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GROUP MEMBERS

OYEM SHARON- BHU/17/01/01/0038
PATI JUDE STEPHEN- BHU/17/01/01/0141
OWOYELE GRACE MOYINOLUWA-BHU/17/01/01/0124
PETERS DENISE ONUKWA- BHU/17/01/01/0195
OPUTA DIVINE IJEOMA- BHU/17/01/01/0299
OMONIYI ROTIMI SAMUEL- BHU/19/01/01/0076
ONUORAH ALEXANDRA ONYINYECHI-BHU/17/01/01/0036
OYIGUH OJOCHEGBE AMANA- BHU/17/01/01/0295
OTOJARERI ESEOGHENE MARGARET- BHU/17/01/01/0196

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OUTLINE

INTRODUCTION
TYPES OF CHILD ABUSE
CAUSES OF CHILD ABUSE
EFFECTS OF CHILD ABUSE
CLINICAL ASSESSMENT OF CHILD ABUSE
COMPLICATION
PREVENTIONS
LAWS AGAINST CHILD ABUSE AND PROTECTION AGENCIES/CHILD RIGHTS
CONCLUSIONS
REFERENCES

GROOUP 2 PRESENTATION

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INTRODUCTION

Two centuries ago, cruelty to children, perpetrated by caregivers, teachers, and employers was widespread, and corporal punishment customary in many countries.
Although child abuse occurs in Nigeria, it has received little attention, this is probably due to the emphasis placed on the more prevalent childhood problems of malnutrition and infection. Another possible reason is the general assumption that in every African society the extended family system always provides love, care and protection to all children.

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WHAT IS CHILD ABUSE ?
WHO, defines child abuse and child maltreatment as "all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power”.
studies reveal that nearly 3 in 4 children aged 2-4 years regularly suffer physical punishment and/or psychological violence at the hands of parents and caregivers,1 in 5 women and also 1 in 13 men report having been sexually abused as a child.
Every year, there are an estimated 40,150 homicide deaths in children under 18 years of age, some of which are likely due to child maltreatment.

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Types of child abuse

There are 4 types of child abuse:

1. Physical abuse

This happens when a child has been hurt or injured, and it is not an accident. It may not always leave visible marks or injuries.
Physical abuse can include:
Hitting, shaking, choking, throwing, burning, biting or using physical restraints.

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2. Sexual abuse

Child sexual abuse happens when an adult or teenager uses their power or authority to involve another child in sexual activity.
Sexual abuse can be physical, verbal or emotional, including:
kissing, holding or fondling a child in a sexual way, exposing genitals to a child, talking in a sexual way that’s not appropriate for the child’s age, penetrating a child’s vagina or anus by penis, finger or other object, showing pornographic films, magazines or photographs to a child, oral sex, rape, incest, child prostitution.

Woman, caught raping 14-year-old, now pregnant with boy's child

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Emotional abuse

Emotional abuse happens when a child is treated in a way that negatively impacts their social, emotional or intellectual development.
Emotional abuse can be caused by:
Rejection, name calling, teasing or bullying, criticism, isolation or locking a child up for extended periods, exposure to domestic and family violence.

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4. Neglect

Neglect happens when a child's basic needs are not met, affecting their health and development. Basic needs include:
Food, housing and clean living conditions, health care, adequate clothing, personal hygiene, and adequate supervision.

ALMAJIRI SYSTEM IN NORTHERN NIGERIA.

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CAUSES OF CHILD ABUSE

POVERTY

Feeding
Education
Healthcare
Child labour

PARENTS CHILDHOOD EXPERIENCES
LACK OF PARENTAL SKILL

Minimal knowledge on basic childhood development

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FAMILY CONFLICT

Spousal domestic violence
Divorce

STRESS

Finances
Terminal illness
Work etc

MENTAL AND PHYSICAL DISORDER

Dealing with a disabled child
Parent with mental illness

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NON BIOLOGICAL RELATIONSHIP TO CHILD

Foster parent households
Step parents
Extended family
Caretakers

UNREALISTIC EXPECTATIONS FOR CHILD

Comparison
Living childhood experiences through child

LACK OF SUPPORT FROM FAMILY MEMBERS AND RELATIVES

This includes spousal support and neglect

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ADDICTION

Substance abuse
Gambling
Sex

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EFFECTS OF CHILD ABUSE

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Child abuse and neglect often live long term scars on the child, ones that are difficult to erase from the mind and body.
It can have a massive impact on the way the child will manage relationship during adulthood and can dent their self confidence.
Children are unable to function normally at school, college or work when they grow up.

