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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