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Introduction and the first incidence of child abuse . Definition of child abuse . Types of child abuse and the warning signs of each types . Child abuse epidemiology in USA & Saudi Arabia . Examples of epidemiological studies in KSA. Risk factors of child abuse. Prevention of child abuse "primary , secondary, tertiary". Effects of child abuse . Health promotion for child abuse .

Children have been recognized as victims of violence, neglect, abandonment and slavery throughout recorded history. Infanticide was an accepted practice for dealing with unwanted children in pre-Islamic cultures in the face of scarce resources.
Islam began to preach against infanticide and intentionally inflicted injuries, and has considered them a capital offense, necessitating punishment to assailants. Prophet Mohammed (peace be upon him) affirmed in his sayings that children should be well treated.

Child maltreatment is a serious and pervasive phenomenon that affects not only the children, but also the family and society. The child may be maltreated by a variety of acts of commissions or omissions by those responsible for his care. The reported incidence of child abuse varies with the definition, and is usually thought to be underestimated.

A little girl named Mary Ellen was abused and the courts would not help because there were no laws to prevent child abuse however animal abuse laws existed. The dedication of several people saved Mary Ellen and led to the founding of The New York Society for the Prevention of Cruelty to Children. The New York SPCC and Prevention of Cruelty to Animal activisties formed the American Humane Society to prevent this type of abuse from happening to other children.

Child abuse (including neglect) is a form of maltreatment of a child, either by inflicting harm or by failing to act to prevent harm. Children may be abused in a family, institutional, or community setting, by those known to them or, more rarely, by a stranger. They may be abused by adults or by other children. There are 4 categories of child abuse: physical abuse, emotional abuse, sexual abuse, and neglect.

TYPES OF CHILD ABUSE

Physical
abuse Sexual

Child Neglect Emotional

abuse

Child abuse

abuse

emotional abuse can severely damage a childs mental health or social development, leaving lifelong psychological scars.

Examples of emotional child abuse include:

Constant belittling, shaming, and humiliating a child. Calling names and making negative comparisons to others. Telling a child he or she is no good," "worthless," "bad," or "a mistake." Frequent yelling, threatening, or bullying. Ignoring or rejecting a child as punishment, giving him or her the silent treatment. Limited physical contact with the childno hugs, kisses, or other signs of affection. Exposing the child to violence or the abuse of others, whether it be the abuse of a parent, a sibling, or even a pet.

Excessively withdrawn, fearful, or anxious about doing something wrong. Shows extremes in behavior (extremely compliant or extremely demanding; extremely passive or extremely aggressive). Doesnt seem to be attached to the parent or caregiver. Acts either inappropriately adult (taking care of other children) or inappropriately infantile (rocking, thumbsucking, tantruming).

CHILD NEGLECT
Child neglecta very common type of child abuse is a pattern of failing to provide the basic needs for a child , whether it be adequate food, clothing, hygiene, or supervision. Child neglect is not always easy to spot. Sometimes, a parent might become physically or mentally unable to care for a child, such as with a serious injury, untreated depression, or anxiety. Other times, alcohol or drug abuse may seriously impair judgment and the ability to keep a child safe.

Clothes are ill-fitting, filthy, or inappropriate for the weather. Hygiene is consistently bad (un-bathed, matted and unwashed hair, noticeable body odor). Untreated illnesses and physical injuries. Is frequently unsupervised or left alone or allowed to play in unsafe situations and environments. Is frequently late or missing from school.

PHYSICAL CHILD ABUSE

Physical abuse involves physical harm or injury to the child. It may be the result of a deliberate attempt to hurt the child, but not always. It can also result from severe discipline, such as using a belt on a child, or physical punishment that is inappropriate to the childs age or physical condition.

WARNING SIGNS OF PHYSICAL ABUSE IN CHILDREN

Frequent injuries or unexplained bruises, welts, or cuts. Is always watchful and on alert, as if waiting for something bad to happen. Injuries appear to have a pattern such as marks from a hand or belt. Shies away from touch, flinches at sudden movements, or seems afraid to go home. Wears inappropriate clothing to cover up injuries, such as long-sleeved shirts on hot days.

