Child Abuse

INTRODUCTION

The various types of abuse (and their estimated incidence) are classified as:

• physical (5–10% of children)

• neglect (12%)

• emotional (11%)

• sexual (♂: 1–8% penetrative, 6–16% non-p; ♀ 4–12% penetrative, 14–36% non-p)

• female genital mutilation

• potential

• Munchausen by proxy

Facts and figures

• Greater risk with younger children and disabled

• Girls are more likely to be abused than boys

• Girls are more often assaulted by someone they know

• Most of the adults who sexually abuse are men (>90%)

• About 75% of offenders are known to the child

• Abuse is the misuse of a power situation (e.g. a close relative) coupled with the child’s immaturity

• An Australian study showed that the distribution of child abuse was physical 15%, emotional 48%, sexual 9% and neglect 28% (see Fig. C8)

• Underdiagnosing and under-reporting are sad facts

Definition Child abuse can be defined by the nature of the abusive act or by the result of the abuse. A parent, guardian or other carer can harm a child by a deliberate act or by failure to provide adequate care.

PHYSICAL ABUSE

Physical abuse should be suspected, esp. in a child <3, if certain physical or behavioural indicators in either the child or the parents are present. Bruising, esp. fingertip bruising, is the most common sign of the physically abused child.

Management The family doctor should diplomatically confront the parent or parents and always act in the best interests of the child. Offer to help the family. An approach would be to say, ‘I am very concerned about your child’s injuries as they don’t add up—these injuries are not usually caused by what I’m told has been the cause. I will therefore seek assistance—it is my legal obligation. My duty is to help you and, especially, your child.’

The stages of management are:

• recognition or disclosure of abuse

• the family separation phase

• working towards rehabilitation

• finding a new family for the child, when rehabilitation fails

NEGLECT

Poor parenting or neglect occurs in at least 5% of children under 5 years.

SEXUAL ABUSE

Incest and sexual abuse of children within the family occur more frequently than is acknowledged. Only 6% of child sexual abuse is by strangers.

Sexual abuse presents in three main ways:

• allegations by the child or an adult

• injuries to the genitalia or anus

• suspicious presentations, esp.:

  • – genital infection

  • – recurrent urinary infection

  • – unexplained behavioural changes/psychological disorders

Sexual abuse can take many forms, including:

• genital fondling

• digital penetration

• penetration with various objects

• simulated sexual intercourse ...