Community health nursing child absue detailed study

Talks details about the child abuse that are commonly seen

1. Child abuse

2. Introduction India, Nigeria, Democratic Republic of Congo, Pakistan and China collectively accounted for half of the total number of under-five deaths globally. Trends in India : According to the Sample Registration System (SRS) Statistical Report, 2020 released in September 2022, India’s Under-5 Mortality Rate stood at 32 while Infant and Neonatal Mortality Rates were 28 and 20 respectively.

3. Child abuse The terms used to describe child abuse include battered child syndrome and non accidental injury to children. Abuse is considered as an act in which intentionally physical, mental or emotional harm is inflicted on a child by a parent or any other person. It may include repeated injuries, unexplained cuts, bruises, fractures, burns, scar, harm, punishment, sexual abuse or exploitation. It is important to note that most reported cases of sexual abuse involve girls. Children in cities are more victims to such violence but also in danger of becoming a part of organized crime rackets, especially when faced with circumstances such as disruption in schooling, dysfunctional family, lack of parental care and exposure to substance abuse.

4. Levels and Places of Child Abuse Home: Abusers are parents or parent's substitutes. Institutions: Schools, day care centres , boardings , hostels, residential centres , orphanages etc. Society: Which allows children to live in poverty or to be denied of the basic necessities of life.

5. Causes of Abuse or Neglect • Marital problems • Financial difficulties • Frustration • Stress due to illness • Parent-child conflicts • Loosing control over anger

6. Causes of Abuse or Neglect In cases of newborn abuse or neglect, main causes include denial of pregnancy depression of mother fear of delivery mother's death giving birth to an unwanted child sex of child (female child in some parts of India) inability to caring

7. Types of child abuse ( i ) Physical abuse (ii) Emotional maltreatment (iii) Sexual abuse (iv) Neglect (v) Domestic and Family Violence

8. 1. Physical Abuse Physical abuse is defined as, 'any non accidental physical act inflicted upon a child by a person having the care of a child: It is not necessarily the "intent to hurt but can also be a justified action to discipline the child .’’

9. Characteristics of physical abuse In this, bruises, burns (immersions in hot water, contact with cigarette, hot iron etc.), injuries, rope tying, fracture etc. may be included. Physically abused children will have constant threat, fear with poor academic performance, depression and low self-esteem.

10. 2. Emotional maltreatment/psychological abuse: It may consist of verbal assaults or threats that provoke fear, poor communication in the child. Parents fail to provide an emotional climate that fosters love, belonging, recognition and enhanced self esteem. Child feel unwanted or unloved and accused for family problems.

11. Parents' attitude in psychological child abuse Acts of omission, e.g. Parents do not showing love and affection Acts of commission, e.g. rejection, insults and child is not allowed to enjoy socialization All the above acts will have negative impact on child's self-esteem and social competence. So the child is withdrawn and emotionally disengaged.

12. Characteristics of psychological abuse Stuttering, enuresis, delinquency, truancy, overeating, childhood depression, disciplinary problems, suicide attempts etc.

13. 3. Sexual Abuse Child sexual abuse is defined as any incident in which an adult uses their power and authority to engage a minor in a sexual act, or exposes the minor to inappropriate sexual behavior or material.

14. Characteristics of sexual abuse Itching, pain, bruises or bleeding in the external genitalia, vaginal or anal area, torn, bloody or stained under-garments, stretched hymen at a very young age, pregnancy in older child, urinary bladder infection, child showing difficulty in walking, avoiding recreational activities, poor peer relationship, preoccupation with sexual organs of self or others, prostitution in older children, changing sleeping patterns, nightmares, use of drugs/alcohols etc.

15. 4.Neglect: It is the condition in which child's basic human needs (shelter, nutrition, hygiene, clothing, proper medical care) are neglected. Financial status, cultural values, parental capacity should be considered before a parent is accused of neglecting a child.

