SGD B.

8 / LT Day
17th

[CHILD ABUSE AND NEGLECT| Behavior Change and Disorders | SGD B8

Learning Task 1. Explain the definition of abuse and neglection in children! Abuse is a non!accidental in"ury to a child #hich $regardless of %oti&e' is inflicted or allo#ed by the person responsible for the child(s care $parents) teacher or care taker'. *t is includes any in"ury #hich is at &ariance #ith the history gi&en %altreat%ent such as %alnutrition) sexual forced) e%otional %altreat%ent or cruel punish%ent. +eglect is the failure $#hether intentional or not' of the person responsible for the child(s care to pro&ide and %aintain physical or e%otional needs) like ade,uate food) clothing) shelter) %edical care) super&ision and/or education. A child %ay be found neglected #ho has been abandoned is being denied proper care and attention physically) educationally) e%otionally) or %orally is being per%itted to li&e under conditions) circu%stances or associations in"urious to his #ell!being is being abused.

-. Describe the i%pacts of abuse and neglected children! Attach ent !ro"#e s .ithout the security and support fro% a pri%ary caregi&er $parent') infants or adolescent %ay find it difficult to trust others #hen in distress) #hich %ay lead to persistent experiences of anxiety or anger) alter the nor%al de&elop%ental process for children) #hich can se&erely affect a child(s ability to co%%unicate and interact #ith others and for% healthy relationships throughout their life. $h%sica# hea#th !ro"#e s A co%%on for% of abuse affecting the health of babies is shaken baby syndro%e. /ealth proble%s resulting fro% shaken baby syndro%e %ay include brain da%age) spinal cord in"uries) hearing loss) speech difficulties and e&en death. +eglected children $#ho don0t ha&e good shelter) clothes and food' al#ays ha&e unhygienic life that %akes their health syste% getting #orse. Abuse children also get serious health proble% because of they get so%e in"uries $physical or sexual' fro% the other. $s%cho#ogica# !ro"#e s Experiences of child abuse and neglect can ha&e serious effects on the de&eloping brain) increasing the risk of psychological proble%s. *nterfere #ith a child(s capacity to integrate sensory) e%otional and cogniti&e infor%ation. The children also feel guilt) repeated scare night%are sha%e) #ithdra#n) extre%e frightened) lose of concentration) decrease in &ocali1ation) depression) poor self!estee% and anxiety. Cognitive and Behaviora# $ro"#e s Abuse and neglect usually associated #ith internalising beha&iours $being #ithdra#n) sad) isolated and depressed' and externalising beha&iours $being aggressi&e or hyperacti&e' throughout childhood. Abuse and neglect in the early years of life can seriously affect the de&elop%ental capacities of infants) especially in the critical areas of speech) learning and language. They cannot pass all the %ilestones) they ha&e difficulties #ith peer $social' relationships and %ay engage in self destruction or suicidal beha&ior. Eating disorders Eating disorders) including anorexia and binge!purge beha&iour $buli%ia') %ay also be associated #ith child abuse and neglect because they #ant to re&enge the in"ury that they got by fasting or eat &ery %uch to o&erco%e stress. 2o%e of the% also get star&ation because don0t get enough food for nutriotion. Dr&g and a#coho# a"&se The psychological effects of child abuse and neglect %ay lead to alcohol and drug abuse proble%s in adolescence and adulthood. 3hildren al#ays think that by consu%ing drug or alcohol) all of the proble% #ill be cope. E&en they kno# the conse,uence of it to their health. Aggression' vio#ence and cri ina# activit% *n addition to feeling pain) children exposed to abuse and neglect are at increased risk of inflicting pain on others and de&eloping aggressi&e and &iolent beha&iours or cri%inal thing in adolescence. They do that) because their pri%ary care gi&er $parent' don0t taking a care to the%. All of their need don0t be granted by their parents) so that they do cri%inal beha&ior like steal other person to get so%e food or pleasure. Teenage !regnanc% and Se(&a# Trans itted Disease An exposed to adolescent sexual abuse had significantly higher rates of teenage pregnancy and increased rates of sexually trans%itted diseases) #hich is the co%plex proble% to the children. They are forced to do sex intercourse) if not they #ill be strike or kill by the perpetrator. Ho e#essness

