CHAPTER and physical health outcomes. Child abuse can have

CHAPTER II

REVIEW OF RELATED LITERATURE

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Child
sexual abuse is a worldwide establishment. It is an insidious, persistent, and
serious problem that, depending on the population studied and definition used,
affects 2-62% of women and 3-16% of men as victims. Pain and tissue injury from
childhood sexual abuse can completely
heal in time, but the psychological and medical outcome
can persist into adulthood. Associated
sexually transmitted diseases (like HIV) and suicide attempts can be fatal. All
physicians who treat children should be aware of the image and consequences of
child sexual abuse and should be familiar
with normal and abnormal genital and anal anatomy of children. This aim is best
accomplished through training and routine examination of the anus and genitalia
of children. Because as many as 96% of children assessed for suspected sexual
abuse will have normal genital and anal examinations, a forensic interview by a
trained professional must be relied on to document suspicion of abuse according
to Johnson C (2004).

Norman
R, Byambaa M, De R, Butchart A, Scott J, Vos T (2012) Child sexual abuse
is considered a qualified risk factor for mental disorders across the lifeline. However,
the long-term consequences of other forms of child abuse have not yet been orderly
examined. The aim of this study was to summarize the evidence relating to the
possible relationship between child physical abuse, emotional abuse, and
neglect, and subsequent mental and physical health outcomes.

Child
abuse can have a long-lasting and destroying effect on the growth and
development of infants, children, and adolescents by Troiano M (2011). Studies
of abused and neglected children indicate that they have a higher class of
delayed intellectual development, poor school performance, aggressive
behaviors, and social and relationship insufficiency compared with nonmaltreated children. Early recognition and
appropriate treatment are one of the most
important factors in preventing further child abuse and maltreatment. Every
practitioner should be educated on the signs and symptoms of child abuse. The
referral to child protective services is a necessity for the future well-being
of the child.

Child
maltreatment exemplifies a toxic relational environment that poses significant
risks for maladaptation across biological and psychological domains of
development. Research on child maltreatment can inform developmental theory,
but more importantly, it can enhance the quality of clinical, legal, and
policy-making decisions for maltreated children by Cicchetti D, Toth S (2005).

Child
abuse is a major public health problem all over the world. There are four major
types of abuse: physical abuse, sexual abuse, emotional abuse and neglect Ermertcan
A, Ertan P (2010). The most common manifestations of child abuse are cutaneous
and their recognition; and differential diagnosis is of great importance.
Clinicians, especially dermatologists, should be alert about the skin lesions
of child abuse. In the diagnosis and management of child abuse, a multidisciplinary
approach with ethical and legal procedures is necessary. In this manuscript,
cutaneous manifestations of physical, sexual, emotional abuse and neglect are
reviewed and discussed.

Wells
K (2009) Pediatricians and other medical providers caring for children need to
be aware of the dynamics in the significant relationship between substance
abuse and child maltreatment. A caregiver’s use and abuse of alcohol,
marijuana, heroin, cocaine, methamphetamine, and other drugs place the child at
risk in multiple ways. Members of the medical community need to understand
these risks because the medical community plays a unique and important role in
identifying and caring for these children. Substance abuse includes the abuse
of legal drugs as well as the use of illegal drugs. The abuse of legal
substances may be just as detrimental to parental functioning as an abuse of illicit substances. Many substance
abusers are also polysubstance users and the compounded effect of the abuse of
multiple substances may be difficult to measure. Often other interrelated
social features, such as untreated mental illness, trauma history, and domestic
violence, affect these families.

This
paper reviews the literature on the nature and incidence of child sexual abuse,
explores the link between child sexual abuse and later sexual exploitation, and
reviews the literature on prevention strategies and effective interventions in
child sexual abuse services Lalor K, McElvaney R (2010). Our understanding of
the international epidemiology of child sexual abuse is considerably greater
than it was just 10 years ago, and studies from around the world are examined.
Childhood sexual abuse can involve a wide number of psychological sequelae,
including low self-esteem, anxiety, and depression. Numerous studies have noted
that child sexual abuse victims are vulnerable to later sexual revictimization,
as well as the link between child sexual abuse and later engagement in
high-risk sexual behavior. Survivors of
child sexual abuse are more likely to have multiple sex partners, become
pregnant as teenagers, and experience sexual assault as adults. Various models
which attempt to account for this inter-relationship are presented; most invoke
mediating variables such as low self-esteem, drug/alcohol use, PTSD, and distorted sexual development. Prevention
strategies for child sexual abuse are examined including media campaigns,
school-based prevention programmes, and therapy with abusers. The results of a
number of meta-analyses are examined. However, researchers have identified
significant methodological limitations in the extant research literature that
impede the making of recommendations for implementing existing therapeutic
programmes unreservedly.

