Child Abuse
and between 6 and 12 years of age in the United States” (Kathleen,M(2004) ). Sexual abuse rates, on the other hand, tend to rise after the onset of puberty, with the highest rates occurring during adolescence ( ). Sexual abuse, however, can also be directed at young children.
Sex is another vulnerability to child abuse. In most countries, girls are at higher risk than boys for infanticide, sexual abuse, educational and nutritional neglect, and forced prostitution. Findings from several international studies show rates of sexual abuse to be 1.5–3 times higher among girls than boys. Globally, more than 130 million children between the ages of 6 and 11 years are not in school, 60% of whom are girls (Macmillan, 1994). In some countries, girls are either not allowed to receive schooling or else are kept at home to help look after their siblings or to assist the family economically by working. Male children appear to be at greater risk of harsh physical punishment in many countries. Although girls are at increased risk for infanticide in many places, it is not clear why boys are subjected to harsher physical punishment. It may be that such punishment is seen as a preparation for adult roles and responsibilities, or else that boys are considered to need more physical discipline. Clearly, the wide cultural gaps that exist between different societies with respect to the role of women and the values attached to male and female children could account for many of these differences.
The majority of programmers focus on prevention of child abuse. Very few emphasize primary prevention approaches in the first place. Family support approaches, health service approaches, therapeutic approaches are described below.
A number of interventions for improving parenting practices and providing family support have been developed. These types of programmers generally educate parents on child development and help them improve their skills in managing their children’s behavior. As an example, Wolfe et al. evaluated a behavioral intervention to provide training in parenting, specifically designed for families considered at risk. Mother–child pairs were randomly assigned to either the intervention or a comparison group. Mothers who received the training in parenting reported fewer behavioral problems with their children and fewer adjustment problems associated with potential maltreatment compared with mothers in the comparison group. Furthermore, a follow-up evaluation by the caseworkers showed that there was a lower risk of maltreatment by the mothers who had received the training in parenting.
A number of health care organizations have developed training programmers to improve both the detection and reporting of abuse and neglect, and the knowledge among health care workers of available community services. In the United States, for example, the “American Medical Association has produced diagnostic and treatment guidelines for child maltreatment and sexual abuse”. (Kempe,1962) The detection of child abuse and neglect, however, is not always simple. Specific interview techniques and types of physical examination are generally required. I have conducted a presentation about ethical dilemma on domestic abuse last year. It was emphasized on nursing role in helping child by solving that dilemma according to teleological and deontological methods.
A review of treatment programmers for physically abused children found that “therapeutic day care with an emphasis on improving cognitive and developmental skills – was the most popular approach” ( ). Therapeutic day care has been advocated for a range of conditions related to abuse, such as emotional, behavioral or attachment related problems and cognitive or developmental delays. The approach incorporates therapy and specific treatment methods in the course of the child’s daily activities at a child care facility. Most programmers of this type also include therapy and education for the parents.
Ill health caused by child abuse forms a significant portion of the global burden of disease. While some of the health consequences have been researched, others have only recently been given attention, including psychiatric disorders and suicidal behavior. Importantly, there is now evidence that major adult forms of illness – including ischemic heart disease, cancer, chronic lung disease, irritable bowel syndrome and fibromyalgia – are related to experiences of abuse during childhood (99– 01). Similarly, there are many studies demonstrating short-term and long-term psychological damage. Such as depression, anxiety, substance abuse, aggression, shame or cognitive impairments. The financial costs associated with both the short term and long-term care of victims form a significant proportion of the overall burden created by child abuse and neglect. Included in the