CHILD ABUSE Recognition and Response (A Handbook for Pediatricians and Allied Medical Professionals)
Rajeev Seth RN Srivastava Jagadeesh N
Shaibya Saldanha
Rajesh Sagar
Foreword by:
Digant D Shastri
CHILD ABUSE Recognition and Response (A Handbook for Pediatricians and Allied Medical Professionals)
Rajeev Seth
MD DNBE FIAP FAAP (USA) President Elect International Society for the Prevention of Child Abuse and Neglect (ISPCAN), USA Past Chair Indian Child Abuse Neglect and Child Labour (ICANCL) Group Indian Academy of Pediatrics (IAP)
RN Srivastava
FRCP(Edin) FAMS Adviser Indian Child Abuse Neglect and Child Labour (ICANCL) Group Past President Indian Academy of Pediatrics (IAP)
Jagadeesh N
MD DNB Professor and Head Department of Forensic Medicine Vydehi Institute of Medical Sciences and Research Centre Bengaluru, Karnataka, India
Foreword
Digant D Shastri
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Child Abuse: Recognition and Response
(A Handbook for Pediatricians and Allied Medical Professionals)
First Edition: 2020
9789389776386
Printed at
- Aastha S Khatwani
- Joint Secretary
- Ministry of Women and Child Development
- Government of India
- Anjali Saxena
- Joint Secretary and Treasurer
- Indian Child Abuse Neglect and
- Child Labour (ICANCL) Group
- Ankita Sharma
- Clinical and Forensic
- Psychologist
- Expressions India
- Ashok Kumar
- Executive Board Member
- Indian Child Abuse Neglect and
- Child Labour (ICANCL) Group
- Bipasha Roy
- Juvenile Justice Board
- Kolkata, West Bengal, India
- Chhaya Prasad
- Executive Board Member
- Indian Child Abuse Neglect and
- Child Labour (ICANCL) Group
- Indian Academy of Pediatrics
- Deepa Das
- Retired Education Specialist
- UNICEF, India
- Digant D Shastri
- President
- Indian Academy of Pediatrics
- (IAP) (2019)
- Enakshi Ganguly
- Co-Director
- HAQ: Centre for Child Rights
- India
- Gayatri Bezboruah
- Professor and Head
- Department of Pediatrics
- Guwahati Medical College
- Guwahati, Assam, India
- Hamsa Vijayraghavan
- Consultant
- Indian Child Abuse Neglect and Child Labour (ICANCL) Group
- Henu Singh
- Regional Head
- Childline India Foundation
- Indra Taneja
- Trustee
- Bal Umang Drishya Sanstha
- (BUDS)
- Member
- Indian Child Abuse Neglect and
- Child Labour (ICANCL) Group
- Jagadeesh N
- Professor and Head
- Department of Forensic
- Medicine
- Vydehi Institute of Medical
- Sciences and Research Centre
- Bengaluru, Karnataka, India
- Japreet Grewal
- Consultant
- United Nations International
- Children's Emergency
- Fund (UNICEF), India
- Javier Aguilar
- Chief Child Protection
- United Nations International
- Children's Emergency
- Fund (UNICEF), India
- Jordan Greenbaum
- Medical Director
- Global Initiatives on Child
- Health and Well Being
- International Centre for
- Missing and Exploited Children
- (ICMEC), USA
- JP Kapoor
- Secretary
- Indian Child Abuse Neglect and
- Child Labour (ICANCL) Group (2016–2018)
- Juanita Kakoty
- Senior Manager
- ARPAN
- Mumbai, Maharashtra, India
- K Sharadha
- Executive Board Member
- Indian Child Abuse Neglect and
- Child Labour (ICANCL) Group
- Kiran Modi
- Managing Trustee, Udayan Care
- New Delhi, India
- Latika Bhalla
- Senior Consultant Pediatrician
- Association of Adolescent and
- Child Care in India (AACCI)
- New Delhi, India
- Monika Gupta
- Associate Professor (Obs & Gyne)
- In-charge, One Stop Center
- Safdarjung Hospital
- New Delhi, India
- Neha Sharma
- Manager
- ARPAN
- Mumbai, Maharashtra, India
- Om Taneja
- Adviser
- Bal Umang Drishya Sanstha
- (BUDS), India
- Rajeev Seth
- President Elect
- International Society for the
- Prevention of Child Abuse and
- Neglect (ISPCAN), USA
- Past Chair
- Indian Child Abuse Neglect and
- Child Labour (ICANCL) Group
- Indian Academy of Pediatrics (IAP)
- Rajesh Sagar
- Professor of Psychiatry
- All India Institute of Medical Sciences
- New Delhi, India
- Ramesh Negi
- Chairman
- Delhi Commission for Protection of Child Rights (DCPCR)
- Govt of NCT of Delhi
- Riti Chandrashekhar
- Research Associate
- Indian Child Abuse Neglect and Child Labour (ICANCL) Group
- RN Srivastava
- Adviser
- Indian Child Abuse Neglect and Child Labour (ICANCL) Group
- Past President
- Indian Academy of
- Pediatrics (IAP)
- Rupa Kapoor
- Member
- National Commission for Protection of Child Rights (NCPCR)
- Government of India
- Sabrina Sabharwal
- Chair
- Child Welfare Committee
- North–West Delhi, India
- Samir Shah
- Executive Board Member
- Indian Child Abuse Neglect and
- Child Labour (ICANCL) Group
- Sammat
- Program Coordinator
- Childline India Foundation
- Sandhya Khadse
- Dean and Professor of Pediatrics
- Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital
- Mumbai, Maharashtra, India
- Chair, Indian Child Abuse Neglect and
- Child Labour (ICANCL) Group
- Sangeeta Saxena