Child
abuse is a serious problem worldwide and can be difficult to detect. Although
children who experience the consequences of abuse will probably be treated at
an emergency department, detection rates of child abuse at emergency
departments remain low by Louwers E, Affourtit M, Moll H, De Koning H, Korfage
I (2010).

Although
child sexual abuse has been a concern for many researchers, therapists, and
advocates for the past 3 decades, several fundamental issues regarding child
sexual abuse remain unresolved Haugaard J (2000). In particular, the term child
sexual abuse has never been unequivocally defined. The lack of a commonly
accepted definition of child sexual abuse continues to inhibit research,
treatment, and advocacy efforts. Early researchers used broad and inclusive
definitions of child sexual abuse–definitions that often continue to be used
today. The consequences of these definitions are discussed, and strategies for
developing other definitions of child sexual abuse are suggested.

Fractures
are common injuries caused by child abuse. Although the consequences of failing
to diagnose an abusive injury in a child can be grave, incorrectly diagnosing
child abuse in a child whose fractures have another etiology can be distressing
for a family. The aim of this report is to review recent advances in the
understanding of fracture specificity, the mechanism of fractures, and other
medical diseases that predispose to fractures in infants and children. This
clinical report will aid physicians in developing an evidence-based
differential diagnosis and performing the appropriate evaluation when assessing
a child with fractures according to Flaherty E, Perez-Rossello J, Levine M,
Hennrikus W (2014).

Kos
L, Shwayder T (2006) Dermatologists, and
child abuse are not frequently associated in the minds of most physicians. Yet
the most common manifestations of child abuse are cutaneous. This article
reviews cutaneous manifestations of physical abuse, including bruises,
lacerations, abrasions, human bites, and burns. It also discusses ways that
dermatologists can differentiate abusive injuries from accidental ones as well
as from the many dermatologic conditions that can mimic child abuse. Finally,
we review what actions the dermatologist should take when suspecting abuse in a
patient.

Maltreatment
of children is a major public health crisis, and it is estimated that each year
more than 3 million children are victims of abuse. Safeguarding the welfare of
children is a priority, and it is the moral and ethical responsibility of
healthcare professionals to detect cases of abuse and intervene appropriately
to prevent further harm Swerdlin A, Berkowitz C, Craft N (2007). Clinicians are
often challenged to differentiate signs of child abuse from skin conditions
that mimic maltreatment. Because cutaneous injury represents the most
recognizable and common form of abuse, dermatologists are often called upon to
help distinguish signs of intentional injury from skin conditions that mimic
maltreatment. However, few resources specific to dermatologic signs of abuse
exist to aid in diagnosis. A review of the literature will provide an
educational resource to assist dermatologists and other clinicians in
differentiating cutaneous signs of child abuse, including physical and sexual
abuse, from mimickers of inflicted injury. 

Sexual
abuse is a problem of epidemic proportions in the United States. Given the
sheer numbers of sexually abused children, it is vital for pediatric nurse
practitioners to understand both short-term and long-term consequences of
sexual abuse. Understanding consequences of sexual abuse can assist the
pediatric nurse practitioner in anticipating the physical and mental health
needs of patients and also may assist in the identification of sexual abuse
victims. Sexual abuse typically does not occur in isolation Hornor G (2010).

Exposure
to interpersonal violence or abuse affects the physical and emotional
well-being of affected individuals Neigh G, Gillespie C, Nemeroff C (2009). In
particular, exposure to trauma during development increases the risk of
psychiatric and other medical disorders beyond the risks associated with adult
violence exposure. Alterations in the hypothalamic-pituitary-adrenal (HPA)
axis, a major mediating pathway of the stress response, contribute to the
long-standing effects of early life trauma. Although early life trauma elevates
the risk of psychiatric and medical disease, not all exposed individuals
demonstrate altered HPA axis physiology, suggesting that genetic variation
influences the consequences of trauma exposure. In addition, the effects of
abuse may extend beyond the immediate victim into subsequent generations as a
consequence of epigenetic effects transmitted directly to offspring and/or
behavioral changes in affected individuals. Recognition of the biological
consequences and transgenerational impact of violence and abuse has critical
importance for both disease research and public health policy.

The
relationship between child abuse and the use or abuse of alcohol has two
aspects. First, some findings have indicated that parental alcohol abuse may be
associated with the physical or sexual abuse of children. Research findings in
this area remain inconsistent, however. Second, the experience of being abused
as a child may increase a person’s risk for alcohol-related problems as an
adult. This relationship has best been demonstrated in women who had been
victims of childhood abuse. Several factors most likely contribute to or
influence this relationship, including coping skills; antisocial behavior; and
psychological problems, such as posttraumatic stress disorder Widom C,
Hiller-Sturmhöfel S (2001).

