Violence against children

Dr miryam Amm
Associate professor of pediatrics and pediatric gynecology-usek faculty of medicine
Master in healthcare management
Charged of teaching medical communication
Children’s rights activist
March 2024
Insta : drmiryamamm
How to Help drs and health professionals:

• Include education in the curricula of pediatrics and its

subspecialties and other health specialties
• Target screening of high risk families or universal
screening to identify unrecognized violence
• Elaborate a plan to implement if screening is positive
• Optimize safety for caretakers and child victims
• Be aware of the national laws
• Support local and national multidisciplinary efforts
directed at recognition, treatment and prevention of
violence against children.
 context
• Prematurity
• Delayed psychomotor skills
• Special needs
• Neonatal separation
• Post partum depression
• Problems inside the couple
• Social isolation
• Parent with psychiatric problems
 Alarming signs:
take your time to examine the skin
• Hematomas at the concave zones of the body
et not the convex ones , like falling on the
cheeks or the neck
• Hematomas at the hidden parts of the body
and at the folds
• Burns have clear borders or take the form of an
object like a cigarette, an iron, or linear burns
at the wrist and the ankle. They can take place
on covered regions like under the diapers
• rib fractures, especially the posterior and middle archs which
can not be seen after a massage or a kine
• Fractures at extremities: toes, fingers
• Metaphyseal fractures
• Complexe skull fractures
• Epiphyseal detachment
• Diaphyseal fractures of long bones
• Periosteal reactions
• Faintness or isolated vomitings in a infant less than 2 years
old, ask about shaking
• Fractures of different age
 Behavioral changes

• Any change in a previous behavior must raise

awareness: bad results at school, bad sleep, bad
eating, enuresis after a clean period, staying
isolated
• In sexual assault: sexualisation of relationships,
recurrent abdominal pain , recidive in enuresis or
encopresis, changes in weight, excessive shyness in
a child who refuses to take off clothes or being
examinated.
 In psychological violence
• Agressiveness
• Addiction, suicidary attempts and leaving
school
• Dieting issues
• Sleep pbs
• Many psychosomatic complaints
• Genital bleeding, secretions, itching,anal
pain,urination pbs…
 Emergency if
• Sexual assault with penetration <72 hours

• Severe somatic ou psy signs:bleeding, unstable

child, etc…
 Believe the child
• At 4 years of age and above, listen to the child
alone without his parents for a short time
 Raise a red flag when…
• The lesion doesn’t correlate with the
developmental stage of the child:
– Bone Fracture before walking age
– Delay in seeking care
• Discrepancy of words between parents
• Adult with exagerated physical proximity with a
child
• vitamins deficiencies after severe diet
• Intrusive adult
Ask direct questions to the child when you
see him alone

• Did we hurt you?

• Did you see someone being beaten?
• Write the child words as he says them
between “”, before 6 years, don’t ask close
questions, but ask open questions.
• Start with general questions:school,life at
home,hobbies,activities,relationships with
family and friends
• Let the child speak at his own and don’t
reformulate or interpret his words
• Respect silence
• Many open questions
• Let him feel that you trust him and you believe
him
 Your aim is to:
• Precise the origin of the lesions

• Discover discrepancies between the lesions

and the stories you get from many persons
 Children with disabilities
• Educate families to understand the child’s
condition using handouts or group instruction
and inform parents about stress management
techniques.
• Older children should be informed about how
to protect themselves from abuse and about
the importance of telling a trusted adult about
abusive experiences
• Pediatricians should advocate for community
programs and services offering effective
prevention, research, and management for
child maltreatment as well as for programs
that address issues increasing the risk for child
maltreatment such as poverty, substance
abuse, mental health issues and poor
parenting skills.
• Not be afraid to report any suspected child
maltreatment
• 7 deadly sins of childhood that are triggers to
child maltreatment:colic,nighttime
awakening,separation anxiety,normal
exploratory behavior,normal negativism, poor
appetite, and resistance to toilet training.
• Crying is a common trigger for abuse. Duration of
crying peaks at 2-4 months when the incidence
of abusive head trauma also peaks, suggesting
that the behaviors are linked.
• Parents may mistake normal separation anxiety
or negativism for unacceptable behavior and may
resort to corporal punishment to handle it, which
may lead to serious injury to the child
• Resistance to toilet training may trigger genital
bruising and immersion burns. The most
common age for immersion burns is 32
months which coincides with the age at which
children are toilet trained.
• Children born prematurely are at increased
risk for abuse because of prolonged separation
from parents, perception of greater need and
perceived financial and emotional burden
• Children with disabilities are 3 times more
likely than those without disabilities to be
maltreated and also lack the ability to disclose
abuse.
• Unplanned or unwanted children are at
increased risk for abuse
• Young maternal and paternal age, parental
history of child abuse and a parent’s
depression are risk factors for a child abuse.
• Parents who are socially isolated , at risk for IPV,
with low educational achievement, poverty and
unemployment are at a greater risk of abusing their
children.
• Factors protective of child maltreatment include
community and environmental contact, the
presence of prevention programs to educate
parents abt parenting, normal crying and other dev
behaviors; and active pediatrician involvement in
parental education
mn
Thank you