Physical abuse vs. Discipline

In physical abuse, unlike physical forms of discipline, the following elements are present:
Unpredictability. The child never knows what is going to set the parent off. There are no clear boundaries or rules. The child is constantly walking on eggshells, never sure what behavior will trigger a physical assault. Lashing out in anger. Physically abusive parents act out of anger and the desire to assert control, not the motivation to lovingly teach the child. The angrier the parent, the more intense the abuse. Using fear to control behavior. Parents who are physically abusive may believe that their children need to fear them in order to behave, so they use physical abuse to keep their child in line. However, what children are really learning is how to avoid being hit, not how to behave or grow as individuals.

SEXUAL CHILD ABUSE

Child sexual abuse is an especially complicated form of abuse because of its layers of guilt and shame. It's important to recognize that sexual abuse doesn't always involve body contact. Exposing a child to sexual situations or material is sexually abusive, whether or not touching is involved.

SEXUAL CHILD ABUSE CON.

what is even more frightening is that sexual abuse usually occurs at the hands of someone the child knows and should be able to trustmost often close relatives. And contrary to what many believe, its not just girls who are at risk. Boys and girls both suffer from sexual abuse. In fact, sexual abuse of boys may be underreported due to shame and stigma.

WARNING SIGNS OF SEXUAL ABUSE IN CHILDREN

Trouble walking or sitting. Displays knowledge or interest in sexual acts inappropriate to his or her age, or even seductive behavior. Makes strong efforts to avoid a specific person, without an obvious reason. Doesnt want to change clothes in front of others or participate in physical activities. An STD or pregnancy, especially under the age of 14. Runs away from home.

CHILD ABUSE EPIDEMIOLOGY

Child abuse is a world-wide phenomenon and can affect children of all ages. The definition and perception of what constitutes child abuse varies over time and between different cultures and ethnic groups.

Children are suffering from a hidden epidemic of child abuse and neglect. Over 3 million reports of child abuse are made every year in the United States; however, those reports can include multiple children. In 2009, approximately 3.3 million child abuse reports and allegations were made involving an estimated 6 million children.

A report of child abuse is made every ten seconds. Almost five children die every day 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.

Child abuse occurs at every socioeconomic level, across ethnic and cultural lines, within all religions and at all levels of education. 31% percent of women in prison in the United States were abused as children. Over 60% of people in drug rehabilitation centers report being abused or neglected as a child. About 30% of abused and neglected children will later abuse their own children, continuing the horrible cycle of abuse.

About 80% of 21 year old that were abused as children met criteria for at least one psychological disorder. The estimated annual cost of child abuse and neglect in the United States for 2007 is $104 billion. Abused children are 25% more likely to experience teen pregnancy. Abused teens are 3 times less likely to practice safe sex, putting them at greater risk for STDs.

Until the 1990s, cases of child abuse and neglect went unpublished by medical professionals in Saudi Arabia. Indeed, some have alleged that the inability or unwillingness of physicians to acknowledge the possibility that parents could abuse their children was the reason why it was hidden for so long.
Some physicians resist diagnosing child abuse or neglect because of inadequate training, the problem of establishing the diagnosis with certainty, the risk of stigmatizing the family, personal and legal risks, and the potential effect on their practice.

Regional Distribution of Abuse Cases

A retroprospective collection of data on all children evaluated by the Suspected Child Abuse and Neglect (SCAN) team in King Abdulaziz Medical City for the National Guard from 2000 to 2008. The cases were further divided into 3 subgroups corresponding to the years 2000-2004, 2005-2006, and 2007-2008 parallel to the stages of development of the national child protection system.

During the study period, there were a total of 188 referrals to the SCAN team. Of these 133 (70.7%) were further investigated as CAN cases. The total number of referred cases increased 10-fold from 6.4 cases per year in the first period to 61.5 cases per year in the third period. The mean age was 5 years, evenly represented by males and females.

Physical abuse was the most common form of abuse in the first period (2000-2004) was 61% and second period (20052006) was 76%, which changed to neglect (41.6%) as the most common form of maltreatment in the third period (20072008) . Parents were the perpetrators in 48.9% of cases throughout the 3 periods. Overall fatality rates were 4.4%, 14.3%, and 7.9% in the first, second, and third periods respectively.