Child
maltreatment exemplifies a toxic relational environment that poses significant
risks for maladaptation across biological and psychological domains of
development. Research on child maltreatment can inform developmental theory,
but more importantly, it can enhance the quality of clinical, legal, and
policy-making decisions for maltreated children. This chapter addresses
definitional, epidemiological, and etiological aspects of child maltreatment. A
developmental psychopathology perspective is directed toward the discussion of
the psychological and neurobiological sequelae of child maltreatment.
Implications for prevention, intervention, and social policy are discussed, and
recommendations for future research are proffered according to Leeb R, Paulozzi
L, Melanson C, Simon T, Arias I (2008).

Despite overrepresentation of fathers as
perpetrators in cases of severe physical child abuse and neglect, the role they
play in shaping risk for physical child abuse and neglect is not yet well
understood Guterman N, Lee Y (2005). This article reviews the possible father
pathways that may contribute to physical child abuse and neglect risk and their
existing empirical support. The present empirical base implicates a set of
sociodemographic factors in physical maltreatment risk, including fathers’
absence, age, employment status, and income they provide to the family. As well,
paternal psychosocial factors implicated in physical child maltreatment risk
include fathers’ abuse of substances, their own childhood experiences of
maltreatment, the nature of fathers’ relationships with mothers, and the direct
care they provide to the child. However, the empirical base presently suffers
from significant methodological limitations, preventing more definitive
identification of risk factors or causal processes. 

Bottoms
B, Nielsen M, Murray R, Filipas H (2012) Religious beliefs can foster,
encourage, and justify child abuse, yet religious motivations for child abuse
and neglect have been virtually ignored in social science research. In this
paper, we compare victims’ retrospective reports of religion-related child
physical abuse to other reported cases of child physical abuse. We describe in
statistical detail the nature and circumstances of the abuse, characteristics
of victims and perpetrators, and the spiritual and psychological impact of the
abuse. Results indicate that although the basic characteristics of
religion-related physical abuse are similar to non-religion-related physical
abuse, religion-related abuse has significantly more negative implications for
its victims’ long-term psychological well-being.

Child
physical abuse is an important cause of pediatric morbidity and mortality and
is associated with major physical and mental health problems that can extend
into adulthood. Pediatricians are in a unique position to identify and prevent
child abuse, and this clinical report provides guidance to the practitioner
regarding indicators and evaluation of suspected physical abuse of children.
The role of the physician may include identifying abused children with
suspicious injuries who present for care, reporting suspected abuse to the child
protection agency for investigation, supporting families who are affected by
child abuse, coordinating with other professionals and community agencies to
provide immediate and long-term treatment to victimized children, providing
court testimony when necessary, providing preventive care and anticipatory
guidance in the office, and advocating for policies and programs that support
families and protect vulnerable children Christian C (2015).

Emotional
abuse and secondary abuse of children are increasingly recognized within the
mental health and legal professions as at least as damaging to adjustment as
physical abuse, sexual abuse, and neglect according to Twaite J,
Rodriguez-Srednicki O (2005). However, emotional and secondary abuse is relatively more difficult for mandated
reporters to recognize and document, and reporting laws are problematic. This
review article was written to acquaint professionals with the seriousness and
prevalence of emotional and secondary child abuse and with the issues surrounding
the reporting of such abuse. 

Skeletal
fractures are concluded in up to a third of children who have been investigated
for physical abuse. The fractures are often conceal, and they occur in infants
and toddlers who cannot give a causal explanation. Children who have been
physically abused represent a small symphony of the total number of childhood
fractures. Most children who nurture fractures do so from falls, motor vehicle
crashes, or other non-abusive trauma. In addition, a small group of children is more exposed to fractures owing to
underlying conditions that contribute to bone fragility.  All health
professionals who see children should be able to recognize the characteristics of fractures resulting from abuse and
begin child protection investigations where necessary, to prevent further
injury that could be fatal. In reality, the possibility of child abuse is often
overlooked in clinical practice according to BJM (2008).

Rebekah
G. Bradley, Elisabeth B. Binder, Michael P. Epstein, Yilang Tang, Hemu P. Nair,
Wei Liu, Charles F. Gillespie, Tiina Berg, Mark Evces, D. Jeffrey Newport,
Zachary N. Stowe, Christine M. Heim, Charles B. Nemeroff, Ann Schwartz, Joseph
F. Cubells, Kerry J. Ressler (2008) Genetic inheritance and developmental life
stress both contribute to major depressive disorder in adults. Child abuse and
trauma alter the endogenous stress response, principally
corticotropin-releasing hormone and its downstream effectors, suggesting that a
gene, environment interaction at this locus may be important in depression.

