There are many children and young people living in our communities live in conditions that are “difficult”. Many children live without proper housing, without clean drinking water or adequate sanitation.

many of them not attend the school. the stories of abuse and misuse of children are all around us. We read

about them in the paper, watch them on the news, see hundreds of children being exploited as we go about our every day lives.

• There is clear evidence that child abuse is a global problem. It occurs in a variety of forms and is deeply rooted in cultural, economic and social practices.

• Before defining “child abuse” its crucial to get informed about “children’s rights” in the first place.

• According to the National Council for Childhood and Motherhood (NCCM) in Egypt, Egyptian children are a national priority.

“So long as little children areallowed to suffer, there is no

true love in this world”Duncan

“The physical or mental injury, sexual abuse or exploitation, negligent treatment, or maltreatment of a child under the age of 18 by a person who is responsible for the child’s welfare under circumstances which indicate that the child’s health or welfare is harmed or threatened.”

Child Welfare Act

“Any behavior directed toward a child that endangers or impairs a child’s physical or emotional health and development”

TYPES OF CHILD ABUSE

• Physical Abuse• Sexual Abuse• Emotional Abuse• Neglect

In 1999, the WHO Consultation on Child Abuse Prevention compared definitions of abuse from 58 countries and drafted the following definition:

‘‘Child abuse or maltreatment constitutes 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.’’

PHYSICAL ABUSE

Physical abuse is any non-

accidental injury to a child under the

age of 18 by a parent or caretaker.

These injuries may include beatings,

shaking, burns, human bites,

strangulation, or immersion in

scalding water or others, with

resulting bruises and welts,

fractures, scars, burns, internal

injuries or any other injuries.

PHYSICAL ABUSE (CONT.)

The term ‘‘battered child syndrome’’ was coined to characterize the clinical manifestations of serious physical abuse in young children.

This term is generally applied to children showing repeated and devastating injury to the skin, skeletal system or nervous system. It includes children with multiple fractures of different ages, head trauma and severe visceral trauma, with evidence of repeated infliction.

Another form is the “The shaken infant”. Shaking is a prevalent form of abuse seen in very young children (less than 1 year). Most perpetrators of such abuse are males. Intracranial haemorrhages, retinal haemorrhages and chip fractures of the child’s extremities can result from very rapid shaking of an infant.

EMOTIONAL ABUSE

Emotional abuse includes the failure of a caregiver to provide an appropriate and supportive environment, and includes acts that have an adverse effect on the emotional health and development of a child.

Such acts include restricting a child’s movements, denigration, ridicule,

threats and intimidation, discrimination, rejection and other nonphysical forms of hostile treatment.

NEGLECT• Neglect refers to the failure of a

parent to provide for the development of the child – where the parent is in a position to do so – in one or more of the following areas: health, education, emotional development, nutrition, shelter and safe living conditions.

• Neglect is thus distinguished from circumstances of poverty in that neglect can occur only in cases where reasonable resources are available to the family or caregiver.

CHILD SEXUAL ABUSEDefinition

Child sexual abuse is the exploitation of a child or

adolescent for the sexual gratification of another

person.

• Sodomy

• Oral-genital stimulation

• Verbal stimulation

• Exhibitionism

SEXUALLY ABUSIVE BEHAVIORS

Voyeurism

Fondling

Child prostitution

Child pornography

Intercourse

Three Major Components of Child Abuse

Child+

Care Giver+

Stress=

Child Abuse

ROLE OF FAMILY PHYSICIAN IN CHILD ABUSE

Protect

Suspect

Inspect

Collect

Respect

Protect...

Patient/family and team safety are paramount.

Protect the life of the patient as well as as much evidence as possible.

Suspect...

Does the history fit what you are seeing- either injury or illness?

Is this a repeat patient or family member of a repeat patient?

Is there a history of family violence?

Collect...

• Collect as much evidence as possible, including…

• Physical and trace evidence

• Information

Respect...

Respect the right to refuse

Respect diversity Respect privacy

Family violence

Factors in altering the cycle of violence

Abuser-to abuser cycle

The Cycle of Abuse...

Recognizing Abuse Injuries...