- Gynecologist and Co-Founder
- Enfold Proactive Health Trust
- Bengaluru, Karnataka, India
- Sanjeev Lalwani
- Professor of Forensic Medicine and Registrar (Academic)
- All India Institute of Medical Sciences
- New Delhi, India
- Santosh T Soans
- President
- Indian Academy of Pediatrics (IAP) 2018
- Shabina Ahmed
- Neurodevelopmental Pediatrician
- Guwahati, Assam, India
- Executive Board Member
- Indian Child Abuse Neglect and
- Child Labour (ICANCL) Group
- Shaibya Saldhana
- Gynecologist and Co-Founder
- Enfold Practice Health Trust
- Bengaluru, Karnataka, India
- Shanti Raman
- Director (Community Pediatrics)
- South Western Sydney Local
- Health District and
- Conjoint Associate Professor
- The University of New South
- Wales (UNSW), Australia
- Sonia Bhatt
- Professor of Pediatrics
- Agra Medical College
- Agra, Uttar Pradesh, India
- Tannistha Datta
- United Nations International
- Children's Emergency Fund (UNICEF), India
- TS Jain
- Medical Director
- Max Superspecialty Hospital
- New Delhi, India
- Uma Agrawal
- Past Secretary
- Indian Child Abuse Neglect and Child Labour (ICANCL) Group
- Uma Nayak
- Professor and Head
- Department of Pediatrics
- Parul Institute of Medical Sciences and Research (PIMSR)
- Vadodara, Gujarat, India
- Secretary
- Indian Child Abuse Neglect and Child Labour (ICANCL) Group
- Vidya Reddy
- Tulir—Centre for the Prevention and Healing of Child Sexual
- Abuse (CPHCSA)
- Chennai, Tamil Nadu, India
- Yawar Qaiyum
- Director
- (Community Operations)
- Bal Umang Drishya Sanstha
- (BUDS)
- New Delhi, India
- Yogesh Sarin
- Director-Professor and Head
- Department of Pediatric Surgery
- Maulana Azad Medical College
- New Delhi, India
India is home to the largest child population in the world, with almost 39% of the total population under 18 years of age (Childline India Foundation, 2018). The health and security of the country's children is integral to any vision for its progress and development. The United Nations Convention on the Rights of the Child (UNCRC), ratified by India in 1992, urges states to ensure the right of children to protection from abuse, violence, neglect and exploitation.
In developing countries such as India, with its adverse socioeconomic situation and large population base, though the reported cases of child abuse and neglect are very less, it is a serious, widely prevalent but under reported public health problem. Poverty, illiteracy and poor access to health and family planning services often result in multiple births per family, which in turn leads to considerable pressure on families particularly in the middle-to-lower income groups and consequently to low availability of resources for the care of children during their early formative years. In 2007, a study conducted by the Ministry of Women and Child Development of the Government of India study revealed that the prevalence of all forms of child abuse is extremely high—physical abuse (66%), sexual abuse (50%) and emotional abuse (50%). A more recent study by the National Commission for Protection of Child Rights (NCPCR), conducted with 6,632 child respondents in 7 states revealed that 99% children face corporal punishment in schools.
Pediatricians, doctors and allied healthcare professionals are often the first point of contact for abused and neglected children. It is incumbent upon the medical sector to address child abuse and neglect in this scenario and tackle the many entrenched problems. They need to play a key role in detecting child abuse and neglect and provide immediate- and long-term care and support to children. Usually pediatricians and medical professionals have a limited knowledge about the identification of the various forms of child abuse. There is thus a need for systematic handbook and training for these professionals in preventing, detecting and responding to cases of child abuse and neglect. The combined convergence of medical and multidisciplinary child protection systems can contribute to comprehensive healthcare, protection, development, treatment, social reintegration and rehabilitation of abused and neglected children.
I congratulate the Indian Child Abuse Neglect and Child Labour (ICANCL) group for developing this handbook on Child Abuse: Recognition and Response in partnership with UNICEF, along with a series of three consultative meeting of professional experts. This book contains basic concepts, recent guidelines and protocols for prompt diagnosis and management of child abuse by pediatricians and allied medical professional. Written in a concise format with flowcharts, it shall be very useful for a busy pediatricians, physicians and allied professionals and help them in mandatory reporting and connecting the abused children and their families to the child protection systems.
