Child Abuse: Recognition and Response Rajeev Seth, RN Srivastava, Rajesh Sagar, Jagadeesh N, Shaibya Saldanha
Aggressive behavior 20
American Psychological Association 9
Amylase 15
Anticipatory guidance and medical professionals 17
Anxiety 39
Assault, short history of 30
Bed-wetting 5, 20
Behavior 39
disorders 39
Biomedical Waste Disposal Rules 60
Birth registration 34
Bite marks 12
Bleeding 20
and coagulation disorder, test for 15
disorders 14
Blood transfusion 65
Body evidence 26
Bruises 12
Building positive parent-child interaction and social support, role of 42
Burns 13
Cancer 6
Catharsis 41
Centers for Disease Control and Prevention 6
abuse 16
and neglect 16, 68, 70
early identification of 3
investigation of 3
long-term consequences of 5
magnitude of problem of 5
medicolegal aspects of 48
overview of 4
prevention of 68
short-term consequences of 5
treatment of 3
types of 2, 4
conducting psychiatric assessment of 39
dignity of 31
exploitation 4, 5
Labour (Prohibition and Regulation) Act 52
maintaining privacy of 31
marriage 53, 65, 66
method of manipulation of 21
neglect 4, 33
physical abuse 8, 11, 16, 17, 19
rights 1, 70
sexual abuse 19, 20, 40, 48, 55, 69
and exploitation, understand medical management of 55
trafficking 52
Welfare Committee 47, 69
Clinically significant disorders 39
Community health 2
Complete blood count 15
Corporal punishment 8, 9
Criminal Procedure, Code of 48
Depression 6, 30, 39, 43
Dissociative disorders 39
District Child Protection Units 47
Eating disturbances 20
Education and early child development 34
Emergency contraceptives 50
Emotional abuse 4, 37
behavioral indicators of 39
neglect 4
Ethylenediaminetetraacetic acid 28
Eye contact 45
Female infanticide 53
evidence, collection of 26
medicine 2
science laboratory 26
Fractures, healing 14
Fundamental rights 52
itching in 20
pain in 20
evidence 27
infections 20
perineum and buttocks, examination of 25
Giddiness, sudden 20
CT scan 15
MRI 15
trauma, abusive 14
Headaches 20
Health administration 2
Heart disease 6
Immunizations, parental denial of 33
Indian penal code 52
Informed consent 56
abdominal 15
accidental 14
areas of 11
genitals 20
treatment of 31
Integrated Child Development Services 68
Integrated Child Protection Scheme 68
Juvenile Justice (Care and Protection) Act 15, 52, 69
Lipase 15
Liver function test 15
Lung disease 6
Mandatory Reporting Under Protection of Children from Sexual Offences Act 50
Marriages 66
Medical Termination of Pregnancy 31, 56
Act and Sexual Assault 31
Medicolegal procedure 32
Medicolegal services 2
Mental health 2
issues 30
Metabolic bone disease 14
Multidisciplinary team 46
approach 44, 46
National Commission for Protection of Child Rights 8, 9
National Health Portal India 14
Nightmares 20
Pain, abdominal 20
Physical abuse 4, 8, 17, 37
assessment of 9
evidence of 12
Physical punishment 8
Post-traumatic stress disorder 39, 41, 42
Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act 53
Pregnancy 20
Prohibition of Child Marriage Act 53
Protection of Children from Sexual Offences Act 4850, 55, 61, 64, 65, 67
Psychoeducation 42
Psychological abuse 37
Psychotic behavior 43
Rape 62
Rastriya Bal Swasthya Karyakram 68
Retinal hemorrhage 14
Right to Education Act 51
Sex selection 53
Sexual abuse 4, 5, 20, 21
Sexual assault 20, 28, 30, 55, 56, 59, 60, 62
Sexual crimes, instances of 1
Sexual harassment 62
Sexual violence 44, 48, 62, 63
Sexually transmitted
disease 64
infections 20, 50
Shaken baby syndrome 14
Skeletal injuries 13
alone, fear of 20
in dark, fear of 20
Special Juvenile Police Unit 47, 51
Special Marriage Act 66, 67
Substance abuse 20
Suicidal risk 43
Suicide attempts 20, 30
Thumb-sucking 5
regressive behaviors 20
Trauma, abdominal 14
Trauma-informed care 44, 45
approach 46
fundamental features of 44
Traumatic stress reactions 43
Urinary tract infections, recurrent 20, 30
Violence, instances of 1
World Health Organization 4, 8
Writing medical report 29
Chapter Notes

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IntroductionChapter 1

RN Srivastava
Various issues concerning child abuse, neglect and exploitation have been a matter of increasing concern over the past three decades. The extent and seriousness of physical and sexual abuse has been recognized. The problems have been discussed by International and Regional Organizations (UN, WHO, UNICEF, ISPCAN and others) at several conventions and conferences, and clear policy statements brought out. Child rights, definitions of child abuse and neglect have been globally agreed upon and the governments have promised to take necessary steps to implement various recommendations.
Instances of violence and sexual crimes against children are very often being reported in the media, which may not necessarily be reflective of an increase in such acts, but a willingness to discuss and engage the society. Governments, NGOs and all those working for child welfare need to work together to tackle the problem and find solutions. Leaders in the community and motivated citizens must realize their duty and do their utmost to protect children from harm and support all efforts to ensure optimal development of all children.
The majority of incidents of child abuse are not reported to the appropriate authorities by the doctors and allied multidisciplinary professionals. Unfortunately, even in cases where there is an opportunity to detect and conduct an appropriate intervention, the medical professionals are not trained to recognize the presenting 2symptoms and signs of various types of child abuse and how to manage and provide support to the children and their families? Several times children may present with symptoms and signs, such as accidental injury, which on the initial assessment may not look like a case of child abuse, but a more detailed multidisciplinary approach may to needed to arrive at the correct diagnosis.
This present handbook has been brought out to serve as a guide to pediatricians and allied medical professionals to identify children who have been subjected to various forms of child abuse and the actions that need to be taken immediately and thereafter. The responsibilities of the first contact physician include providing the necessary urgent treatment and taking proper measures to meet forensic and legal requirements. These issues were extensively discussed by leading experts from related disciplines at three workshops June 9–10, August 5–6 and September 30, 2018, at India Habitat Center, New Delhi, with support from UNICEF India. The views of the experts and their advice have guided the preparation of this handbook.
Medical doctors in the specialty of pediatrics, family and community health, gynecology and obstetrics, mental health, forensic medicine, medicolegal services, health administration, planning and communication may come in contact with abused and exploited children in the course of their professional work. Thus, this handbook is for them and for all allied healthcare professionals who have a responsibility to provide primary healthcare, development, protection and welfare to children: in all settings where they have to respond to situations in which child abuse is likely to occur or could have occurred. It aims to provide guidelines for early recognition, investigation and response to child abuse in Indian settings.