SGD B8| Behavior Change and Disorders4 5edical 6aculty 7 8dayana 8ni&ersity -91-

SGD B.8

SGD B.8 / LT Day

17th

[CHILD ABUSE AND NEGLECT| Behavior Change and Disorders | SGD B8

:oung people #ho are re%o&ed fro% the care of their parents because of abuse or neglect %ay also face ho%elessness and une%ploy%ent soon after lea&ing out of ho%e. *t #ill be the beginning of the other aspect of i%pact. )ata# i !act The %ost tragic and extre%e conse,uence of child abuse and neglect is abuse or neglect that results in death. ;. Explain the sy%pto% of psychiatric disorder caused by abuse and neglect of children! 3hildren #ho get abuse or neglected by their pri%ary caregi&er $parents' can %anifest %any psychiatric proble%. They #ill get ood disorder) %ore depressed because of it and so%e of the% #ill be %anic because they #ant to i%itate $re&enge' the thing that they got. They also suffering fro% an(iet% disorder and eat disorder. They get extre%ely scare to other person because they afraid they #ill got it again fro% other person and they don0t ha&e a good %ood to eat. Se(&a# disorder al#ays happened to children #ho get sexual abused and #ill get recurrent night%are $ s#ee! disorder' because of bad experience fro% other. They al#ays spend their anger by consu%ing dr&g*a#coho#) e&en they kno# the risk to their health. And finally the children tend to s&icide to cope all of those proble%. <. Explain the strategy of therapy for children #ho are abuse and neglected! The therapist has an i%portant role in helping a child reco&er fro% the effects of abuse and neglect. The therapist ser&es a nu%ber of functions) including helping the child address issues related to abuse and neglect) ser&ing as a %odel for appropriate adult child relationships) #orking to i%pro&e fa%ily relationships) and supporting positi&e and producti&e peer relationships and support syste%s. Treat%ent strategies 2trategies for treating the abused child are &aried and #ill be used as appropriate to the child0s presenting proble%s. =eco%%ended treat%ent approaches include > ?sychoeducation > Anxiety %anage%ent > Exposure related to feared experience > cogniti&e!beha&ioral strategies > graduated exposure to aspects of the abusi&e experience > relaxation training > education regarding abuse process and effects of abuse > skills training > supporti&e strategies > teaching self!protecti&e strategies > beha&ioral strategies/parent training > clarification of responsibility/bla%e and offender(s beha&ior > 5onitoring and support for periods of ti%e after the abuse @. Explain ho# to refer patient #ith abuse and neglect! .e ha&e to contact/refer a child to the health care pro&ider or other speciali1e depart%ent if a child has ?hysical changes) such as unexplained in"uries) #eight loss) or se&ere tiredness 8nexplained beha&ior changes 5ake sure that their parents acco%panying the children to the doctor) and say to the% that this disorder is serious and %ust be handled in speciali1ed. And educate the% that this disorder $in"ury' can cope by other depart%ent. The follo#ing consultations %ay be #arranted ?ediatric and radiologist expertise are i%portant because %any abusi&e fractures in infants are subtle on radiographs. =outine pediatric radiologist in&ol&e%ent is ideal. *n locations #here pediatric radiologists are not routinely a&ailable) one should be consulted in cases in #hich dating of bone in"uries beco%e central to the %altreat%ent in&estigation and #hen concerns arise regarding osteogenesis i%perfecta $A*' or other bone %inerali1ation proble%s. Arthopedists can assist #ith diagnosis and %anage%ent in cases of skeletal fractures of the long bones. /e%atologists can assist #ith diagnosis and %anage%ent of bleeding disorders. ?lastic surgeons %ay be needed to assist #ith the %anage%ent of serious burns. Aphthal%ologists should be in&ol&ed #hene&er abusi&e head trau%a $A/T' is suspected) for a for%al e&aluation including exa%ination of the eyes for retinal he%orrhages.

