Physical abuse is any non-accidental injury to a child under the age of 18 by a parent or caretaker. Characterized by injury, such as bruises, lesions and fractures that result from hitting (hand, stick, strap, or other object), punching, shaking, kicking, beating, choking, burning (with open flame or hot objects – boiling water, cigarettes), throwing, stabbing or otherwise harming a child. The parent or caretaker need not have intended to hurt the child for it to constitute physical abuse. Other specific types of physical child abuse include:
SHAKEN BABY SYNDROME (SBS) is the collection of signs and symptoms resulting from the violent shaking of a baby that can cause tearing of the brain lining (dura), bleeds, permanent brain injury, or death. Physical abuse indicators include when the child:
• Reports injury by a parent or another adult caregiver.
• Has unexplained burns, bites, bruises, broken bones, black eyes, or welts in the shape of an object (wire hanger, stick, belt, etc).
• Has fading bruises or other noticeable marks.
• Seems frightened of the parents and protests or cries when it is time to go home.
• Flinches or cowers at the approach of adults. Consider the possibility of physical abuse when the parent or other adult caregiver:
• Offers conflicting, unconvincing, or no explanation for the child’s injury.
• Describes the child as ‘evil,’ or other negative way.
• Uses harsh physical discipline with the child
RECOGNISING PHYSICAL ABUSE
It can sometimes be difficult to recognise whether an injury has been caused accidentally or non-accidentally, but it is vital that all concerned with children are alert to the possibility that an injury may not be accidental, and seek appropriate expert advice. Medical opinion will be required to determine whether an injury has been caused accidentally or not. Situations that should cause particular concern include:
• Delayed presentation / reporting of an injury;
• Admission of physical punishment from parents / carers, as no punishment is acceptable at this age;
• Associated family factors such as substance misuse, mental health problems, and domestic violence and abuse;
• Observation of rough handling;
• Difficulty in feeding / excessive crying;
• Significant behaviour change;
• Recurrent injuries;
• Multiple injuries at one time.
EMOTIONAL ABUSE ((verbal abuse, mental abuse, and psychological maltreatment)
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. It is also any attitude, behaviour, or failure to act that interferes with a child’s mental health or social development. A repeated pattern of caregiver behavior or extreme incident(s) that convey to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another’s needs. It can range from a simple verbal insult to an extreme form of punishment. Emotional abuse is almost always present when another form of abuse is found. Emotional abuse can have more long-lasting negative psychiatric effects than either physical abuse or sexual abuse. Emotional abuse is illustrated by:
• Belittling, rejecting, ridiculing, blaming, scape-goating, bullying.
• Terrorizing, threatening violence or fearful conditions.
• Isolating, confinement, restricting the child from social interactions, etc.
• Exploiting or corrupting.
• Denying the child an emotional response.
• Calling names and making negative comparisons to others
• Telling a child he or she is “no good,” “worthless,” Physical Abuse “bad,” or “a mistake”
• Frequent yelling, threatening, or bullying
• Ignoring or rejecting a child as punishment, giving him or her the silent treatment
• Limited physical contact with the child—no hugs, kisses, or other signs of affection
• Exposing the child to vio lence or the abuse of others Emotional abuse Indicators: Emotional abuse may be difficult to recognise, as the signs are usually behavioural rather than physical. The manifestations of emotional abuse might also indicate the presence of other kinds of abuse. The indicators of emotional abuse are often also associated with other forms of abuse. The following may be indicators of emotional abuse:
• Shows extremes in behavior – overly compliant or demanding behaviour, extreme passivity, or aggression.
• Has delayed in physical or emotional development.
• Has attempted suicide..
• Developmental delay;
• Abnormal attachment between a child and parent/ carer e.g. anxious, indis criminate or no attachment; • Indiscriminate attachment or failure to attach;
• Aggressive behaviour to wards others;
• A child scapegoated within the family;
• Frozen watchfulness, particularly in pre-school children;
• Low self-esteem and lack of confidence;
• Withdrawn or seen as a ‘loner’ difficulty relating to others. 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. Neglect is a pattern of failing to provide for a child’s basic needs. It is abuse through omission; of not doing something resulting in significant harm or risk of significant harm.
There are four types of neglect:
1. Physical neglect: Failure to provide food, wear appropriate clothing, supervision, a safe and clean home.
2. Medical neglect: Failure to provide the necessary medical or dental care for a child’s condition.
3. Educational neglect: Failure to enrol a school-age child in school or to provide necessary special education. Allowing excessive absences from school.
4. Emotional neglect: Failure to provide emotional support, love, and affection to a child. Exposure of a child to spousal. 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 neglect is not always easy to spot. Sometimes, a parent might become physically or mentally unable to care for a child, such as with a serious injury, untreated depression, or anxiety. Other times, alcohol or drug abuse may seriously impair judgment and the ability to keep a child safe.
RECOGNISING NEGLECT
The growth and development of a child may suffer when the child received insufficient food, love, warmth, care and concern, praise, encouragement and stimulation. Professionals need to be aware of the possibility of parents / carers neglecting to adequately care for their children. Factors of neglect may include:
• Parents / carers not giving their child prescribed treatment for a medical condition that has been diagnosed and taking their child to essential follow-up medical appointments. Persistent failure by parents / carers to engage with relevant child health promotion programmes such as immunisation, health and development reviews, and screening;
• Dental neglect – rotten or grossly discoloured teeth with noticeable odour; child unable to eat normally; covers mouth with hand; child in chronic pain.
• Not feeding properly, or being fed an inadequate or inappropriate diet;
• Suffering severe and / or persistent infestations such as scabies or head lice;
• Being consistently dressed in inappropriate clothing to Church, school and social functions.
• Okusaga Raphael works with St. Patrick’s Missionary society as Child safeguarding officer, District of West Africa, Maryland, Lagos
