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PHYSICAL AND SEXUAL

ABUSE
RIZAL SANIF
MEDICAL FACULTY
UNIVERSITY OF SRIWIJAYA
2006

Physical abuse
The deliberate infliction of physical injury on a
child, usually by childs caregiver, is termed
physical abuse.
Minor physical injury is responsible for more
reported cases of maltreatment than major
physical injury, but major physical abuse
causes more deaths.

Undang-undang RI nomor 23 tahun 2004


Penghapusan kekerasan dalam rumah tangga

BAB III pasal 6:


Kekerasan fisik sebagaimana dimaksud pasal 5
huruf a adalah perbuatan yang mengakibatkan
rasa sakit, jatuh sakit atau luka berat.

PHYSICAL ABUSE

HITTING
PUSHING
SHOVING
BURNING
SHAKING
KICKING
BEATING
CONFINEMENT

BEING TIED (I.E. TO


CHAIR, BED, ETC)
BRUISING
FAILING TO
PROVIDE
NECESSITIES FOR
LIFE
FORCED SEXUAL
ACTIVITY

Factors predisposing to physical abuse


The exact cause of child abuse is not know, but
three mayor criteria :
Parental characteristics,
Characteristics of the child and
Environmental characteristics
influence the potential for abuse.

Parental characteristics
Physical punishment tends to occur during the
childhood of abusive parents, most of the
parents were not physically abuse as children.
Abusive parent who report receiving severe
punishment as children are much more likely to
injure their own children.

Parental characteristics

Abusive parents tend to have difficulty


controlling aggressive impulses, and the free
expression of violence is one of the most
consistent qualities of these families.
Abusive families are often more socially
isolated and have fewer supportive
relationships than non abusive parents.

Parental characteristics

Children of teenage mothers are more at risk


for abuse than children of older mother.
Other factors identified in abuse parents
include low self-esteem and less adequate
maternal functioning

Characteristics of the child


Children temperament, position in the family,
additional physical need if ill or disabled, activity level
or degree of sensitivity to parental needs all contribute
to potential for physical abuse.
Occasionally the abused child is illegitimate,
unwanted, brain damage (especially in situations in
which the parents cannot accept the retardation),
hyperactive or physically disable

Characteristics of child

Sometime children are abuse because they


remind the parent of someone the parent
dislike, such as a younger brother or sister who
received all the attention from their own parent.
A difficult pregnancy, labor or delivery is often a
predisposing factor in abuse, especially when
the infant is born prematurely or with congenital
anomalies

Environmental characteristics
Typically the environment is one of chronic
stress, including problems of divorce, poverty,
unemployment, poor housing, frequent
relocation, alcoholism and drug addiction.

Physical abuse

Suggestive physical finding


Bruises and welt.
On face, lips, mouth, back, buttocks, or area of
torso.
Regular pattern descriptive of object used, such
as belt, buckle, hand, wire hanger, chain,
wooden spoon, squeeze or pinch marks.

Burn
On soles of feet, palm of hands, back or
buttocks.
Pattern descriptive of object used, such as
round cigar or cigarette burns glove like
sharply demarcated area from immersion in
scalding water, rope burns on wrist or ankle
from being bound, burn in the shape of an iron,
radiator or electric stove burner.

Physical finding on physical abuse

Fractures and dislocations


Skull, nose or facial structures.
Injury may denote type of abuse, such as spiral
fracture or dislocation from twisting of an
extremity or whiplash from shaking the child.
Lacerations and abrasions
On backs of arm, legs, torso, face, or external
genitalia.
Unusual symptoms, such as abdominal
swelling, pain, and vomiting from punching

Physical finding on physical abuse

Chemical
Unexplained repeated poisoning, especially
drug overdose.
Unexplained sudden illness, such as
hypoglycemia from insulin administration.

Sexual abuse

SEXUAL ABUSE
Defined as the involvement of developmentally
immature children or adolescent in sexual activities
that they do not fully comprehend, to which they are
unable to give informed consent, or that violate taboos
of family relationships.
Sexual abuse as the use, persuasion, or coercion of
any child to engage in sexually explicit conduct (or any
simulation of such conduct) for producing any visual
depiction of such conduct, or rape, molestation,
prostitution or incest with children.

