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A study on the different types of child abuse

Female Genital Mutilation Child maltreatment is behavior toward a child that is outside the norms of conduct and entails substantial risk of causing physical or emotional harm. Four types of maltreatment are generally recognized: The causes of child maltreatment are varied and not well understood. Abuse and neglect are often associated with physical injuries, delayed growth and development, and mental problems. Diagnosis is based on history, physical examination, and sometimes laboratory tests and diagnostic imaging.

Both sexes are affected equally; the younger the child, the higher the rate of victimization.

  • Case Report Peter, a 12-year-old boy, accompanied by his maternal aunt, presented at the local university Dental Hospital Pediatric Dental Clinic in Kenya in October 2012, with a complaint of a large, painful left facial swelling related to the left upper incisors;
  • Stunted growth and death resulting from starvation or exposure to extremes in temperature or weather may occur;
  • Both the type and extent of mistreatment appear to have different effects on the child's subjective experience;
  • These infants may be comatose or stuporous from brain injury yet lack visible signs of injury with the common exception of retinal hemorrhage or they may present with nonspecific signs such as fussiness and vomiting;
  • Emotional abuse can also occur when words or actions are omitted or withheld, in essence becoming emotional neglect eg, ignoring or rejecting children or isolating them from interaction with other children or adults.

About three fifths of all reports to Child Protective Services were made by professionals who are mandated to report maltreatment eg, educators, law enforcement personnel, social services personnel, legal professionals, day care providers, medical or mental health personnel, foster care providers. Of substantiated cases in the US in 2015, 75. Many children were victims of multiple types of maltreatment. Available at the Children's Bureau web site.

Classification Different forms of maltreatment often coexist, and overlap is considerable. Physical abuse Physical abuse involves a caregiver inflicting physical harm or engaging in actions that create a high risk of harm. Assault by someone who is not a caregiver or in a position of responsibility to the child eg, a shooter in a school mass shooting is not specifically child abuse.

Specific forms include shaking, dropping, striking, biting, and burning eg, by scalding or touching with cigarettes. Abuse is the most common cause of serious head injury in infants. In toddlers, abdominal injury is also common. Infants and toddlers are the most vulnerable because the developmental stages that they may go through eg, colic, inconsistent sleep patterns, temper tantrums, toilet training may frustrate caregivers.

This age group is also at increased risk because they cannot report their abuse.

  1. Many children were victims of multiple types of maltreatment. Child abuse can also be in the form of emotional abuse involving coercive, constant belittling, shaming, humiliating a child, making negative comparisons to others, frequent yelling, threatening, or bullying of the child, rejecting and ignoring the child as punishment, having limited physical contact with the child e.
  2. Documentation of the history and physical examination should be as comprehensive and accurate as possible, including recording of exact quotes from the history and photographs of injuries.
  3. Female Genital Mutilation Child maltreatment is behavior toward a child that is outside the norms of conduct and entails substantial risk of causing physical or emotional harm.
  4. The present case report describes a child who was abuse by a very close relative, and who caused physical and psychological trauma to the young lad. Physical abuse Both history and physical examination provide clues suggestive of maltreatment.
  5. Verbally and sexually abused children did not believe it was their fault if the mistreatment was moderately extensive but did if it was mild or severe. He had asymmetrical face due to the swelling involving his left submandibular region and spreading upwards to the inferior orbital margin, febrile 39.

The risk declines in the early school years. Sexual abuse Any action with a child that is done for the sexual gratification of an adult or significantly older child constitutes sexual abuse see Pedophilic Disorder.

Forms of sexual abuse include intercourse, which is oral, anal, or vaginal penetration; molestation, which is genital contact without intercourse; and forms that do not involve physical contact by the perpetrator, including exposure of the perpetrator's genitals, showing sexually explicit material to a child, and forcing a child to participate in a sex act with another child or to participate in the production of sexual material. Emotional abuse Emotional abuse is inflicting emotional harm through the use of words or actions.

Emotional abuse can also occur when words or actions are omitted or withheld, in essence becoming emotional neglect eg, ignoring or rejecting children or isolating them from interaction with other children or adults.