SGD B8| Behavior Change and Disorders4 5edical 6aculty 7 8dayana 8ni&ersity -91-

SGD B.8

SGD B.8 / LT Day

17th

[CHILD ABUSE AND NEGLECT| Behavior Change and Disorders | SGD B8

3hild psychiatrist %ay be needed to assess the %ental health needs of the child and fa%ily) as #ell as to coordinate an o&erall psychosocial treat%ent plan. .e can also refer the children to therapists counselor) social #orker and child protection agencies $Bo%nas Anak' to get appropriate solution for their proble%) specially proble% #ith their car gi&er.

C. Explain the diagnosis physically abuse children according D25 *D T=! 3linicians %ust al#ays consider to diagnose that this disorders are caused by physically abuse) #hen a child sho#s bruises or in+&ries that cannot "e ade,&ate#% e(!#ained or that inco !ati"#e -ith the histor% that the !arent gives. 2uspicious physical indicators are bruises and %arks that .or s% etrica# !atterns) such as in"uries to "oth sides of the face and regular patterns on the back $accidental in"uries are unlikely to result in sy%%etrical patterns'. Eruises %ay ha&e the sha!e o. the instr& ent &sed to a/e the ) such as belt buckle or a cord. Eurns by cigarettes result in sy%%etrical) round scars. *%%ersions in boiling #ater produce burns that look like socks or glo&es or doughnut shape. ?hysical aggression can cause %ultiple and spiral fracture) especially in young baby. =etinal he%orrhage al#ays happened in an infant that result fro% shaking. 7. Explain clinical features e%otional abuse children! E otiona# a"&se $or psychological abuse' is a pattern of beha&ior that i%pairs a child(s e%otional de&elop%ent. This %ay include constant criticis%) threats) or re"ection) as #ell as #ithholding lo&e) support) or guidance. E%otional abuse is often difficult to pro&e and child protecti&e ser&ices %ay not be able to inter&ene #ithout e&idence of har% or %ental in"ury to the child. E%otional abuse is al%ost al#ays present #hen other for%s are identified. *ndicators of e%otional abuse in children > 6eelings of #orthlessness about life and the%sel&es > Less able to &alue others > Lack of trust in people and their expectations > Lack of interpersonal skills necessary for interaction in social > 3annot %ake attention #ell > Eeha&ioural disorders such as disrupti&eness) aggressi&eness) bullying > 3o%pulsi&e lying and stealing > Destructi&e or &iolent beha&iour > =ocking the body or sucking things > Eeing &ery #ithdra#n or depressed > /igh le&els of anxiety > 6ear of ne# situations and passi&e > 2ho#ing delayed speech or speech disorder > Drug or alcohol abuse) sniffing petrol) glue or other substances > *nappropriate e%otional responses to painful situations > Delays in physical) %ental and e%otional de&elop%ent F. Explain clinical features neglected children! *ndicators of neglect in children or young people > 6re,uent hunger and seen sickly > 2ca&enging or stealing food > 2ee%ing constantly tired or lacking life or energy > Lo# self!estee% > *nappropriate clothing > Li&e no%adic or in inappropriate place) eg. under the bridge > ?oor personal hygiene $and signs of %edical proble%s as a result' leading to social isolation > Extended stays at school) public places) others0 ho%es > A flat and superficial #ay of relating) lacking a sense of general interaction > Anxiety about being dropped off or abandoned > ?oor or slo#ed physical and social de&elop%ent > 6re,uent lateness or truancy fro% school > 8ntreated %edical proble%s G. Explain e&aluation process child #ho ha&e been sexually abuse!