The Indian Academy of Pediatrics (IAP) recognizes that child maltreatment exerts a multitude of short- and long-term health effects on children. The IAP stands committed to promote this book for training pediatricians and allied medical professionals all over the country through its partners and networks. Such training would raise awareness and increase the capacity of pediatricians and allied medical professionals to offer high quality services to children and to work together with professionals from other fields in maximizing the impact of a comprehensive multidisciplinary response to child health and maltreatment.
I am sure that the handbook shall provide important learning experience for postgraduates, academic faculties, practicing pediatricians and allied child health professionals.
On behalf of IAP, my special thanks to all the editors, contributors, project supervisors, coordinators, rapporteurs, proofreaders and publishers for the timely release of the book.
Digant D Shastri
President
Indian Academy of Pediatrics
Preface
Child abuse and neglect is a serious and widely prevalent public health problem. Child abuse exerts a multitude of short- and long-term health effects on children. It can also lead to serious and often lifelong adverse consequences on their mental and physical health, reproductive health, academic performance, and social functioning.
Pediatricians and allied healthcare professionals are often the first point of contact for abused and neglected children. They play a key role in detecting child abuse and neglect and provide immediate and longer-term care and support to children. However, despite being important stakeholders, often pediatricians and medical professionals have a limited understanding on how to provide health care and protection to the abused groups of children? There is an urgent need to systematically train them in recognition detecting and responding to various forms of child abuse and response in clinical settings.
The Indian Child Abuse Neglect and Child Labour (ICANCL) group of Indian Academy of Pediatrics (IAP) had received a grant from UNICEF India in 2018 for a project on “Prevention of child abuse and capacity-building of pediatricians and allied medical professionals”. Our activities there under involved the creation of a reference handbook for medical professionals, through three consultative workshops with experts in the field. This present handbook Child Abuse: Recognition and Response has been prepared and redacted under that project funded and supported by our partnership with UNICEF India. The handbook enables to understanding of the basic concepts; current guidelines and Standard Operating Protocol (SOP) for prompt recognition and management of survivors of child abuse by pediatricians and allied medical professionals in Indian settings.
Child Abuse: Recognition and Response is a product of much hard work and has contributions from the most renowned experts in the field of child health and protection, such as our ICANCL group adviser Dr (Professor) RN Srivastava, Dr (Professor) Jagadeesh N, Dr Shaibya Saldanha, Dr (Professor) Rajesh Sagar, Dr Digant D Shastri (President, IAP), Dr Santosh Soans (Past President, IAP), Office Bearers of ICANCL group: Dr (Professor) Sandhya Khadse (Chair), Dr (Professor) Uma Nayak (Secretary), Dr Anjali Saxena (Treasurer), our overseas member, Dr (Professor) Shanti Raman, many other distinguished doctors, and multidisciplinary professionals from the entire country, who along with me gave their precious time and energy, in the best interest of children. Senior officials from Government of India, including Ms Aastha Saxena Khatwani (Joint Secretary Ministry of Women and Child Development) have also given me key guidance at the inception of this project, along with Mr Javier Aguilar (Chief Child Protection) and Ms Tannishtha Datta (Child Protection Specialist, UNICEF India). I remain indebted to all the group of experts in the field of child rights and protection who participated in all the workshops for their professional contributions.
This book provides an introduction of child abuse, its various forms and adverse health effects, concise chapters on clinical recognition and response to physical, sexual, emotional abuses and neglect. It contains a brief approach to trauma-informed care, medico-legal aspects, multidisciplinary team and case-based approach to learning. As doctors have an important role in prevention of child abuse, a special chapter on has been included in the appendix. It shall be endeavored to disseminate the handbook for further training and academic engagement with pediatricians, medical practitioners and allied medical professionals throughout the country through IAP networks as well as workshops through ICANCL group. I will seek support from Ministry of Women and Child Development and Ministry of Health and Family welfare, Government of India to enable me to reach out sections of this handbook for training of frontline health workers including Auxiliary Nurse Midwifery (ANM), Anganwadi and accredited social health activist (ASHA) workers at the district, block, taluk, and village levels and for child protection workers among marginalized communities.
I sincerely hope that this handbook shall be read with interest and will be an invaluable resources guide to pediatricians, allied physicians such as gynecologists, psychiatrists, forensic medicine specialists, psychologists, nurses, teachers, police, legal, policy programs, Government and Non-Governmental organizations, frontline health and community workers.
I remain indebted to the dedication of the project coordinator Hamsa Vijayaraghavan. A special thanks to Riti Chandrashekhar (ICANCL Group Research Associate), for concisely collating all the rich academic contributions of group of experts, help in editing and formatting the handbook with great care and judgement.
Rajeev Seth
President Elect
International Society for the Prevention
of Child Abuse and Neglect (ISPCAN)
Past Chair
Indian Child Abuse Neglect and Child Labour (ICANCL) Group
Indian Academy of Pediatrics (IAP)