Three
definitional issues regarding children exposed to domestic violence are
examined. First, the multiple ways in which a child can be exposed to violence
is discussed. A taxonomy of 10 types of exposure is proposed. Nine key
characteristics of domestic violence, as they relate to children and children’s
exposure, are then outlined. The third issue addressed concerns why children
who are exposed to domestic violence can be considered victims of child
maltreatment. These children, by nature of their experience in the home, are
psychologically maltreated and are also at high risk for physical abuse and
some risk for sexual abuse George W. Holden (2003).

Emotional
abuse, label often used synonymously with the term emotional maltreatment,
psychological battering, psychological abuse, and soul murder, has been called
“the most elusive and damaging of all
types of maltreatment for child” and represents “the core issue and the most
destructive factors across all types of child abuse and neglect.” The very
illusiveness, however, of the identification of emotional and psychological
abuse cast doubt on the accuracy of available data relating to its occurrence,
and it is likely that the incidence and prevalence of such abuse are subject to
significant underreporting. Nevertheless, it appears from numerous studies that
the emotional abuse of children has been continuous to be a growing problem
according to Sana Loue, J.D, Ph.D., M.P.H (2006).

Jessica
Dixon Weaver (2010) Psychological abuse is the most prevalent type of child
abuse. It lies at the core of child maltreatment because it is embedded in and
interacts with physical and sexual abuse, as well as physical neglect. It also
has a more extensive and destructive impact on
the development of children than any type of abuse. Yet, the current child
protection system fails to adequately address the problem because the normative
framework of the child protection system does not always include the
psychological abuse of children. For the majority of states, the physical
health, safety, and well-being of children are focal points in determining
whether abuse or neglect occurs. Although
federal law requires that “serious emotional harm” be included in the
definition of abuse for all states, less than one-third
of all states in America allow for children to be removed from their parents
due to psychological abuse alone.

Fractures
are common injuries caused by child abuse. Although the consequences of failing
to diagnose an abusive injury in a child can be grave, incorrectly diagnosing
child abuse in a child whose fractures have another etiology can be distressing
for a family. The aim of this report is to review recent advances in the understanding
of fracture specificity, the mechanism of fractures, and other medical diseases
that predispose to fractures in infants and children. This clinical report will
aid physicians in developing an evidence-based differential diagnosis and
performing the appropriate evaluation when assessing a child with fractures
according to AAP (2014).

More
children in the Philippines are becoming victims of abuse, violence, and exploitation. In addition, the country
lacks a national child protection monitoring and reporting system to determine
the exact number of children in need of special protection, such as victims of
abuse, violence, and exploitation by
UNICEF (2003).

In
a remote Philippine village, toddlers played oblivious at a nursery as the
house next door became part of a horrifying child pornography ring, with live
footage of children performing sex acts being streamed online to pedophiles
around the world. The depraved scenes in the bungalow were being repeated in
many homes throughout Ibabao, a secluded community on Cebu island where
internet child pornography had for some of its 5000 residents become more
lucrative than fishing or factory work according to SMH (2014).

CRIN
(2011) The exploitation of an undisclosed number of Filipino children in
prostitution, pornography and sex tourism industries, as well as agriculture,
domestic work, drug trafficking and child soldiering, is a “significant
problem” in the country, said the report, which is posted on the Web site
of the US Embassy in Manila.

Republic
Act Number 9262 “Violence against
women and their children” refers to any act or a series of acts
committed by any person against a woman who is his wife, former wife, or
against a woman with whom the person has or had a sexual or dating
relationship, or with whom he has a common child, or against her child whether
legitimate or illegitimate, within or without the family abode, which result in
or is likely to result in physical, sexual, psychological harm or suffering, or
economic abuse including threats of such acts, battery, assault, coercion,
harassment or arbitrary deprivation of liberty by LawPhil (2004).

In
a larger research study that investigated the conceptualizations, experiences,
and coping behaviors of 294 male and female college students exposed to parental
verbal abuse, this paper identifies and measures seven culture-specific coping
behaviors in the Philippine setting, as experienced by 143 highly abused
students identified in the study Esther J. Esteban (2005). Results indicated
that both males and females coped essentially through silence. Neither used
humor to relieve anxiety nor an intermediary to facilitate communication with
the abusive parent. Multivariate analysis of variance suggested that while both
experienced fits of anger, females were
more inclined than males to accept and tolerate verbal abuse, suppress
feelings, and attempt to please the abusive parent. Female victims were
disadvantaged due to: differentiated child-rearing expectations and practices;
birth order; and the female victim’s attitudes, affective reactions, and
failure at meaningful communication with the abusive parent.