Child Abuse: Recognition and Response Rajeev Seth, RN Srivastava, Rajesh Sagar, Jagadeesh N, Shaibya Saldanha
INDEX
A
Aggressive behavior 20
American Psychological Association 9
Amylase 15
Anticipatory guidance and medical professionals 17
Anxiety 39
Assault, short history of 30
B
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
C
Cancer 6
Catharsis 41
Centers for Disease Control and Prevention 6
Child
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
D
Depression 6, 30, 39, 43
Dissociative disorders 39
District Child Protection Units 47
E
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
F
Female infanticide 53
Forensic
evidence, collection of 26
medicine 2
science laboratory 26
Fractures, healing 14
Fundamental rights 52
G
Genital
areas
itching in 20
pain in 20
evidence 27
infections 20
perineum and buttocks, examination of 25
Giddiness, sudden 20
H
Head
injury
CT scan 15
MRI 15
trauma, abusive 14
Headaches 20
Health administration 2
Heart disease 6
I
Immunizations, parental denial of 33
Indian penal code 52
Informed consent 56
Injury
abdominal 15
accidental 14
areas of 11
genitals 20
treatment of 31
Integrated Child Development Services 68
Integrated Child Protection Scheme 68
J
Juvenile Justice (Care and Protection) Act 15, 52, 69
L
Lipase 15
Liver function test 15
Lung disease 6
M
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
N
National Commission for Protection of Child Rights 8, 9
National Health Portal India 14
Nightmares 20
P
Pain, abdominal 20
Physical abuse 4, 8, 17, 37
clinical
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
R
Rape 62
Rastriya Bal Swasthya Karyakram 68
Retinal hemorrhage 14
Right to Education Act 51
S
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
Sleeping
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
T
Thumb-sucking 5
regressive behaviors 20
Trauma, abdominal 14
Trauma-informed care 44, 45
approach 46
fundamental features of 44
Traumatic stress reactions 43
U
Urinary tract infections, recurrent 20, 30
V
Violence, instances of 1
W
World Health Organization 4, 8
Writing medical report 29
×
Chapter Notes

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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
The Publishing Cost of this Handbook was Supported in Part by Global Karma Health & Education Trust
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
Professional Experts Consulted
  • 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
Foreword
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)