children s health issues
Overview of Child Neglect and Abuse
Diagnosis of Child Neglect and Abuse
A doctor's examination Photographs of injuries For physical abuse, sometimes laboratory tests or imaging tests such as x-rays and computed tomography (CT) scans For sexual abuse, testing for infections and sometimes collection of samples of body fluids, hair, and other material for forensic evidence Neglect and abuse are often difficult to recognize unless children appear severely Undernutrition or are obviously injured or unless neglect or abuse is witnessed by other people. Neglect and abuse may not be recognized for years. There are many reasons why neglect and abuse go unrecognized. Abused children may feel that abuse is a normal part of life and may not mention it. Physically and sexually abused children are often reluctant to volunteer information about their abuse because of shame, threats of retaliation, or even a feeling that they deserve the abuse. Physically abused children who are able to communicate often identify their abuser and describe what happened to them if asked directly. However, sexually abused children may be sworn to secrecy or so traumatized that they are not able to talk about the abuse and may even deny abuse when specifically questioned. When doctors suspect neglect or any type of abuse, they look for signs of other types of abuse. They also fully evaluate the physical, environmental, emotional, and social needs of the child. Doctors observe interactions between the child and the caregivers whenever possible. Doctors document the child's history by writing down exact quotes and taking pictures of any injuries. Aneglected childmay be identified by health care practitioners during an evaluation for an unrelated issue, such as an injury, an illness, or a behavioral problem. Doctors may notice that a child is not developing physically or emotionally at a normal rate or has missed many vaccinations or appointments. Teachers and social workers are often the first to recognize neglect. Teachers may identify a neglected child because of frequent unexplained absences from school. Emotional abuseis usually identified during evaluation for another problem, such as poor performance in school or a behavioral problem. Children who are emotionally abused are checked for signs of physical and sexual abuse. Physical abuse may be suspected when an infant who is not yet cruising (walking by holding on to furniture) has bruises or serious injuries or seemingly minor injuries to the neck. Infants who are uncharacteristically sleepy or lethargic are evaluated for brain injury. Abuse may be suspected when a toddler or older child has bruises in unusual locations, such as on the back of the legs and buttocks. When children are learning to walk, bruises often result, but such bruises typically occur on prominent bony areas on the front of the body, such as the knees, shins, chin, and forehead. Abuse may also be suspected when parents seem to know little about their child's health or seem unconcerned or overly concerned about a serious injury. Parents who abuse their child may be reluctant to describe to the doctor or friends how an injury occurred. The description may not fit the age and nature of the injury or may change each time the story is told. Abusive parents may not immediately seek treatment for a child's injury. If doctors suspect physical abuse, they usually take photographs of the external injuries (such as bruises). Doctors may do imaging of the brain (a Computed Tomography (CT) [CT] scan or Often, sexual abuse is diagnosed on the basis of the child's or a witness's account of the incident. However, because many children are reluctant to talk about sexual abuse, it may be suspected only because the child's behavior becomes abnormal. Doctors should suspect sexual abuse if a young child has a Overview of Sexually Transmitted Infections (STIs) . If doctors suspect a child has been sexually abused, they examine the child. If the suspected abuse occurred within 96 hours of arrival at a medical facility, they typically also collect legal evidence of possible sexual contact, such as swabs of body fluids and skin surfaces. This collection of evidence often uses what is known as a rape kit. Photographs of any visible injuries are taken. In some communities, health care practitioners who are specially trained to evaluate sexual abuse of children do this examination. Doctors typically also do tests for sexually transmitted infections and, when appropriate, for pregnancy. 