide sufficient food, clothing, shelter, medical care, education to the child

Physical indicators

• Constant hunger
• poor hygiene
• inappropriate clothing

Behavioral indicators

• Begging or stealing food
• Frequent sleepiness

Emotional/Verbal Abuse

• Its intentional verbal or behavioral acts that result in adverse emotional consequences as rejection, isolation, constant criticism

Physical indicators

• Speech disorders
• Lag in physical development

Behavioral indicators

• Conduct disorders(withdrawal, destructiveness)
• Behavioral extremes(aggressive or passive)

By far however, most of the abusive words used on and by the children in Kenya have sexual connotation

Cultural violence

• Forced Circumcision/Female Genital Mutilation(FGM)
• Early/child and forced marriages

They are grounded in traditions and custom, and which negate basic human rights as observed in the constitution of Kenya

• 1 in 3 girls worldwide are married before the age of 18, and 1 in 9 before the age of 15. Areas with the highest rates of child marriage are Sub-Saharan Africa and South Asia.

Shaken Baby Syndrome (SBS)

• Can be a fatal form of child abuse. Characterized by intracranial hemorrhage, retinal hemorrhage and loss of consciousness due to vigorous shaking of the infant

Facts on SBS

• Shaking is more likely to be done by a male, fathers make up 76% of all shakers
• If the shaker is female its more likely to be the baby sitter
• About 70% of the victims are killed, other 30% live with severe permanent injuries
• 1 in 4 babies die as a result of SBS

Battered Child

• It’s a clinical condition characterized by repeated intentional acts of trauma to a young child. Deprivation of food and water is a variant of this trauma. Also called child abuse syndrome or non-accidental injury.

Spectrum of injury

• Soft tissue injury
• Thermal injury
• Skeletal injury
• Internal injuries(brain, abdomen or eye)

Physical violence in Kenya

• In a study-Perpetrators-Teachers (24%), followed by school mates (19%) and lastly friends (14%), parents accounted for 20% of the mentions with mothers (at 11%)
• The most common-via use of a stick, rod, belt or plastic flip.
• Other forms include kicking, slapping, pinching, punching with more severe forms of physical abuse, like burning by pouring hot liquid or using a hot rod and cutting also existed

What are the consequences of child abuse?

• Affective and behavioral disorders
• Developmental delay and learning difficulties
• Failure to thrive and growth retardation
• Low self-esteem, multiple sexual partners
• Low enrollment in schools with multiple dropouts
• Predisposition to adult psychiatric disorders
• Death or disability in severe cases
• STDs, HIV and unwanted pregnancy from sexual assault
• Suicidal attempts
• Addictions e.g. Alcohol and other substances
• An increased risk of the abused becoming an abuser leading to Abuse cycle

History of Child abuse

• A delay n bringing the child to the hospital
• A significant discrepancy between the history given by parents and the clinical findings
• Unexplained malnutrition
• Inconsistent or vague explanation
• Reports by the patient of sexual activities with the parent
• Tearing, bruising and specific inflammation of the mouth or genitals
• Pregnancy and the girl is evasive in naming her partner

Why child abuse is often NOT reported?

• Culture- stigma for victim
• Victims are often young children
• Health professional unaware of signs and symptoms
• Health professionals unwilling to report
• The child-might be afraid, threatened, not hurt, did not feel like, forgave the perpetrator, think no one would believe them, thought they had made a mistake or did not know where to report

What is your role in child abuse?

1. Protect- Protect the life of the patient, patient/family safety is paramount
2. Suspect- Does the history fit what you are seeing either injury or illness? Is this a repeat patient or family member of repeat patient? Is there a history of family violence?
3. Collect-collect as much evidence as possible including physical and trace evidence and information

Any solutions to child abuse?

1.  Guidance and counseling/psychotherapy for the older children
2.  Skilling and empowering the children-skills and knowledge to protect themselves
3.  Parental education/sensitization
4.  Having better structures and more institutions (like orphanages)-child protection desks/refuge centers
5.  Enforcement of the law.