Abuse in a medical setting Child abuse in a medical setting previously called Munchausen syndrome by proxy, now called factitious disorder imposed on another in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5] a study on the different types of child abuse when caregivers intentionally produce or falsify physical or psychologic symptoms or signs in a child.

Caregivers may injure the child with drugs or other agents or add blood or bacterial contaminants to urine specimens to simulate disease. Many children receive unnecessary and harmful or potentially harmful tests and treatments. Neglect differs from abuse in that it usually occurs without intent to harm. Different types of neglect can be defined as Physical neglect includes failure to provide adequate food, clothing, shelter, supervision, and protection from potential harm.

Emotional neglect is failure to provide affection or love or other kinds of emotional support. Educational neglect is failure to enroll a child in school, ensure attendance at school, or provide home schooling Medical neglect is failure to ensure that a child receives appropriate care or needed treatment for injuries or physical or mental disorders.

Child abuse: A classic case report with literature review

However, failure to provide preventive care eg, vaccinations, routine dental examinations is not usually considered neglect. Cultural factors Severe corporal punishment eg, whipping, burning, scalding clearly constitutes physical abuse, but for lesser degrees of physical and emotional chastisement, the boundary between socially accepted behavior and abuse varies among different cultures.

Likewise, certain cultural practices eg, female genital mutilation are so extreme as to constitute abuse. However, certain folk remedies eg, coining, cupping, irritant poultices often create lesions eg, bruises, petechiae, minor burns that can blur the line between acceptable cultural practices and abuse.

Members of certain religious and cultural groups have sometimes failed to obtain life-saving treatment eg, for diabetic ketoacidosis or meningitisresulting in a child's death. Additionally, in the US, certain people and cultural groups have increasingly been declining to have their children vaccinated, citing safety concerns see Anti-Vaccination Movement.

It is not clear whether this refusal of vaccination is true medical neglect. However, in the face of illness, refusal of scientifically and medically accepted treatment often requires further investigation and sometimes legal intervention. Etiology Abuse Generally, abuse can be attributed to a breakdown of impulse control in the parent or caregiver. Parental characteristics and personality features can play a role.

Abusive parents may see their children as a source of unlimited and unconditional affection and look to them for the support that they never received.

As a result, they may have unrealistic expectations of what their children can supply for them, they are frustrated easily and have poor impulse control, and they may be unable to give what they never experienced. Drug or alcohol use may provoke impulsive and uncontrolled behaviors toward their children. Parental mental disorders also increase the risk of maltreatment. Sometimes strong emotional bonds do not develop between parents a study on the different types of child abuse children.

This lack of bonding occurs more commonly with premature or sick infants separated from parents early in infancy or with biologically unrelated children eg, stepchildrenincreasing the risk of abuse. Situational stress may precipitate abuse, particularly when emotional support of relatives, friends, neighbors, or peers is unavailable.

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Physical abuse, emotional abuse, and neglect are associated with poverty and lower socioeconomic status. However, all types of abuse, including sexual abuse, occur across the spectrum of socioeconomic groups.

The risk of sexual abuse is increased in children who have several caregivers or a caregiver who has several sex partners.

Neglect Neglect usually results from a combination of factors such as poor parenting, poor stress-coping skills, unsupportive family systems, and stressful life circumstances. Neglect often occurs in impoverished families experiencing financial and environmental stresses, particularly those in which parents also have mental disorders typically depression, bipolar disorder, or schizophreniaabuse drugs or alcohol, or have limited intellectual capacity.

  • This age group is also at increased risk because they cannot report their abuse;
  • Bruising characteristics discriminating physical child abuse from accidental trauma;
  • Likewise, certain cultural practices eg, female genital mutilation are so extreme as to constitute abuse.

Children in single-parent families may be at risk of neglect due to a lower income and fewer available resources. Symptoms and Signs Symptoms and signs depend on the nature and duration of the abuse or neglect. Confusion and localizing neurologic abnormalities can occur with CNS injuries. Lack of visible head lesions does not exclude traumatic brain injury, particularly in infants subjected to violent shaking. These infants may be comatose or stuporous from brain injury yet lack visible signs of injury with the common exception of retinal hemorrhage or they may present with nonspecific signs such as fussiness and vomiting.

