Child Abuse And Neglect

Subject: PSYCHIATRY 2 Topic: ABUSE AND NEGLECT Lecturer: DR.UY Shifting /Date: 4TH SHIFTING/ JAN 29, 2009 Trans group: kix, ces, pau, may

ABUSE AND NEGLECT REPUBLIC ACT NO. 7610 An act providing for stronger interference and special protection against child abuse, exploitation and discrimination, and for other purposes

ETIOLOGY  “Perpetrator”: Parents (?)  Stressful Living /condition  Child characteristics

CHILDREN refers to:  person below eighteen (18) years of age or  those who are over but are unable to fully take care of themselves from abuse, neglect, cruelty, exploitation or discrimination because of a physical or mental disability or condition;

THE PERPETRATOR  often known to the child  Mother (physical abuse)  Men (sexual abuse)  Active baterrer and passive baterrer  Inappropriate expectations, treat as older  Physically abused as a child

CHILD ABUSE Psychological and physical abuse, neglect, cruelty, sexual abuse and emotional treatment 2. Any act by deeds or words which debases, degrades or demeans the intrinsic worth and dignity or a child as a human being 3. Unreasonable deprivation of his basic needs for survival, such as food and shelter  28% of children under age 5 are severely and moderately underweight based on international standards (World Summit Goals for children, 1998)  49% of the total population of infants and 26% of the total population of the children with ages ranging from 1-6 years old suffer from iron deficiency anemia 4. Failure to immediately give medical treatment to an injured child, resulting in serious impairment of his growth and development or on his permanent incapacity or death  Infant mortality rate is pegged at 42.73 per 1000 livebirths (DOH)  there is one hospital for every113, 040 people  there is only one doctor for every 24, 417 people;  1 nurse for every 22, 3309  1 dentist for every 578, 124 and  1 midwife for every 722, 654 people (Philipppine Textbook of Statistics) 1.

EPIDEMIOLOGY  Research studies conducted in schools that for every 3 Filipino children, one child experiences abuse (Manila Bulletin, 11 February 1996)

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There were 2393 children who fell prey to rape, attempted rape, incest, acts of lasciviousness and prostitution (DSWD 1st semester CY 1999)

 CHILD ABUSE AS SERVICED BY DSWD:  Sexually abused -4,129  Neglected – 2,549  Physically abused – 1,440  Victims of Child Labor – 358  Sexually exploited-284

PARENTS  Parents as victims  mental incapacity/ lack of coping mechanisms  substance abuse ENVIRONMENT  overcrowding  housing problems  poverty, unemployment  social isolation  conflict areas CHILD FACTORS  premature  mentally retarded  physically disabled  difficult children CLINICAL PICTURES OF CHILD ABUSE (ER)  body trauma, bruises, abrasions, cuts, laceraions, burns, hematomas, soft tissue swelling  inability to move extremity  abdominal injury  hypernatremic dehydration  neurological deficits, seizures, coma DIAGNOSIS OF PHYSICAL ABUSE  multiple spinal fractures  retinal hemorrhages  children repeatedly brought to the hospitals for treatment of peculiar or puzzling problems by overly cooperative parents(Munchausen Syndrome by proxy)  bruises and injuries that are incompatible with history  symmetry or regular patterns  shape of the instrument of abuse  immersion in water CHILD AND YOUTH WELFARE CODE OF THE PHILIPPINES Article 59 of PD 603 1974 Criminal liability shall attach to any parent who:

MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY KC JAM CECILLE DENESE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC PENG KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU RACHE ESTHER JOEL GLENN TONI

Subject: psychiatry Topic:abuse and neglect Page 2 of 3

1. Conceals or abandons the child with an intent tot make such child lose his civil status 2. Abandons the child under such circumstances as to deprive him of love, care and protection she needs  there are 1.5 M street children. DSWD estimates that this number increases annually by 6,365 3. Sells or abandons the child to another person for a valuable consideration  of the 1.5 M streetchildren 60,000 are prostituted (ECPAT 1996)  the DSWD claims that the annual average increase of the prostituted children 3,266.  the Philippines is the fourth country with the most number of prostituted children (Intersect, December 1995) 4. Neglects the child by not giving him the education which the family’s station in life and financial conditions permit  only 19% of children aged 4 to 6 years old are able to go to public schools and private preschools  60% of the children drop out of the school when they reach grade 2 (PDI, 18 May 1997)  62 towns in the country do not have a high school CLINICAL FEATURES OF A NEGLECTED CHILD  overt failure to thrive less than 1 yr old  malnutrition  poor skin hygiene  inappropriate dress

 physical and developmentally depressed PHYSIOSOCIAL DWARFISM PSYCHOLOGICAL FEATURES  Behavior: withdrawn and frightened  aggressive and labile mood  depression, low self- esteem anxiety  delay in developmental milestones LABORATORY EXAMS  physical exam  endocrinological exam  external genital examination  radiologic exam: fractures at different stages of healing SEXUAL ABUSE ABUSER: adults within the immediate or extended family  History is difficult to obtain Clinical Features: -most often, no definitive physical evidence unless profound injury -Genital injury - STD in child -no specific behavioral manifestations prove that sexual abuse has taken place -young children with detailed knowledge -play and may initiate with peers -extremely fearful of adults

