Child Abuse

Health ImpactJinan Usta MD

Health problems

• The psychological and medical squeal of abuse can appear immediately or later, sometimes later

Child abuse- injuries

• Skin: bruising, cuts, wounds, redness or bulla

• Brain: micro hemorrhages, bleeds• Eyes: retinal hemorrhages, conjunctival

hemorrhages, orbital swelling• Abdomen: acute abdomen, hematuria• Skeleton: fractures multiple or in various

stages of healing• Sudden death

• Chronic: – Pains: headache, back, abdomen….– Chronic illnesses: arthralgias, hypertension,

diabetes, asthma- bad control – GU/GI symptoms.. – Psychosomatic symptoms: fatigue, dizziness.– Immune system deficiency

Indirect health consequences of abuse

• Increase injurious health behaviors

• Reduce preventive health behaviors

• Problems managing co morbid state

Lifetime Health Impact

• Smoking

• Alcoholism

• Substance abuse

• Obesity

• Depression

Lifetime Health Impact

• Pulmonary disease

• Hepatitis

• Heart disease

• Diabetes

• Suicide

Mental health problems

• Difficulty to concentrate, poor school performance

• Eating disorders• Withdrawal, low self esteem• Anxiety, fear, sleeplessness, nightmares• Obsessive compulsive- perfectionist• Depression, guilt, suicide• Borderline, excessive daydreaming, Dissociative

symptoms • Drug addiction, substance abuse

Behavioral problems

• Aggressiveness: violence is acceptable way to assert one’ s view, or to discharge stress

• Hyperactivity and regressive behaviors

• Avoidance, mistrust

Cognitive problems

• The world is a dangerous place, chronic perception of helplessness and powerlessness, low self esteem

• Impaired sense of self: difficulty protecting self or setting boundaries

Relationship problems

• Violence is an inherent part of a loving relationship

• Intimacy dysfunction: difficulty in self disclosure or expressing warmth in intimate relationships, high need for closeness

Role of the health care provider

• Victims of abuse are frequent visitors to the health care system

• Importance of detection by screening, providing guidance and counseling and assistance

• The approach is very delicate and sensitive- can endanger the child

Role of the health care provider

• Provide ways to discipline the child-

THERE ARE SO MANY WAYS TO DISCIPLINE A CHILD - COROPORAL PUNISHMENT EVEN FOR THE SAKE OF DISCIPLINE IS CHILD ABUSE

Recommendations

• Encourage all primary health care professionals to screen for abuse

• Train health care professionals in skills needed to support the abused child and his family

Recommendations

• Incorporate screening for child abuse in all school health programs

• Introduce, within the school curricula, the teaching of child’s rights

• Conduct series of workshops teaching discipline for parents and teachers