14mekala, VMCON Karaikal

Indian Journal of Advanced Nursing ISSN online (2394-7160), ISSN print (2319-815X) Volume III, Issue
III, July- Sept 2017, Mekala P, Dr. Jeyalakshmi, Dr. Bharathidasan, Child maltreatment p-10-13
REVIEW ARTICLE
COMMON COMMUNITY VIOLENCE: CHILD MALTREARMENT
Mekala P1, Dr. Jeyalakshmi S2, Dr. Baharathidasan R3
Author’s affiliation
Lecturer Vinayaka Mission’s College of Nursing, Karaikal, India
Guide & Reader in Nursing, Rani Meyyammai College of Nursing, Chidambaram.India
Co-Guide,Associate Professor, Vinayaka Mission’s Medical College & Hospital, Karaikal, India
Corresponding author
Mekala P, Lecturer Vinayaka Mission’s College of Nursing, Karaikal, India
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INTRODUCTION safety and well-being. Child neglect

Child abuse is an international phenomenon. includes:
The terms abuse and maltreatment are often Physical Neglect - Children need enough
used interchangeably in literature. Child care to be healthy and enough supervision to
maltreatment can also be an umbrella be safe. Adults that care for children must
term covering all forms of child abuse provide clothing, food and drink. A child
and child neglect.In general, abuse refers to also needs safe, healthy shelter, and
(usually deliberate) acts of commission adequate supervision.
while neglect refers to acts of omission. Emotional Neglect - Children require
Definition enough affection and attention to feel loved
The World Health Organization (WHO) and supported. If a child shows signs of
defines child abuse and child psychological illness, it must be treated.
maltreatment as "all forms of physical Medical Neglect - Parents and caregivers
and/or emotional ill-treatment, sexual abuse, must provide children with appropriate
neglect or negligent treatment or treatment for injuries and illness. They must
commercial or other exploitation, resulting also provide basic preventive care to make
in actual or potential harm to the child's sure their child stays safe and healthy.
health, survival, development or dignity in Educational Neglect - Parents and schools
the context of a relationship of share responsibility for making sure children
responsibility, trust or power”. have access to opportunities for academic
Types of Child Abuse success.
WHO distinguishes four types of child Risk Factors for Child Maltreatment
maltreatment:  Parental factors
1. Physical abuse  Individual factors
Physical abuse includes striking, kicking,  Relationship factors
burning, biting, hair pulling, choking,  Community factors
throwing, shoving, whipping or any other  Societal factors
action that injures a child.  Productive factors
2. Emotional abuse Causes of Child Maltreatment
When a parent or caregiver harms a child’s There is not any single fact which
mental and social development, or causes causes child abuse; abuse usually occurs in
severe emotional harm, it is considered families where there is a combination of risk
emotional abuse. factors. Abuse and neglect occur most often
3. Sexual abuse of children in families who are under pressure and lack
Sexual abuse occurs when an adult uses a support. Most abuse other than sexual abuse
child for sexual purposes or involves a child occurs in families to which some, or all, of
in sexual acts. It also includes when a child the following apply:
who is older or more powerful uses another  Poverty
child for sexual gratification or excitement.  Lack of education
4. Child neglect  Serious marital problems
Child neglect is when a parent or caregiver
 Frequent changes of addresses
does not give the care, supervision, affection
 Violence between family members
and support needed for a child’s health,
 Lack of support from the family
 Loneliness and social isolation
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 Unemployment  Height, weight and head

 Inadequate housing circumference to be plotted on growth
 Low self-esteem and self confidence chart
 Depression  Sexual Maturity Rating for
 Alcohol and/or drug abuse adolescents
 Mental or physical ill health  All injuries are to be marked on
anatomical diagrams. Special sites to
 Work pressures
look for injuries include ears, inside
 Certain community attitudes like
the mouth, soles, genitalia and anus.
acceptance of violence, force physical
 Systemic examination is done
punishment of children
especially to look for other injuries.
 Racism  Examination of genitalia in girls
 Inequality between men and women. should be done in supine frog leg,
knee chest prone and left lateral
Assessment of the Affected Child position.
1 The presence of a chaperone,  Details of hymen and injuries are to
preferably a nurse is a must during be noted. If possible, photographic
the assessment. evidence to be recorded. Anal
2 The assessment should be recorded dilatation on a rectal examination
in a special Performa. indicates sodomy. Presence of
3 History taking from the parent or discharge, genital ulcers, warts and
caretaker should be documented inguinal lymphadenopathy are to be
separately from that of the child. noted.
Points to be covered in history Investigations
include place, time, witness, The following investigations need to be
present and past history, noticeable done
behavior change, developmental  Sexually Transmitted Disease
and immunization history. Family screening, including low and high
history, pedigree chart and social vaginal (in post pubertal girls) swabs
history are extremely important. and urethral swabs in boys and serology
 A psycho social history includes details for HIV, Hepatitis B and Syphilis are
regarding home, education, eating done in cases of:
behavior, activities and peers, drugs, o Acute sexual assault
depression, suicide, sexual history and o Penetrative abuse
sleep pattern. o Vaginal/ urethral discharge
 The following should be assessed: o STD in abuser
 Resistance to examination, especially  Pregnancy test is done for an adolescent
in a case of sexual abuse and girl
dissociation (going to sleep during  Forensic samples maintaining the chain
examination) of evidence include skin, hair, clothing,
 General demeanor (like unkempt saliva, oral and genitourinary secretions
appearance in neglect) are sent in cases of acute sexual assault.
 Vitals and tip-to-toe general physical  Skeletal survey can be done to explain
examination, especially noting pallor, associated multiple unexplained
bruises, vitamin deficiencies
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injuries. It is mandatory if the abused

