Psychiatry - Child Abuse: Screening, Education, and Intervention

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If you are in the medical world, either as a physician or as a medical student, or even random people who go about their daily lives, chances are that you might have come across an abused child. Today, let's address the issue of child abuse as it affects the health of a child as well as the psychology of such children. As a health practitioner, if you see a case of child abuse, it is important to report it to the appropriate authorities so they can look into it.

Child abuse can be in three ways, Physical, sexual, and emotional or psychological abuse. What is painful is that it is always inflicted by people who are close to the children such as caregivers, and parents. According to a paper by the Centers for Disease Control, 1 in 7 children in the US experience child abuse or neglect.


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In the case of physical abuse, the child would have injuries that are inflicted by the caregiver or parents. Child abuse can be seen in children as low as 2 months to 1 year old. According to WHO, about 3 in 4 children between the age of 2 years to 4 years suffer from child abuse. As a practitioner, identifying child abuse can be done via physical examination where injuries and bruises have been inflicted on the child. Taking a history is important, as it is very vital to know the caregiver's history. When you ask an abusive caregiver or parent about the history of the bruises or injuries that the child has, they tend not to be consistent especially when the question is asked over and over again in different ways. Children with physical abuse can have these bruises on the buttock, neck, trunk, and ear. Children can have fractures at different parts of the body, and this can be identified through Scans such as X-rays. This fracture can be found around the ribs or long bones of the child as a result of hitting by the caregiver or parent. In severe cases, the child could have Shaken baby syndrome as a result of head trauma caused by abuse. The child could also experience retina hemorrhages as a result of hitting which would hit the wrong places, and also children could suffer subdural hematoma as a result of the child's brain hitting the brain.

Child abuse is often common in single or younger parents, it is also common with parents who abuse drugs or have a history of substance abuse. Parents with Psychiatric histories also abuse children. In Africa, it is common for parents who have a low level of education. A lot of African children who are now adults can testify to this. Parents who have unplanned or unwanted pregnancies tend to transfer aggression and frustration to the child, leading to abuse. One child risk factor I see with child abuse is when the child has learning disabilities and this isn't the child's fault so I do not see reasons, why the parent should abuse them for what they do not have control over, although they might have behavioral issues and can be difficult to work with that, doesn't give a window for abuse.

Sexual child abuse is usually done by a known male guardian or a close person to the child. It is usually common among children who are in the prepuberty stage and it is usually common in females, although males are also abused. Upon examination, the physician can notice trauma toward the mouth, anus, and genitalia. Another red flag is Sexually Transmitted Diseases. Children should not have STIs.

Psychological abuse has to do with talking down on children, making them feel not wanted and worthless. This is child abuse that is done via verbal abuse or privately and publicly humiliating the child, criticism, and intimidating the child. Also, confining a child to a room or object for a long period of time is another form of psychological abuse.

A child can experience a single type of abuse or multiple types of abuse, and these abuses can lead to an increased risk factor for Mood Disorders, Post-traumatic stress disorder (PTSD), Depression, Anxiety disorders, Personality disorders, and Suicide attempts or self-injury in children. It is important to treat children as soon as possible to prevent the trauma gotten from the abuse become a part of their identity. Medical help for children who have been sexually abused will be advised immediately, while children who have been psychologically and physically abused will need therapy for a while so they can trust again, help boost their self-esteem, and be able to differentiate between normal behavior and abusive one.



Reference

https://www.cdc.gov/violenceprevention/childabuseandneglect/fastfact.html

https://www.who.int/news-room/fact-sheets/detail/child-maltreatment

https://www.cdc.gov/violenceprevention/childsexualabuse/fastfact.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159672/

https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19010020

https://www.mayoclinic.org/diseases-conditions/child-abuse/symptoms-causes/syc-20370864



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