Skin Injuries TEARS Human Bite Marks Hair Loss Falls Head, facial, oral injuries Shaken baby Syndrome

Human Bites

Strongly suggest abuse Easily overlooked Location of bite marks on infants differ from sites

on older children

Bruises

Generally speaking: fresh injury is red to blue 1-3 days deep black or purple 3-6 days color changes to green and then brown 6-15 days: green to tan to yellow to faded, then

disappears The younger the child the quicker the color

resolves.

Bruises

Burns

Abusive Burn Patterns Scald: Immersion & Splash Burns Flexion Burns Contact Burns

“Pseudoabusive” Burns

Burns

Suspicious Fractures

Falls

In most cases, falls cause a minor injury. If a child is reported to have had a routine fall but

has what appear to be severe injuries, the inconsistency of the history with the injury indicates child abuse.

Head, Facial, Oral Injuries

Head is a common area of injury. Approx. 50 % of physical abuse patients have

head or facial injuries. Injuries to the sides of the face, ears, cheeks,

and temple area are highly suspicious for abuse. Mouth/lip/teeth injuries

RESEARCH OF NATIONAL STUDY ON CHILD ABUSE.

RESEARCH OF NATIONAL STUDY ON CHILD ABUSE

• Tow out of every three children were physically abused.

• out of those children physically abused in family situation, 88.6% were physically abused by parents .

• 65% of school going children reported facing physical punishment.

• 53.22% children reported having faced one or more forms of sexual abuse .

• 50%of abuse are person known to child or in the position of trust and responsibility .

• most of children did not report the abuse to anyone .

• every second child reported the facing emotional abuse.

• equal percentage of both girl and boys reported facing emotional abuse.

In India there are so many Children who can not going to School and his/her parents forced to started the working which we called as a Child laborers. We see in local grocery store, the domestic worker in our neighborhood, little children begging at traffic lights and railway station etc. His/her parents can’t understand that it is not a age for working, but still many of the parents are doing the mistake.For this there are many case study

Here one true story of RAMESH KUMAR is shared, this is also a child who were abused.

I THINK THAT…..

It never rains but it pours they say. That's exactly what happened for 10 year-old Ramesh Kumar, and for him the flood of troubles took three long years to recede.A charming boy with a disarming smile, he was born into a family of bonded labourers who would toil day and night at a brick kiln in Sitamarhi district of Bihar. He landed up in the 'family business' when he was just eight years old.Carrying bricks was too much for Ramesh's little hands, but had no choice, for months until one day in 2013 when an activist of Bachpan Bachao Andolan (BBA) rescued him. The BBA activist brought thedistraught boy to Bal Ashram – a long stay rehabilitation home for rescued child labourers in Jaipur –where he was taken care of and his belief in happiness grew.At the Ashram, it was like all the misery had vanished away;  but little did the boy know what fate had in store.

Eight months later after being rescued, Ramesh went home hoping  his parents would let him go to school. They didn't. “My parents beat me up when I insisted on going to school,” he says, cheerful, choosing not to let his thoughts travel back to the tragic days.

“They told me not to even think of it. I would often cry.”

Ramesh was back to square one - slavery. But eventually the kiln had to shut and the family were free.However, out of job and in need of money, Ramesh's  father forced him to work at a local restaurant for the monthly 600 rupees. There, the little boy cooked food and washed all the utensils for twelve hours a day,but again only  until one decisive day.

That day, Ramesh and his colleagues were thrashed by their 'employer' for a silly mistake. Fed up of the pain and anguish, he took it upon himself to break the bonds of torture, believing he had had enough.

At night he ran away.He hid behind bushes on the way, and in the dead of the darkness took a journey towards a new dawn. With the little money he had, Ramesh purchased a train ticket to Jaipur and reached Bal Ashram once again.There, he was welcomed with open arms again and now, many moths later, the boy is cheerful again.

Ramesh has ever since participated in many functions organised in and outside Bal Ashram. Once, he felt elated after entering a huge auditorium for some programme. “It was the first time I went to such a place. I had never even thought  there will be something like this,” he said.When I go home, I will tell papa what all I saw. Now he will believe me and repent why he didn't send me to school.”

Stories of ChangeRAMESH KUMAR

Thank You…………………