651544_634252997144960000 (1)

CHILD ABUSE: 

CHILD ABUSE BY ROSEMARY PALMER RN, RM, BSc Hons (Sport science & administration), ADM

ETIOLOGY: 

ETIOLOGY Combination of 3 factors: child + parent+ circumstances Psychopathology of abuser Cultural, social, economic factors Child specifics e.g. abnormal, preterm, hyperactive.

CONTRIBUTING FACTORS: 

CONTRIBUTING FACTORS Abuser perceives childs actions as misconduct. Hit to discipline Rejection or resentment of child Step child Atypical child behaviur e.g. hyperactive, cries a lot To get back at spouse –use child Drugs/ alcohol related Stress e.g. divorce/unemployment Lack of bonding

TYPES OF ABUSE: 

TYPES OF ABUSE Psychological Physical Sexual

SEXUAL ABUSE : 

SEXUAL ABUSE Fondling Inappropriate sexual acts e.g. oral stimulation Naked display Pornography Penetrative sex Incest Sodomy

SIGNS SEXUAL ABUSE: 

SIGNS SEXUAL ABUSE Infections repeatedly –warts, sti, uti, HIV +ve when parents –ve, toilet problems Bleeding Withdrawal Fear Physical neglect/ over protectiveness Bruising

PSYCHOLOGICAL ABUSE: undermines self esteem & dignity.: 

PSYCHOLOGICAL ABUSE: undermines self esteem & dignity. Humiliation Neglect in feeding/ home/ schooling/ clothing etc. Lack of supervision/ inclusion in family unit Lack of bonding –no feelings from parent Abnormalities/ preterm/ unwanted pregnancy Poverty Family breakdown e.g. divorce

SIGNS PSYCHOLOGICAL ABUSE: 

SIGNS PSYCHOLOGICAL ABUSE Poor school performance Neglect in appearance Poor development/ growth Disturbed behaviour patterns Suicide Poor eye contact Clinging/ withdrawn Bed wetting/ dirtying pants ‘sick’ all the time

PHYSICAL ABUSE :non-accidental injuries: 

PHYSICAL ABUSE :non-accidental injuries Need not be massive injuries. Can be discreet e.g. pinching upperarms. Sleep deprivation “tripped over” To overt injury e.g. ribs broken. Beating with object and inappropriate violence. Also a physical abuse to nutritionally neglect child Force drugs to child Neglect safety of child appropriate to age.

ABUSER PROFILE: 

ABUSER PROFILE May be mentally unstable anyway Drug user Family breakdown could be catalyst. Over protective, dominant, persuasive Often appear ‘normal’ but low self esteem as well Do it from power/ dominance/ frustration/ hate/ dislike of child/ a form of spouse abuse Poverty/ unemployed Step parent, unmarried Want attention

IDENTIFICATION: 

IDENTIFICATION Very difficult as abuser can be clever in protecting him/her self. Threatens child if tells anyone etc. Over information or no information given Explanation for injury does not fit profile Inappropriate reaction to allegation Doesn’t touch/ speak to child Changes hospitals frequently –not willing to give consent for diagnostics e.g. xray If child admitted –doesn’t visit.

CHILD COPING MECHANISMS: 

CHILD COPING MECHANISMS Denial Regression Avoidance of abuser Compulsive repetition. May not know this is wrong and tries to get others to do same. Inappropriate behaviour e.g. to others at school, abuser, sibling e.g.Bullying Poor development physically & emotionally Poor school performance Loner- displaces feelings to objects/ animal.

PRIMARY PREVENTION : 

PRIMARY PREVENTION Pre -conceptual: Family education classes eg at school. What to expect, demands etc. Genetic counselling. Community groups for women, church groups. ANC: note mothers behaviour- neglecting pregnancy, not got anything ready for birth or baby. Helplessness, tearfulness. Rejection of advice. Inappropriate behaviour. Unbooked. May have tried abortion and failed. Education. Discussion groups. LISTEN Labour: un –cooperative. Appears to be doing everything wrong to endanger baby. No doula. Doesn’t want to see or touch baby. Early bonding & participation in care.

PowerPoint Presentation: 

Puerperium ; seems to neglect baby. Forgets to change, feed. Gets frustrated easily with baby. Has no clothes etc ready. Observe attitude. Initial 24hrs mum may not have totally bonded but should still show signs of caring. Education, discussion, bonding activities. Referral. Baby blues go into depression/ psychosis. Does not seem to have support mechanisms in place- husband doesn’t visit.

SECONDARY PREVENTION: 

SECONDARY PREVENTION Team approach – e.g. social worker, community nurse, psychiatrist, paediatrician, GP. Removal of child from abuser by retention order. Abuser rehabilitation necessary before child returned. A reportable situation to police. Hospitals often have crisis units for this sort of thing.

MANAGEMENT: 

MANAGEMENT Inspect child’s body. Document everything Report Diagnosis verified Family counselling, history taking etc Child may be put into care with treatment plan Abuser rehabilitation plan initiated once issues identified e.g. poverty, alcohol abuse etc. Perpetrator may be voluntarily removed or arrested or child removed if more appropriate. Do not judge. Assist.

AT RISK CHILDREN: 

AT RISK CHILDREN Unwanted pregnancy Poverty Drug/ alcohol abuse Abnormal child Step child Sickly child who cries a lot Stressed family –work/ unemployed etc Wrong sex Under 5 but legislation says UNDER 18 Hyperactive child