Distribution by Forms of Abuse of the cases are concentrated in the three main regions of ArRiyadh, Eastern and Makkah

The risk factors for child abuse can be divided up into 3 different categories: community/societal, parent related, and child related here is how the factors break down :

1-Community/ Societal
High crime rate .. Lack of or few social services .. High poverty rate .. High unemployment rate ..

History of physical or sexual abuse (as a child) .. Teen parents .. Single parents.. Emotional immaturity.. Poor coping skills.. Low self-esteem.. Substance abuse.. Known past history of child abuse..

Lack of social support (community and extended family).. Domestic violence .. Lack of parenting skills .. Lack of preparation for the stress of a new infant .. Depression or other mental illnesses .. Multiple young children.. Unwanted pregnancy.. Denial of pregnancy..

Prematurity Low birth weight Handicap

Risk factors for child abuse and neglect

While child abuse and neglect occurs in all types of familieseven in those that look happy from the outsidechildren are at a much greater risk in certain situations

Witnessing domestic violence is terrifying to children and emotionally abusive. Even if the mother does her best to protect her children and keeps them from being physically abused, the situation is still extremely damaging. If you or a loved one is in an abusive relationships, getting out is the best thing for protecting the children

Living with an alcoholic or addict is very difficult for children and can easily lead to abuse and neglect. Parents who are drunk or high are unable to care for their children, make good parenting decisions, and control often-dangerous impulses. Substance abuse also commonly leads to physical abuse.

Parents who suffering from depression, an anxiety disorder, bipolar disorder, or another mental illness have trouble taking care of themselves, much less their children. A mentally ill or traumatized parent may be distant and withdrawn from his or her children, or quick to anger without understanding why. Treatment for the caregiver means better care for the children.

Some caregivers never learned the skills necessary for good parenting. Teen parents, for example, might have unrealistic expectations about how much care babies and small children need. Or parents who were themselves victims of child abuse may only know how to raise their children the way they were raised. In such cases, parenting classes, therapy, and caregiver support groups are great resources for learning better parenting skills.

Parenting can be a very time-intensive, difficult job, especially if youre raising children without support from family, friends, or the community or youre dealing with relationship problems or financial difficulties. Caring for a child with a disability, special needs, or difficult behaviors is also a challenge. Its important to get the support you need, so you are emotionally and physically able to support your child

Primary prevention consists of activities that are targeted toward the community at large. These activities are meant to impact families prior to any allegations of abuse and neglect. Primary prevention services include public education activities, parent education classes that are open to anyone in the community, and family support programs. Primary prevention can be difficult to measure because you are attempting to impact something before it happens, an unknown variable

Secondary prevention consists of activities targeted to families that have one or more risk factors including families with substance abuse, teen parents, parents of special need children, single parents, and low income families. Secondary prevention services include parent education classes targeted for high risk parents, respite care for parents of a child with a disability, or home visiting programs for new parents.

Tertiary prevention consists of activities targeted to families that have confirmed or unconfirmed child abuse and neglect reports. These families have already demonstrated the need for intervention, either with or without court supervision..

 Strengthen family and community connections and support.

Treat parents as vital contributors to their children's growth and development. Create opportunities for parents to feel empowered to act on their own behalf.

Respect the integrity of the family.

Enhance parents' capability to foster the optimal development of their children and themselves.

 Establish links with community support systems.

Provide settings where parents and children can gather, interact, support and learn from each other. Enhance coordination and integration of services needed by families. Enhance community awareness of the importance of healthy parenting practices. Provide emergency support for parents 24 hours a day..

THE EFFECTS OF AABUSE

CHILDERN

Girls
-External behavior..

Boys

-Internalizing problems..
-Externalizing problems ..

Abuse affects boys and girls in different ways. Girls are less likely to show the effects in external behavior, but instead will have problems of low self-esteem, depression, anxiety, somatic complaints, mood swings, and lower levels of social skills. Boys suffer both internalizing problems and externalizing problems (such as hitting, cruelty to others, truancy, lying, stealing, skipping school, destroying things, and associating with bad friends who get into similar trouble) as well as lower levels of social skills

One study indicates that children who saw their mother being abused, compared with those who did not, are : 24 times more likely to commit sexual assault crimes, 50 times more likely to abuse drugs or alcohol, 74 times more likely to commit crimes against another person, and 6 times more likely to commit suicide

Witnessing such abuse affects not only future behavior, but also present physical and mental health . Children with their mothers in shelters for battered women show a high incidence of health problems among infants and mood-related disorders among preschoolers. Boys have more behavioral "acting-out" problems, and girls tend to have more "emotional" problems (that is, they are more withdrawn and need to stay close to mother). Sometimes these young children are even suicidal..