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ASPECTS IN WHICH CHILD ABUSE CAN AFFECT A CHILD

PHYSICAL EFFECT
SEXUAL EFFECT
SOCIAL AND BEHAVIOURAL EFFECT
MEDICAL AND PHYSIOLOGICAL EFFECT
EFFECT ON WITNESSING CHILD

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PHYSICAL EFFECT

The children may show symptoms of fatigue and constant tiredness. They may fall asleep in school due to the lack of sleep at home.
Children who are victims of domestic violence are often frequently ill, and may suffer from poor personal hygiene. Children who witness domestic violence also have a tendency to partake in high risk play activities, self-abuse, and suicide.

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SEXUAL EFFECT

Disturbances in desire, arousal and orgasm may result from the association of sexual activity, violation and pain.
Survivors of sexual child abuse might have had several sexually transmitted diseases such as human immune-deficiency virus(HIV)
They may also have high risk of damaging their genitals like VVF(vesicovaginal fistula) in females.
early adolescent or unintended pregnancy and prostitution.

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SOCIAL AND BEHAVIOURAL EFFECTS

Children exposed to domestic violence frequently do not have the foundation of safety and security that is normally provided by the family as such, The children experience a desensitization to aggressive behavior, poor anger management, poor problem solving skills, and learn to engage in exploitative relationships.
The adolescent may display these symptoms by joining a gang or becoming involved in dating relationships that mimic the learned behaviour.
Children may think that violence is an acceptable behavior of intimate relationships and become either the victim or the abuser.

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MEDICAL AND PHYSIOLOGICAL EFFECTS

These include temporal to permanent damages to body part and mind such as injuries, fractures and mental health problems
Depression is a common problem for children who experience domestic violence. The child often feels helpless and powerless. More girls internalize their emotions and show signs of depression than boys. Boys are more apt to act out with aggression and hostility.
Post traumatic stress disorder (PTSD) can result in children from exposure to domestic violence. Symptoms of this are nightmares, insomnia, anxiety, increased alertness to the environment, having problems concentrating, and can lead to physical symptoms.

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EFFECTS ON WITNESSING CHILD

These effects are on children who witnessed any form of abuse(e.g between parents) but were not directly abused by the abuser;

Child grows to become violent
Poor feeding and sleeping routines are disrupted
Frequent illness
Irritability, sadness, anxiety
Need for attachment is disrupted
Startles easily

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CLINICAL ASSESMENT OF CHILD ABUSE

This simply means the clinical approach by a physician to the evaluation of suspected abuse in children.

Such assessments are collaborative and multidisciplinary because the diagnosis of child abuse is a combination of clinical features rather than a single diagnostic test.

This examination goes beyond physical symptoms but significant mental health problems are assessed.

Individual family variables are considered example; domestic violence, substance abuse and the mental health of the parents.

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The physician is able to come to a logical conclusion of an abuse by conducting a;
i)Detailed medical and social history
ii)Thorough physical examination
iii) Laboratory tests and
iv) Radiological photographs
The general purpose of a medical assessment/ examination is threefold;
To assist with the interagency assessment as to whether abuse has occurred.
To ensure that any evidence which is collected and presented is of a high quality thus ensuring that the child has the optimum level of protection and support.
Lastly, to ensure that the wider health care needs of the child are fully identified and arrangements are made to meet those needs

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1.History taking�

The history is that portion of the medical assessment that describes the factors related to abusive incident(s) in a clear, chronological narrative.

History should be obtained in a nonaccusatory manner and should include details of injuries or incidents, the patient's medical and social history and information from witnesses.

HISTORY TAKING STEPS

There are three steps involve in the history taking process

1.Building report:

Both the child/adolescent and the parent/ caregiver needs to trust a medical provider in order to provide complete information, agree to the physical examination, and be open to the therapeutic experience that the visit can provide. Building rapport begins as soon as you interact with them.

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2.Taking a history from the non-offending parent/caregiver without the child/adolescent present:

After a brief time with all the family members together make a move to taking a history from the parent/ caregiver. Reassure the child/adolescent that you will be talking with him/her shortly.

3.Taking a history directly from the child/adolescent:

Every effort should be made to take this history without other family member presents. If there are siblings present, interview each separately.