16. Neglect can be defined as any serious act or omission by a person having the care of a child that, within the bounds of cultural tradition, constitutes a failure to provide conditions that are essential for the healthy physical and emotional development of a child Parent fails to adequately meet the needs of the child like provision of food, shelter, clothing, medical care, love and affection and supervision on child's activities, etc. Such neglected children will not have much attachment with parents he/she will lack confidence and socially isolated.

17. 5. Domestic and Family Violence It occurs in intimate relationship. It may include a range of abuse like physical, sexual, emotional financial abuse, psychological, etc. Children are fearful, anxious and unpredictable about the threats.

18. Protective services for children Emergency shelter, day care centre, telephone hotlines etc. (use of Phone No.1098 for under troubled children) Parent's education Counseling Financial assistance Foster home care School guidance Assertiveness training. Legal measures: Strict implementation of POCSO (Prevention of children from sexual offences Act 2012)-Considering abused children words as a proof in court (As per Tamil Nadu Court)

19. Management of Child Abuse-legislations The Indian constitution contains several provisions for protection, development and welfare of children. The child labour protection and regulation Act was enacted in 1986.It protects the employment of children from any factory or mine or any another hazardous occupation. The State shall direct its policy in such a manner that the tender age of children is not abused, children are given opportunities and facilities to develop in healthy manner and childhood is protected against exploitation.

20. National Policy on Education emphasized universal enrolment and universal retention of children at elementary school stage. Crèche services to children of poor working women in unorganized sector were expanded. Adoption services were promoted. The Juvenile Justice Act was enacted in 1986 to deal effectively with the problem of neglected or juvenile delinquents.

21. Article 24 : No child below 14 years shall be employed to work in any factory or in any hazardous employment. Article 39 : The state shall direct its policy towards securing that children are given opportunities and facilities to develop in a healthy manner and in conditions of freedom and dignity. Article 45: The state shall endeavor to provide free and compulsory education to all children till they complete the age of 14 years

22. Prevention of child Abuse

23. Primary Level prevention Creating general awareness among the people about the extent and nature of the problem through the mass media. Education of the general public about the causes, prevention and control of child abuse Encouraging family support system, interpersonal communication and equal distribution of family resources to all the members. The nurse can teach the parents acceptable and workable way to discipline children so that the limits are maintained without causing the child emotional or physic harm. Developing self-care services like day care facilities for normal and physically and mentally handicapped children for their care and supervision

24. . Special care to the mothers, who are predisposed to hysterical or emotional illness such as the teenage mothers and those having several children or family discord. Improving general health status and socio economic status by encouraging the female literacy and prenatal training, family welfare services to prevent unwanted pregnancies, promoting income generating activities etc. Training of health and social welfare personnel to recognize child abuse and activate the implementation of the children's acts.

25. Secondary and tertiary levels of prevention Recognition of child abuse cases, reporting to the authorities and diagnosis by the doctor. Establishing rapport and investigating the associated factors. Providing specific care according to the kind of trauma, good physical care and love to the abused child. Individual counseling and psychotherapy of parents and children to deal with specific psychosocial and physical problems. • Group therapy in the form of self help groups, community day care centers, where battering parents and their children can interact and gain sup. port from each other.

26. Nursing Care of Abused Children 1. Assessment: Physical and X-ray examination; examination of genitals, anus; evidence of malfunction, ill health; observe signs of physical, psychological or sexual abuse; lacking behavior of child. 2. Nursing diagnosis: Altered comfort related to pain from physical abuse; impaired verbal communication, ineffective individual or family coping; inadequate nutrition assessment; disturbance in self concept due to a sense of inferiority.

27. 3. Implementation (Intervention): Responsibilities are multifold. At school it lies on school health nurse, at home it is to be done by community health nurse, and at hospital by clinical nurse. This can be done by developing a trusting relationship with child, family or school staff. Immediate care should be focused on meeting physical and emotional needs. Psychological support should be given. Family and the child should be provided a healthy and safe environment.

28. Thank you