Children who are frequently abused are often fearful and irritable and sleep poorly. They may have symptoms of depressionposttraumatic stress reactions, or anxiety. Violent or suicidal behavior may occur.

Sexual abuse In most cases, children do not spontaneously disclose sexual abuse and rarely exhibit behavioral or physical signs of sexual abuse. If a disclosure is made, it is generally delayed, sometimes days to years.

In some cases, abrupt or extreme changes in behavior may occur. Aggressiveness or withdrawal may develop, as may phobias or sleep disturbances. Some sexually abused children act in ways that are sexually inappropriate for their age.

Physical signs of sexual abuse that involves penetration may include Difficulty in walking or sitting Bruises or tears around the genitals, anus, or mouth Vaginal discharge, bleeding, or pruritus Other manifestations include a sexually transmitted infection, and pregnancy. Within a few days of the abuse, examination of the genitals, anus, and mouth will likely be normal, but the examiner may find healed lesions or subtle changes.

Emotional abuse In early infancy, emotional abuse may blunt emotional expressiveness and decrease interest in the environment.

Child abuse: a study of the child's perspective.

Emotional abuse commonly results in failure to thrive and is often misdiagnosed as intellectual disability or physical illness.

Delayed development of social and language skills often results from inadequate parental stimulation and interaction. Emotionally abused children may be insecure, anxious, distrustful, superficial in interpersonal relationships, passive, and overly concerned with pleasing adults.

Children who are spurned may have very low self-esteem. Children who are terrorized or threatened may seem fearful and withdrawn. The emotional effect on children usually becomes obvious at school age, when difficulties develop in forming relationships with teachers and peers.

Often, emotional effects are appreciated only after the child has been placed in another environment or after aberrant behaviors abate and are replaced by more acceptable behaviors. Neglect Undernutrition, fatigue, poor hygiene, lack of appropriate clothing, and failure to thrive are common signs of inadequate provision of food, clothing, or shelter.

Stunted growth and death resulting from starvation or exposure to extremes in temperature or weather may occur. Neglect that involves inadequate supervision may result in preventable illness or injury. Symptoms and signs reference a study on the different types of child abuse. Bruising characteristics discriminating physical child abuse from accidental trauma.

Diagnosis High index of suspicion eg, for history that does not match physical findings or for atypical injury patterns Supportive, open-ended questioning Sometimes imaging and laboratory tests Reporting to authorities for further investigation Evaluation of injuries and nutritional deficiencies is discussed elsewhere in The Manual. Recognizing maltreatment as the cause can be difficult, and a high index of suspicion must be maintained.

Because of social biases, abuse is considered less often in children living in a 2-parent household with an at least median-level income. However, child abuse can occur regardless of family composition or socioeconomic status. Sometimes direct questions provide answers. Children who have been maltreated may describe the events and the perpetrator, but some children, particularly those who have been sexually abused, may be sworn to secrecy, threatened, or so traumatized that they are reluctant to speak about the abuse and may even deny abuse when specifically questioned.

A medical history including a history of the events should be obtained from children and their caregivers in a relaxed environment. Examination includes observation of interactions between the child and the caregivers whenever possible.

Documentation of the history and physical examination should be as comprehensive and accurate as possible, including recording of exact quotes from the history and photographs of injuries. Often it is unclear after the initial evaluation whether abuse occurred.

In such cases, the mandatory reporting requirement of suspected abuse allows appropriate authorities and social agencies to investigate; if their evaluation confirms abuse, appropriate legal and social interventions can be done. Physical abuse Both history and physical examination provide clues suggestive of maltreatment. Bruises on the buttocks and the back of the legs are extremely rare from falls. No fractures are pathognomonic of abuse, but classic metaphyseal lesions, rib fractures especially posterior and 1st riband depressed or multiple skull fractures caused by apparently minor traumascapular fractures, sternal fractures, and spinous processes fractures should raise concern for abuse.