THE SOCIAL HISTORY

A social history should include the following;

Information about the child/adolescent( name, home address, date of birth, sex, ethnicity, place of birth, school attended and grade level etc.)

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Information about the parent(s)/caretaker(s)[name ,home address, work address, telephone number, country of origin, name(s) of child’s legal guardian if other than the parent(s), name(s) of those involved in child care.

THE MEDICAL HISTORY

The medical history should contain information about the following: 1.Chief complaint:

Accurately record in the parent/caregiver’s own words the reason for evaluation.
Document the cause(s) or concern(s) that precipitated or prompted the necessity for an evaluation of abuse(e.g obvious injury, disclosure on the part of the child, a witness to the event(s), suspicions based on behavior changes etc..) 2.Past medical history:
Developmental history
Previous injuries or hospitalizations
Allergies
Other medical problems

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3. Family health history:

History of bleeding disorders or bleeding in a family member

Other inherited illness(osteogenesis imperfecta, collagen vascular disorder)

History of growth delay in siblings, parents, or relatives

Abuse in other family members

ENDING THE HISTORY TAKING

Before proceeding with the physical examination explain to the patient that the purpose of the head-to-toe examination is to ensure his/her well-being. This will help the child/adolescent prepare for the physical examination.

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2. Physical assesment

The physical assessment consists of preparing the child for a general, genital examination and when appropriate, the collection of physical evidence. Accidental injuries often occurs on bony prominences while inflicted injuries tend to occur in protected areas ,such as the neck, buttocks, trunk and upper arms. The TEN 4 bruising clinical decision rule may be useful to identify children and infants who should be evaluated for physical abuse. The TEN-4 rule states that bruising on the torso, ear or neck in a child four years or younger ,or bruising of any region in a child younger than four months requires further evaluation for abuse.

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The physical examination should include:
-A full physical examination; child's general appearance, vital signs, nutritional status, growth parameters.
-Skin examination.
-Genital examination
-An injury specific examination( extremities, neurological).
- Dental and mouth assessment
All children with suspected abuse should be examined in a hospital gown to facilitate a full examination. Parental interactions should be documented in objective and not subjective terms

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3.Laboratory Assessment

In cases of physical abuse the laboratory is commonly used to determine the extent of tissue damage. Now if there’s little suspicion of injury laboratory assessment is of little value.

Laboratory assessment involves the following:

Evaluation for bleeding disorders

When child abuse is suspected and bruises are present, clotting studies to evaluate for abnormal bleeding. A detailed workup by a hematologist may be required if there is bleeding disorders.

These are some recommended laboratory test:

Platelet count

This is because thrombocytopenia is the most common cause of bleeding.

Complete Blood Count (CBC)

This is to evaluate for specific hematologic disorders and sexually transmitted diseases (STDs) in cases of sexual abuse.

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Evaluation of visceral injury

Abdominal trauma is particularly a sign of trauma. A complaint of abdominal pain and hemodynamic compromise increases suspicion to intra-abdominal injury. The following injuries are commonly associated with abuse; pancreatic trauma, duodenal trauma and liver trauma.

Recommended screening test includes the following:

Kidneys (Urinalysis for evaluation of blood in urine)
Bowel or rectum (stool guaiac fot evaluation of rectal bleeding)

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4. Radiological investigation

This involves the use of imaging to diagnose patients. It is usually recommended for all cases of suspected abuse in children younger than 2years, children older than 5yrs can usually give a sufficient history of pain. once a child is suspected to be abused, radiological investigation must be carried out involving the whole skeletal system including chest radiograph. Fractures in children due to inflicted injury(abuse) can be divide into

1.HIGHLY SPECIFIC INJURIES: these include CML’s(chronic metaphyseal lesion), scapular fractures, spinous process fractures, sternal fractures and Rib fractures(anterior and posterior rib fractures in children younger than 3 years are more specific for inflicted injury than lateral rib fractures which occurs accidentally).

.2.MODERATE- SPECIFICALLY FRACTURES: these includes multiple fractures( especially in bilateral), epiphyseal seperation, vertebral body fractures, digital fractures and complex skull fractures,

3.COMMON BUT LOW-SPECIFICITY FRACTURES: these include clavicle fractures, long bone shaft fractures(especially in a non ambulant child), and linear skull fractures, which could also happen accidentally.