SGD B8| Behavior Change and Disorders4 5edical 6aculty 7 8dayana 8ni&ersity -91-

SGD B.8

SGD B.8 / LT Day

17th

[CHILD ABUSE AND NEGLECT| Behavior Change and Disorders | SGD B8

The presenting sy%pto%s %ay be so general $eg) sleep disturbances) abdo%inal pain) enuresis) encopresis) or phobias' that caution %ust be exercised #hen the pediatrician considers sexual abuse) because the sy%pto%s %ay indicate physical or e%otional abuse or other nonabuse!related stressors. 3hildren %ay be anxious/afraid about gi&ing a history) being exa%ined) or ha&ing procedures perfor%ed. Ti%e %ust be allotted to relie&e the child(s anxiety. 2igns of trau%a should be carefully docu%ented by detailed diagra%s illustrating the findings or photographically. 2pecific attention should be gi&en to the areas in&ol&ed in sexual acti&ityHthe %outh) breasts) genitals) perineal region) buttocks) and anus. Any abnor%alities should be noted include genital/rectal bleeding. *n fe%ale children) the genital exa%ination should include inspection of the %edial aspects of the thighs) labia %a"ora and %inora) clitoris) urethra) periurethral tissue) hy%en) hy%enal opening) fossa na&icularis) and posterior fourchette. *n %ale children) the thighs) penis) and scrotu% should be exa%ined for bruises) scars) chafing) bite %arks) and discharge. *n both sexes) the anus can be exa%ined in the supine) lateral) or knee to chest position Ather physical signs or laboratory findings that are suspicious for sexual abuse re,uire a co%plete history fro% the child and caregi&ers. *f the child does not disclose abuse) the physician %ay #ish to obser&e the child closely to %onitor changes in beha&ior or physical findings. And also #e ha&e to inter&ie# $neighbor' relati&e people $collateral infor%ation' to get specific infor%ation because the perpetrators could be the parent. 19. Explain the pre&ention child abuse in fa%ilies and co%%unity! Co &nit%0 ! Educate the co%%unity about this proble% by doing sociali1ation and gi&e serious punish%ent to people #ho against it ! 3o%%unity progra%s) such as ho%e &isits by nurses and social #orkers) can help fa%ilies change beha&iors or pre&ent the start of abuse in high!risk fa%ilies. ! 2chool!based progra%s to i%pro&e parenting) co%%unication) and self!i%age can help pre&ent future abuse and %ay help to identify abused children. ! Apti%alisation the institution that responsible to this proble%. $build branch of Bo%nas Anak in &illage' ! 5ake facilitations that %ake people easily get the right aces #hen seeking abuse/neglect in their en&iron%ent. )a i#%0 ! ?arenting classes are &ery helpful. +e#ly#ed adults #ithout children should be encouraged to take these classes before they ha&e each child. The dyna%ics in the ho%e change #hen each ne# child is born. ! Educate the parents ho# to care and gi&e affect to child in appropriate #ays. 11. Explain the treat%ent that can be pro&ided to children that ha&e been physically abuse! Treat%ent should be directi&e and focused on the abuse itself. Treat%ent approaches should 1' help and encourage the child to talk and think about the abuse/neglect #ithout e%barrass%ent or anxiety -' help the child to express feelings about the abuse to cope it ;' reduce the intensity and fre,uency of beha&ioral and e%otional sy%pto%s <' clarify and change distorted) inaccurate) or unhealthy thinking patterns that %ight negati&ely affect the child0s &ie# of self and others. @' help the child de&elop healthier life and gi&e beha&ioral therapy C' educate the child regarding self!protecti&e strategies. 7' teach the caregi&er about the risk doing physical abuse. F' teach the pri%ary caregi&er $parents' about appropriate #ay to care/punish their child. G' separate the child #ith the perpetrator for enough ti%e) and do decentilisation. G' refer child to psychiatry or social #orker or child protecti&e agency $Bo%nas Anak' to cope the proble%. 19' treat%ent is also carried by other acco%panying sy%pto%s) such as psychiatric sy%pto%s depression $A%itriptyline') 5anic $Lithiu% 3arbonate') anxiety $Dia1epa% / 3hlordia1epoxide') inso%nia $?henobarbital') panic $*%ipra%ine'.

SGD B8| Behavior Change and Disorders4 5edical 6aculty 7 8dayana 8ni&ersity -91-

SGD B.8