STATUTORY RAPE - intercourse between a man over 16 years old and a woman under the age of consent RESULTANT PSYCHOLOGICAL EFFECTS •Vulnerability depends on…. -type of abuse -its chronicity -age of the child -overall relationship of the victim and abuser  anxious, hyperalert, depressed  PTSD, dissociative personality disorder  substance abuse DIFFERENTIAL DIAGNOSIS:  Parental feuding and custody disputes TREATMENT OF CHILD ABUSE  Ensure safety and well-being  Treat emergent conditions  Counseling  Reporting  Prevention – education, identification PHYSICAL ABUSE OF ADULT  Spouse abuse  Husband’s aggression is bullying behavior to humiliate their wives and build their own self- esteem -threatened or frustrated at home, work and peers DYNAMICS:  Identifying with the aggressor  Testing behavior  distorted desires to express manhood  Dehumanization of women FEATURES OF SPOUSE ABUSE: -Pregnant -Broken limbs and ribs -Internal Bleeding -Brain damage - Emotional drama -Dependence -Lack of self-esteem -Fear of life HISTORY AND PHYSICAL EXAM  Interview alone, without partner present  Simple and direct questions  Confidential setting If yes.... 1. 2. 3. 4. 5. 6.

encourage her to talk about it listen non-judgmentally validate document assess the danger to your patient provide treatment, referral and support

If no....  beware of the clinical findings that may indicate abuse: - injury to the head, neck, torso, breast, abdomen, ang genitals

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-bilateral or multiple injuries -delay between onset of injury and seeking treatment -explanation of patient inconsistent with the type f injury -any injury during the pregnancy -chronic pain symptom s -psycological distress, sleep disorders, suiciadal ideation -prior history of trauma -partner who seem overly protective or will not leave her side SEXUAL COERCION -one person predominates the other by force or compels the other person to perform a sexual act STALKING  A pattern of harassing or menacing the behavior coupled with a threat to do harm  Most are men but women who stalk are just likely as men to attack their victims violently SEXUAL HARASSSMENT

 Sexual advances, request for sexual favors, verbal or physical conduct of sexual nature- all of which are unwelcomed by the victim  if a man is being harassed usually by another man

 Behavioral Types: abusive language, request for special favors, sexual jokes, staring, ogling, and giving messages.  Victims: don’t come forward due to fear RAPE Conventional definition: perpetration of an act of sexual intercourse with a woman against her will and consent Whether her will is overcome by a force or fear or by drug or toxicants She is incapable of exercising rational judgment Below arbitrary age of consent - But can occur between married partners, or persons of the same sex RAPE IS COMMITTED: 1. By a man who shall have carnal knowledge of a woman under any of the following circumstances: a. through force, threat or intimidation; b. when the woman is deprived of reason or otherwise unconscious c. by means of fraudulent machination or grave abuse of authority; and d. when the offended party is under 12 years of age or is demented, even though none of the circumstances mentioned above be present 2.

by any person who, under any of the circumstances mentioned in the paragraph 1 hereof, shall commit an act of sexual assault by inserting his penis into another person’s mouth or anal orifice, or any instrument, or object, or any other part of the body such as fingers or toes, into the genital or anal orifice of another person. Source: (The Anti-Rape Law of 1997)

CRIME OF RAPE  An act of violence and humiliation that is expressed through sexual means  expresses power or anger not sexuality

 Requires only slight penile penetration of the victim’s outer vulva  an average of seven women were raped daily in the Philippines

RAPE OF WOMEN  Male Rapists -Sexual sadists (arouse by pain or their victims) -Exploitive predators (victims as objects of gratification) -Inadequate men -Men who rape because of anger and rage  often accompanies another crime  Women can be raped at any age  Commonly occurs in own neighborhood or frequently inside or near her home  most are premeditated  half by strangers  10% involve more than one attacker DATE RAPE -Aquaintance rape -rapist is known to the victim In addition to the same symptoms of rape -berate themselves for poor judgment in choice of male friends -more likely to blame themselves CLINICAL EFFECTS  During the rape- shock, fright, and panic  Primary Motivation- to stay alive  After the rape- shame, humiliation, confusion, fear and rage The type, reaction and degree of damage vary: -violence of attack itself -vulnerability of the woman -support system available to her immediately after the attack MANAGING A RAPE VICTIM Best if immediate support is received and she can ventilate her emotions Supportive therapy to restore her sense of adequacy and control over her life