Dr Dharmakanta Kumbhakar
(The writer can be reached at firstname.lastname@example.org)
Child abuse and neglect consist of any act of commission or omission by a parent or other caregiver that results in harm, the potential for harm, or the threat of harm to a child, which impairs a child's physical or emotional health and development. WHO defines child abuse as a form of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment, 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. It can occur in a child's home, or in the organizations, schools or communities the child interacts. It creates a lack of trust and relationship difficulties.
The earlier child abuse is caught, the better the chance of recovery and appropriate treatment for the child and the abuser. Following signs may signal the presence of child abuse- A) The child shows sudden changes in behaviour or school performance/ has not received help for physical and medical problems brought to the parent's notice/has learning problems, not due to the physical or psychological problem/is always watchful even in danger/lacks adult supervision/overt complaint, passive/come to school early, go late, don't like to back home B)The parent- shows little concern on child/denies child existence or blame the child for problem/sees the child as entirely bad, worthless and burdensome/ask school teacher to punish the child for problem/looks the child for own care, attention, satisfaction/demands more performance from the child than can achieve C) The parent and child- rarely touches or look each other/consider their relationship entirely negative/state they don't like each other. Major types of child abuse are -
Physical child abuse is acts of commission that cause actual physical harm or have potential harm. This includes hitting, kicking, slapping, burning, pinching, hair pulling, biting, choking, shoving, whipping, and padding. Death in abused children is most often the consequence of a head injury or injury to the internal organs. Abuse is suggested by patterns of injury to the skin and skeletal manifestations, including multiple fractures at different stages of healing. There is evidence that about one-third of severely shaken infants die and that the majority of the survivors suffer long-term consequences such as mental retardation, cerebral palsy or blindness. Signs of physical child abuse are – the child has an unexplained and frequent burn, bites, welts, cuts, bruises, broken bones or black eye/has fading bruises or another mark after an absence in school/always watchful even in danger/injuries have a pattern of hand or belt/wears inappropriate cloth to cover the injury/seems frightened to parent and don't want to go home/shrinks at the approaching adult/report injury by a parent or other caregiver/if a parent cannot explain the child injury/describe the child as evil/has a history of child abuse/become over disciplined and punish the child.
Child sexual abuse (CSA) or child molestation is a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation and gratification. This includes fondling, penetration, intercourse, exploitation, pornography, exhibitionism, child prostitution, child grooming, group sex, oral sex, or forced observation of sexual acts. It involves mental, physical and emotional abuse of a child through overt and covert sexual acts, gestures and deposition.
We should suspect CSA when we observe- the child is getting trouble walking and sitting; change in the social behaviour of the child-a happy child becomes introverted, silent, refuses to participate in group activities/becomes insecure and cling to a trusted adult/become excessively submissive, fearful or excessively violent, easily enraged/child tries to avoid coming in contact with a particular person; change in the personal grooming of the child-neglects personal appearance /deliberately tries to look unhygienic, shabby or unattractive/begin to wear multiple layers of clothing, inappropriate for weather/change in eating habits, the child starts losing weight or may it excessively, thus put on weight; changes in academic performance/poor concentration/ distracted/ sleepy /lack of interest; replaying the abuse with another child generally younger or same age, become pregnant or contract venereal disease.
Emotional Child Abuse is any attitude or behaviour which interferes with a child's mental health or social development. This includes constant belittling, shaming, and humiliating a child; calling names and negative comparisons to others; telling them that they are bad, no good, and worthless or mistake; frequent yelling, threatening or bullying; ignoring or rejecting a child as punishment, giving silent treatment; limited physical contact with the child and exposing the child to violence or the abuse of others. It also includes the failure to provide the affection and support necessary for the development of a child's emotional, social, physical and intellectual wellbeing. It can severely damage a child's mental and social development, leaving a lifelong psychological scar. Signs of emotional child abuse are- report lack of attachment to parent/self blamed/has attempted suicide/reacts distancing from the abuser/use the abusive word and fight back by insulting the abuser/delayed physical or emotional development/acts as either inappropriately adult or children/shows extreme behaviour/excessively withdrawn, fearful or anxious about doing something wrong.
Child neglect is the failure of a parent or other person with responsibility for the child to provide the basic needs for the development of the child, where they are in a position to do so. This includes lack of supervision, inappropriate housing or shelter, inadequate provision of food and water, inappropriate clothing for season or weather, abandonment, denial of medical care and inadequate hygiene. Signs of child neglect are- frequently absent from school/frequently late or missing from school/begs or steal food or money/lack needed medical, dental, immunization or glasses/consistently dirty, unbathed and have severe body odour/lack sufficient cloth for the weather as ill-fitting cloth/abuses alcohol or other drugs/states that there is no one at home to provide care /when a parent is indifferent to the child, apathetic and depressed, abusing alcohol or drug and behave irrationally.
The causes of child abuse and neglect are -Lack of parenting skill-Parent setting expectations for their child that are clearly beyond the child's capability; frustration caused by child non-compliance/unemployment and financial crisis of parent/stress and lack of support to parent/superstition like treat child as bitch/non-biological parent/large family/domestic violence are a contributory factor for child abuse; children resulting from unintended pregnancies/children with disabilities are vulnerable for abuse and neglect; untreated mental illness of parent/parent that substance abuse like alcohol, cocaine etc. likely to mistreat a child.
Trauma-focused cognitive behavioural therapy/Abuse-focused cognitive behavioural therapy/Rational Cognitive Emotive Behavior Therapy/Child-parent psychotherapy/ Group therapy/Play therapy/Art therapy etc., are a few modalities for the treatment of abused children and abusers.
To prevent child abuse and neglect one should correct the parenting skill(Parents should think that they have crossed the line and something might be wrong when they cannot stop anger on the child, begin to hit and shake or throw them, feel emotionally disconnected from their child by leaving alone, meeting the daily needs of their children seems impossible and other responsible people has expressed concern on their activity on the child/Parent should learn what age-appropriate is and what is not for the child, develop new parenting skills to control emotions, taking care of own to control anger and take professional help)/child school programme - good touch –bad touch/ empowering the child about safety /pregnancy planning/creating awareness/celebrating National Child Abuse Prevention month every April/participating in Blue Ribbon Campaign/reporting to child helpline and implementing the law.