Define Child Abuse & Neglect. Describe its types, management, prevention and prognosis.

Definition

• Child abuse and neglect (child maltreatment) is any act of commission or omission by a caregiver that causes harm, potential harm, or threat of harm to a child.
• It is under-recognised and has serious lifelong consequences.

Types

• Physical abuse — non-accidental injury (NAI).
• Sexual abuse.
• Emotional/psychological abuse.
• Neglect — physical, medical, educational or emotional.
• Fabricated or induced illness (Munchausen syndrome by proxy).

Red Flags in the History

• A history inconsistent with the injury or with the child's developmental stage.
• Delayed presentation, a changing/vague story, or inappropriate caregiver behaviour.
• Recurrent 'accidents' or injuries.

Suggestive Physical Findings

• Bruises at unusual sites or in patterns (belt, hand), and injuries of different ages.
• Fractures suggestive of abuse — metaphyseal ('corner'), posterior rib, and multiple/spiral fractures in a non-ambulant child.
• Burns — cigarette burns, symmetrical immersion (glove-and-stocking) scalds.
• Abusive head trauma ('shaken baby') — the triad of subdural haemorrhage, retinal haemorrhages and encephalopathy; a torn frenulum in infants.

Evaluation

• Detailed history and a thorough, fully documented examination (with a growth assessment).
• Skeletal survey (occult fractures), fundoscopy (retinal haemorrhages), and neuroimaging as indicated; coagulation screen to exclude bleeding disorders.
• Multidisciplinary assessment.

Management

• Treat the injuries and stabilise the child.
• Ensure the child's safety — admit if necessary; involve child-protection services.
• Mandatory reporting — in India, sexual abuse must be reported under the POCSO Act; follow local child-protection law.
• Psychological support and counselling; long-term follow-up and prevention.

Sexual Abuse — Specific Points

• May present with genital/anal injuries, sexually transmitted infections, pregnancy, or sexualised behaviour; often no physical signs.
• Requires sensitive, expert evaluation, forensic considerations, and mandatory reporting under POCSO.

Risk Factors

• Child factors (prematurity, disability, difficult temperament), caregiver factors (substance abuse, mental illness, own abuse history), and social stressors (poverty, isolation).

Long-term Consequences

• Physical injury/disability; psychological trauma — depression, anxiety, PTSD, behavioural problems.
• Impaired development and attachment; intergenerational cycle of abuse.

Munchausen Syndrome BY Proxy

In fabricated or induced illness, a caregiver invents or produces symptoms/signs in a child (e.g. By giving substances), leading to unnecessary investigations and harm; it requires a high index of suspicion and careful, multidisciplinary handling.

Prevention

• Support for at-risk families, parenting education, early identification of stressors and mental-health/substance problems.
• Home-visiting programmes and social support reduce risk.

Role of the Paediatrician

• Recognise, stabilise and document; exclude medical mimics (bleeding/bone disorders) without delaying protection.
• Coordinate with child-protection services, social workers and law enforcement as appropriate.

Prognosis & Follow-up

Outcomes depend on the severity/chronicity of maltreatment and the support provided; early intervention, a safe environment and psychological therapy improve long-term physical and mental-health outcomes.