Witnessing or experiencing abuse and violence increases the likelihood that a child will become a violent adult .Children react to quarreling parents by disobeying, crying, hitting other children, and, in general, becoming much more antisocial than their peers .. Ronald Simons, Professor of Sociology at Iowa State University, notes that Ineffective parents produce aggressive first graders who are rejected by their peers and as a consequence must form friendships with other deviant youth ..

Luckily, not all children who grow up witnessing abuse between their parents or experiencing abuse themselves go on to become abusers; however, approximately one-third of them do

The longer the child experiences abuse, the more likely he or she is to become an adult abuser, and the more varied the forms of abuse, the deeper the effect will be.. Intense but unpredictable episodes can cause a massive increase in long-lasting fear and anxiety..
The younger the child is when the abuse starts, the deeper the effects ..

Compared with non-abused adolescents, teenagers who were sexually abused as children are more depressed, more anxious, more selfconscious, and more prone to poor selfesteem. They are more likely to use drugs and be delinquent, have poor relationships with the rest of their families, feel they have received less emotional support from families and friends, and perform more poorly at school; they also tend to move between domiciles more frequently, thus adding to their levels of anxiety and stress.

Ensure protection of rights of children in conflict with the law.. Define criminal responsibility and penalty in proportion to child age.. Initiate measures to protect children against delinquency.. Monitor juvenile courts effectiveness.. Promote physical and psychological rehabilitation .. Establish family friendly courts ..

 Facilitate friendships and support. Strengthen parenting Respond to family crises.

Link families to services and opportunities.

Support children's social and emotional development.

health educated and background knowledge about development level of child .. good communicated with child and license to them ..

Learn to recognize and take advantage of teachable moments with child .. Know where children spend their time ..

Learn children our right's.. Teach kids safety skills .. Teach child communicate with other children ..

* The role of the school in protecting your child from abuse

Your child's school should have a number of measures in place to help protect them, including : Staff who have been trained to be alert to signs of abuse .. A senior member of staff with responsibility for child protection .. Procedures for checking on staff before they are allowed to work with children .. A child protection policy which includes procedures to be followed if a teacher or other member of staff is accused of harming a child ..

The following services are provided by specially trained professionals:

A coordinated investigation .. Forensic interviewing (as requested by law enforcement and child protective services) . . Child advocacy and family support .. Medical examination .. Mental health services .. Referrals to appropriate community resources .. Court preparation .. Educational programs .. Prevention programs and outreach to the community ..

The following services are provided by licensed professional counselors, social workers and Master of Counseling student interns ..

Advocacy and Support Services .. Play Therapy .. Group Counseling .. Individual and Family Counseling .. Community Education ..

Ensure all rights of street children through:

 Changing the community's negative perception. Building a comprehensive database. Capacity building for cadres dealing with street children.. Introducing legal amendments and strengthening enforcement mechanisms.. Supporting NGOs caring for street children from drug abuse, violence and exploitation.. Demonstrating vocational, health and psychological rehabilitation services.. Expanding the social net programs and direct services for poor families to eradicate root causes of the problem..

http://bestpractice.bmj.com/bestpractice/monograph/846/basics/epidemiology.html http://helpguide.org/mental/child_abuse_physical_emotional_sexual_neglect.htm #types http://www.ncbi.nlm.nih.gov/pubmed/19493505 http://www.childhelp.org/pages/statistics Prevent Child Abuse Americ : Public Policy Position Statements Summary . http://www.preventchildabuse.org/advocacy/documents/PositionStatements2Pag eSummary.pdf The A-team : THE CHILD ABUSE CRISIS. http://www.ateam.org/child_abuse_statistics.html HEALTH PROMOTION IN THE CHILDCARE SETTING . http://www.sccfd.org/forms/childcare_cntr_health+safety.pdf http://www.childwelfare.gov/pubs/factsheets/signs.cfm