Undang-undang RI nomor 23 tahun 2004


Penghapusan kekerasan dalam rumah tangga

BAB III pasal 8:


Kekerasan seksual sebagaimana dimaksud
dalam pasal 5 huruf c meliputi :
a. Pemaksaan hubungan seksual yang
dilakukan terhadap orang yang menetap
dalam lingkup rumah tangga tersebut;
b. Pemaksaan hubungan seksual terhadap
salah seorang dalam lingkup rumah
tangganya dengan orang lain untuk tujuan
komersial dan/atau tujuan tertentu

SEXUAL ABUSE
Sexual touching,
fondling, kissing or
hugging
Oral and anal sex
Forces masturbation on
self or abuser
Incest
Forced to watch adults in
sexual behavior
Raped or penetrated

Date rape
Sodomy
Exhibitionism and
sexual exploitation
Forced to watch
pornographic material
Forced to pose for
sexual pictures
Sexual torture

Sexual abuse

The contact may be a single event between


the child and a stranger occurring with or
without the use of force, or it may be a longstanding sexualized relationship with a parent,
step-parent, or other know individual and may
be involve repeated encounters over months
to year.

Sexual abuse

The sexual interaction may start with fondling


and progress over the course of months to
vulva coitus and penetration.
The assailant is know to the child in 70 90 %
of cases, and in half of cases a relative is
involved.

Sexual assault is defined as any sexual act


performed by one person on another without
that persons consent.
The use or treat of force may be involved, or
the person may be nor able to give consent
because of age, mental or physical capacity, or
impairment with drugs or alcohol

Sexual abuse

The recognition of sexual abuse is frequently


prompted by a childs disclosure to a parent,
friend, teacher, or health professional.
Disclosure may be intentional or accidental.
In most cases, the child does not anticipate the
sequelae of the allegation

Sexual abuse may became evident during evaluation


for somatic symptoms or behavioral difficulties.
Girls with vaginal bleeding, foreign bodies in the
vagina, sexual transmitted diseases need an specially
careful history for sexual abuse, and the history is
often best obtained without the parent present.

Occasionally, a pregnancy in a young adolescent is


the first sign of long-standing incest

Because clinicians frequently feel


uncomfortable about making the diagnosis of
sexual abuse, even obvious problems are
sometimes overlooked.
In cases of incest, there is a great deal of
pressure from families to have the child retract
the story to prevent disruption of the family unit
and possible incarceration of parent

Suggestive physical finding


Bruises, bleeding, lacerations or irritation of
external genital, anus, mouth or throat.
Torn, stained, or bloody underclothing
Pain on urination or pain, swelling, and itching
of genital area
Penile discharge

Suggestive physical finding on sexual abuse

Sexually transmitted disease, nonspecific


vaginitis or venereal warts.
Difficulty in walking or sitting.
Unusual odor in genital area.
Recurrent urinary tract infection.
Presence sperm
Pregnancy in young adolescent

Clinicians should ask question :


that would reveal the possibility of sexual abuse
at routine physical examination, especially in
children and adolescents with somatic
complaints or behavioral changes such as:
regression, nightmares,
running away,
school failure or pregnancy.

HOW TO MANAGE THIS PROBLEM ?


Multidisciplinary teams that include a social
worker, psychologist, psychiatrist, nurse, and
physicians are extremely helpful in sorting out
the complex issues involved in child sexual
abuse cases.

Sexual abuse prevention


The American Academy of Pediatrics (AAP)
encourages parents to make sure their
schools have prevention programs for
students and teachers, to discuss the subject
with their children, to teach their children
about body part, to be good listeners, and to
know with whom their children are spending
time

Young children should have sufficient


knowledge of their bodies to know what types
of behavior from adults to avoid or report.
Children need to know that they can refuse
demands for physical closeness, even from
friends or relatives.
They should be told early to ovoid accepting
rides from strangers or candy or money in
exchange for close relationships.