Republic of the Philippines UNIVERSITY OF NORTHERN PHILIPPINES Tamag, Vigan City Graduate School Masters on Art in Nursing MCN

201 By: GERRY R. PINGEN Child Abuse Refers to the maltreatment, whether habitual or not, of the child below 18 years of age, which includes any of the following: o Psychological and physical abuse, neglect, cruelty, sexual abuse and emotional maltreament; o Any act by deeds or words which debases, degrades or demeans the intrinsic worth and dignity of child as a human being; o Unreasonable deprivation of his basic needs for survival such as food and shelter; or o Failure to immediately give medical treatment to an injured child resulting in serious impairment of his growth and development or in his permanent incapacity of death. Incidence: A report of child abuse is made every ten seconds. Almost five children die everyday as a result of child abuse. More than three out of four are under the age of 4. It is estimated that between 60-85% of child fatalities due to maltreatment are not recorded as such on death certificates. 90% of child sexual abuse victims know the perpetrator in some way; 68% are abused by family members. All socioeconomic levels Both genders All ages youngest is 6 months old Every geographic area Every racial, religious and educational background Forms of Child Abuse a. Physical Abuse Non-accidental physical injury may include severe beatings, burns, biting, strangulation and scalding with resulting bruises, welts, broken bones, scars or serious internal injuries. Physical Indicator Bruises, welts, or burns shaped like objects (iron, heater, etc.) Bruises in unusual places (eyes, back, mouth, buttocks, genital area, thighs) "Sock" or "Glove" burns on hands or feet Small round burns from cigarettes Rope burns on ankles, wrists, or torso Adult size bite marks Suspicious fractures Physical discipline administered with an object (i.e. belt, wooden spoon etc.) Marks from physical discipline that last more than an hour or so

Behavioral Indicators has difficulty getting along with others, avoids physical contact with others little respect for others apprehensive when other children cry overly compliant, withdrawn, gives in wears clothing to purposely conceal readily and allows others to do for injury, i.e. long sleeves him/her without protest gives inconsistent versions about plays aggressively, often hurting peers occurrence of injuries complains of pain upon movement or seems frightened by parents contact often late or absent from school has a history of running away from home comes early to school, seems reluctant to go home afterwards Sexual Abuse Sexual abuse is any sexual contact with a child or the use of a child for the sexual pleasure of someone else. This may include exposing private parts to the child or asking the child to expose him or herself, fondling of the genitals or requests for the child to do so; Oral sex or attempts to enter the vagina or anus with fingers, objects or penis, although actual penetration is rarely achieved. Indicators and Assessments Genital findings Venereal disease may be located in the mucosa of the vagina, penis, anus, or mouth. semen in the vagina of a child, torn or missing hymen, other vaginal injury or scarring, vaginal opening greater than 5 mm, and injury to the penis or scrotum

Oral findings injury to the palate or pharyngeal gonorrhea. Anal Findings destruction of the anal sphincter, perennial bruising or abrasion, shortening or eversion of the anal canal, fissures to the anal opening, wasting of gluteal fat, and Funneling

Behavioral Indicators Children often do not tell us with words that they have been sexually abused or that they have successfully resisted an assault and don't know quite what to do next. There are many reasons children might hesitate or be afraid to tell us about what has happened, including their relationship to the offender, fear of the consequences, retaliation or uncertainty about whether or not they will be believed. Withdrawal or anti-social attitudes Exaggerated interest in sex or "acting out" sex with other children Unusually seductive behavior Fear of intimate contact (hugging or sports) Sexual knowledge beyond their years and developmental ability Emotional Abuse

Emotional Abuse is a pattern of behavior that attacks a child's emotional development and sense of self-worth. Includes excessive, aggressive or unreasonable demands that place expectations on a child beyond his or her capacity. Constant criticizing, belittling, insulting, rejecting and teasing are some of the forms these verbal attacks can take. Also includes failure to provide the psychological nurturing necessary for a child's psychological growth and development -- providing no love, support or guidance

Indicators of Emotional Abuse Observable Indicators child rocks, sucks, bites self inappropriately aggressive, destructive to others suffers from sleep, speech disorders restricts play activities or experiences demonstrates compulsions, obsessions, phobias, hysterical outbursts

Behavioral Indicators negative statements about self shy, passive, compliant lags in physical, mental and emotional development self destructive behavior highly aggressive cruel to others overly demanding

Neglect Failure to provide for a child's physical needs. Includes lack of supervision, inappropriate housing or shelter; Inadequate provision of food; Inappropriate clothing for season or weather; Abandonment, denial of medical care; and Inadequate hygiene. Classifications: Physical Neglect failure to provide for a childs minimum health care needs Emotional Neglect failure to provide basic nurturing and affection; failure to seek proper psychological care, permission to

indulge in drug or alcohol abuse, other maladaptive behavior. Educational Neglect failure to send the child to school and ensure that a child is not truant, regardless of economic situation.

Abusers are family, friends and neighbors Factors Leading to Child Abuse 1. Stress... is a major factor in child abuse. Stress can come from the workplace, social isolation, marital problems, and illness.

2. Unreasonable expectations...

When parents are unaware of their children's limitations they often set too high of expectations, when these are not met, the parent may think that the child is intentionally misbehaving. 3. Lack of Parenting Knowledge... Parents who have not had good role models may not fully understand their child's needs/wants or appropriate methods of discipline. This may lead them to feel guilty or inadequate, taking these feeling out on their children. 4. Financial Hardship... When parents are having financial difficulty they may see their child's needs as a reminder of his/her "failure", blaming their children for the financial troubles. 5. Family Background... Studies have proven that abused children are at a higher risk to abuse their own children. As a child who has seen or been abused on a regular basis they often see abuse as "normal" or a viable form of discipline.. 6. Special Child They maybe more or less intelligent than other children in the family; they may have been unplanned, have birth defects, or have an attention span deficit. A category of children who are at high risk includes those who are born prematurely or who have an illness at birth. Nursing Care Prevent abuse Identify suspected cases of child abuse or neglect Determine extent of injuries Protect from further abuse Promote therapeutic environment during hospitalization Relieve anxiety in child Promote wellness in child Promote a sense of parental adequacy during childs hospitalization Plan for discharge Prevent recurrence Support parents Teach parents Lessen environmental crisis

Priorities Republic Act 7610, the anti-child abuse law requires reporting of suspected cases to authorities o Remember that the nurse does not have to decide with certainty that abuse has occurred o Nurses are responsible for reporting suspected child abuse with accurate and thorough documentation of assessment data o Report cases to barangay officers, DSWD personnel, police within 48 hours