NOTE: A radiologist should be able to rule out rare inherited bone disorders like osteogenesis imperfecta

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The above diagram shows subdural hemorrhage indicating rotational brain movement. This is a condition of Abuse head trauma(shaken baby syndrome),It is as a result of severe/forcefully shaking of infant and small children in anger or frustration by thier parents or caregivers, often because they wont stop crying, it can cause permanent brain damage.

Note:Epidural hemorrhage is more common with accidental injury than with child abuse injury.

CML/Bucket handle fractures are observed in children less than 2 years of age, this occurs as a result of forcibly pulling or twisting the limbs.

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COMPLICATIONS

Premature death
Childhood disabilities
Substance use
Psychopathology(anxiety disorder, depression,PTSD,Eating disorders)
Poor academic output
Poor interpersonal relationships

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PREVENTION

PRIMARY

-parent and child education

-Screening for psychosocial risk factors

-advocacy against child abuse

-improve living conditions

SECONDARY

-early diagnosis and adequate treatment of identified conditions

TERTIARY

-rehabilitation to minimize disability arising from child abuse

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LAWS AND AGENCIES AGAINST CHILD ABUSE/ CHILD RIGHTS

Whenever an abuse on a child occurs and its brought before the court, the court considers the severity of punishments based on age, gender, severity of abuse, socioeconomic background and other factors . Acts on the laws already in place and exert verdicts.

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CHILDREN OCCUPY A SPECIAL PLACE IN THE LAW!!

PLEASE HELP ME

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When a child is assaulted, abused, exposed or neglected in a manner to cause physical or mental, they are laws and agencies set in place to protect children from harm or persons irrespective of who they are. They could be a group, agencies such as; institutions, non governmental organizations and Governmental organizations.

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AGENCIES AGAINST CHILD ABUSE

UNICEF(United nations international children emergency fund)
WOTCLEF (women trafficking and child labour eradication foundation)
NACCRAN(National Council of Child Rights Advocates of Nigeria)
ANPPCAN( African Network For The Prevention And Protection Against Child Abuse And Neglect)
ECOWAS Declaration on the fight against trafficking in persons including children.
CRAGON(Child Rights Advocacy Group of Nigeria)
NATIONAL AGENCY FOR THE PROHIBITION OF TRAFFICKING IN PERSONS

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LAWS AGAINST CHILD ABUSE

The federal, state and local government have passed laws to protect abused children and further abusing of children In the nation and these laws include;
The Child Right Act(CRA) 2003
Ebonyi State Law N0.010(2001)on the abolition of harmful traditional practices against children and women.
Edo state female child genital mutilation(prohibition) law 2002.
Anambra state banning of children from hawking during school hours.

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CHILD RIGHTS

In 1989, against the backdrop of a changing world order world leaders came together and made a historic commitment to the world’s children.
They made a promise to every child to protect and fulfill their rights, by adopting an international legal framework – the United Nations Convention on the Rights of the Child.
The Convention says:

Childhood is separate from adulthood, and lasts until 18; it is a special, protected time, in which children must be allowed to grow, learn, play, develop and flourish with dignity.

The Convention went on to become the most widely ratified human rights treaty in history and has helped transform children’s lives.

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PROMOTION TO CHILD RIGHTS

THE (4) GENERAL PRINCIPLES:

a) All rights to be recognized for each child in the jurisdiction without discrimination on any ground (Article 2)

b) The best interests of the child to be a primary consideration in all actions concerning children (Article 3)

c) Right to life and maximum possible survival and development (Article 6)

d) Respect for the child’s views in all matters affecting the child; opportunity to be heard in any judicial or administrative proceedings affecting the child (Article 12)

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IMPEDIMENTS

IGNORANCE

SOCIAL, CULTURAL, RELIGIOUS NORMS

LACK OF POLITICAL WILL

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CONCLUSION

Child abuse contributes significantly to morbidity in childhood with ominous consequences in adulthood. The nature of children make them vulnerable to abuse and prone to violation of their rights. Ensuring their survival and protecting their rights , even in the most dire circumstances is paramount to humanity having a secured future.

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REFERENCES

Who.int/news-room/fact-sheets/detail/child-maltreatment
Azubuike Nkangineme, 2011, Paediatrics and Child Health in a tropic region, 2^nd Edition.
https://www.healthline.com/health/mental-health/types-of-child-abuse#:~:text=Child%20abuse%20is%20any%20mistreatment,responsibility%20in%20the%20child's%20life
Please contact Prof E. E. Eseigbe at eeeseigbe@yahoo.com

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