child is below 2 years. 1. Learn the facts and understand the risks.
 Multiple bruising entails a detailed Realities - not trust - should influence
hematological profile, including your decisions regarding your child.
bleeding and coagulation profile. It is also likely that you know an abuser!
 Neuro imaging and Ultrasonography of Most are not "strangers," but are our friends
abdomen are indicated in a case of head and family members.
and abdominal injury respectively. 2. Minimize Opportunity - "If you
Treatment and Follow Up eliminate or reduce one-adult/one-child
situations, you will dramatically lower
3.1.1.1.1 Medical management the risk of sexual abuse for your child."
 Short term goal is to ensure safety and 3. Talk About It - Children often keep
provide emergency care if needed. abuse a secret, but barriers can be broken
 Long term goals include complete down by talking openly about it.
physical and psychosocial wellbeing of 4. Stay Alert - Don't expect obvious signs
the child as well as ensuring when a child is being sexually abused.
reintegration into the family and social Signs are often there but you have to
system. spot them.
Rehabilitation 5. Make a Plan - Learn where to go, who to
There is a need for specific support for the call, and how to react.
parents as well asthe family as a whole.Such 6. Act on Suspicions. A child's wellbeing
support may be needed from the time of may depend on it.
suspicion or disclosure of 7. Get involved.
maltreatmentonwards, through to the healing
process. Support should be provided until all CONCLUSION
membersof the family have been referred to Child maltreatment is a sensitive issue in the
the appropriate services according to their society. So it necessary to be empathic and
individualneeds. nonjudgmental attitude when dealing with
Many non-profit organizationworking these clients and family members. Repeated
in India, which aims to restore children's interviews are avoided. The child and the
rights. Eg: Child Rights and parents are to be treated with respect and
You(CRY)renamed now asChild Relief and dignity without making accusations.Child
You. centered and child friendly approach is
Prevention of Child Maltreatment essential. Safety of the child is considered to
7 Steps to Protecting Our Children from be of utmost importance.
Sexual Abuse
REFERENCES
1.GM Dhaar , I Robbni . (2008). Foundation of Community Medicine . 2 nd edition. by Elsevier, a
division of Elsevier India Pvt. Ltd.
2.Frances A. Maurer.Cladia M. Smith .(2013).Community /Public Health For Families
And Population. 5th edition by Elsevier, a division of Elsevier India Pvt. Ltd.
3.Park.K.(2013). Text book of Preventive and Social Medicine . 22nd edition.
Bybanarsidasbhanot publications.
4.Dr.Piyush Gupta Dr.O.P. Ghai .(2007).Text book of Preventive and Social Medicine.
13
2nd edition CBS publications.

5.Judith Ann Allender ,CherieRector,Kristine D .Warner.(2014). Community Public
Health Nursing. 8th edition. Lippincott Williams& Wilkins publications.
6.Marcia Stanhope, Jeanette Lancaster.(2014). Public Health Nursing , Population –
Centered Health Care In The Community. 8th edition. Elsevier Mosby Publications.
7.International Journal of Child Abuse And Neglect, The Great Recession And The
Risk For Child Maltreatment, Page No. 721-729.
8.Indian Academy And Pediatric, Jan 2014, Types Of Child Abuse.
9.Elsevier Journal, September 2013, Signs and Symptoms of Child Abuse.
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Indian Journal of Advanced Nursing ISSN online (2394-7160), ISSN print (2319-815X) Volume III, Issue

INTRODUCTION safety and well-being. Child neglect

 Unemployment  Height, weight and head

injuries. It is mandatory if the abused

2nd edition CBS publications.

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