Professional Documents
Culture Documents
Elizabeth Park
Child Abuse
There are different forms of child abuse
Neglect Physical abuse Emotional abuse Sexual abuse
Neglect
Defined by Children First Guidelines An omission, where a child suffers significant harm or impairment of development, by being deprived of
Food Clothing Warmth Hygiene Intellectual Stimulation Supervision and safety Attachment to, and affection from, adult Medical care
Neglect
Generally becomes apparent over a period of time, rather than a specific time point Eg- child suffers series of minor injuries (supervision and safety) Child is failing to thrive- may be being deprived of adequate nutrition Child consistently misses school- deprived of intellectual stimulation
Threshold of significant harm- childs needs are neglected to the extent that his or her well being and/or development are severely affected.
Signs
Abandonment and children left at home repeatedly without adequate supervision Malnourishment, lack of warmth, lack of adequate clothing Lack of protection and exposure to danger Failure to attend school
Emotional Abuse
Normally to be found in the relationship between a caregiver and a child (as opposed to specific event or pattern of events) Childs needs for affection, approval, consistency, security not met Rarely manifested in terms of physical symptoms
Unrealistic or inappropriate expectations of a childs capacity to understand something or to behave and control himself in a certain way Over or under protection of the child Failure to show interest in or provide age appropriate opportunities for childs cognitive and emotional development Use of unreasonable or over harsh disciplinery measures Exposure to domestic violence
Emotional abuse demonstrated by childs 1)behaviour- excessive clinginess or avoidance of parent/ carer 2)emotional state (low self esteem, unhappiness) 3)development (non organic failure to thrive) Threshold of significant harm reached when abusive interactions become typical of the relationship between the child and the parent
Physical Abuse
Any form of non accidental injury that causes significant harm to a child
Shaking Use of excessive force when handling Deliberate poisoning Suffocation Munchausens syndrome by proxy Allowing or creating a substantial risk of significant harm to the child
Sexual Abuse
Sexual abuse is probably the most emotive and is currently topical due to the recent Ryan report outlining abuse in Church run settings A recent survey in the USA using a nationally representative group of parents and children found that 82 of 1000 children had been sexually victimised in the previous year Difficulty in reporting exact numbers, as very young children or children with learning disability may not be able to communicate
Examples ctd
Masturbation in the presence of a child or involvement of the child in the act of masturbation Sexual intercourse with the child, whether oral, vaginal or anal Sexual exploitation of a child Consensual sexual activity between an adult and a child under 17 years
Behavioural effects are influenced by the childs age, development, physical acts performed, threats and bribes, fear of retribution, fear of culpability, chronicity of acts, childs resiliance and relationship with the perpetrator, and effective treatment
Physical consequences
A careful or experienced perpetrator will be unlikely to perform acts that will result in his or her detection Immediate suspicion is more likely if the child has severe pain, bleeding, tissue injury, unless the perpetrator can prevent this from being noticed, eg by keeping child home from school Findings after penetration include hymen fossa, tears, or transection in girls; neisseria gonorrhoea, or deep lacerations to the anal
DO NOT Display shock or disapproval of the childs alleged abuser, a parent, or the situation Make promises to the child about how the situation will work out Make promises you cannot keep
DO Listen Find an appropriate place Use the childs language Express belief that the child is telling the truth Stay in control of your emotions
DO Reassure child it is not his or her fault, he or she did nothing to deserve this, he or she is not bad Assess child immediate need for safety Let child know you will do your best to protect/ support Record in chart
Investigating allegations of child abuse is NOT your duty.. It is your duty to report all cases where there is a suspicion of child abuse, or discuss with the duty social worker if you are unsure. It is also NOT your duty, nor is it advisable, to delve into details about the abuse, an experienced social worker will have more skill in this area
Legislation in Ireland
Child Care Act 1991
Dealing with children in need of care and protection
Statistics in USA
Father only or other relative: 21.5%, 19.4% Parents: 45.3% of child abuse cases Day care in 2.7% of cases
Prevention
Education in childhood, continuing through school Efforts must not focus on child, as child may have difficulties with size difference, trust, training to obey adults, naievety about sex Child victims and perpetrators should receive treatment and risk assessment Screening for family history of child abuse Physicians should be particularly aware of children with learning difficulties, behavioural problems, medical problems, who may be at increased risk of abuse
Case Studies
Please break into groups of 4 Discuss your management of the following cases:
1) A 12 year old boy has presented to you (the GP) with his mother. He has not been eating well. He has become withdrawn. He is refusing to go to school for the last two weeks. He has also been going missing from home for long periods. His mother thinks he is being bullied at school, and leaves him on his own with you as she feels he will talk easier. Sean shows you some marks on his back, and says that he has something that is not easy to tell you. He
1) How would you make it easier for Sean to talk? 2) Sean reveals that his father has been hitting him with a belt. This has been going on for some time, but has been much worse recently, as his father lost his job, and seems to be in a bad mood all the time. 3) What is your next step?