CHILD ABUSE and

NEGLECTED

dr. Melisa Lilisari, SpA, M.Kes

Every child has
the basic
human rights to
be safe

For thousands of children,

violence is a part of
everday life
Definition
Child abuse:
all forms of physical and/or emotional ill-
treatment, sexual abuse, neglect, or
negligent treatment or commercial or other
exploitation, resulting in actual or potential
harm to the child’s health, survival,
development or dignity in the context of a
relationship of responsibility, trust or power
Any harm to a child caused by parents
or other caregivers
 Physical
 Emotional
 Sexual abuse
 Neglect
 How is child abuse defined?
• Any recent act or failure on the part of the parent
or caretaker which results in death, serious physical
or emotional harm, sexual abuse or exploitation, or
• An act or failure to act which present an imminent
risk of serious harm
 What are the major types of
child abuse and neglect
1. Physical abuse: non accidental physical injury
(ranging from minor bruises to severe fractures or
death) as a result of punching, beating, kinking,
biting, shaking, throwing, stabbing, choking, hitting
(with a hand, stick, strap, or other object), burning,
or otherwise harming a child, that is inflicted by a
parent, caregiver, or other person who has
responsibility to the child
 What are the major types of
child abuse and neglect
2. Neglect: tha failure of a parent, guardian, or other
caregiver to provide for a child’s basic need.
Neglect may be physical (failure to provide
necessary food or shelter, or lack of appropriate
supervision), medical (failure to provide necessary
medical or mental health treatment), educational
(failure to educate a child or attend to special
education needs), emotional (inattention to a
child’s emotional needs, failure to provide
psychological care, or permitting the child to use
alcohol or other drug)
 What are the major types of
child abuse and neglect
3. Sexual abuse: includes activities by a parent or
caregiver such as fondling a child’s genitals,
penetration, incest, rape, sodomy,indecent
exposure, and exploitation through prostitution or
the production of pornographic materials
 What are the major types of
child abuse and neglect
4. Emotional abuse: a pattern of behaviour that
impairs a child emotional development or sense of
self-worth. This may include constant criticism,
threats, or rejection, as well as withholding love,
support, or guidance. Emotional abuse is often
difficult to prove, and, therefore, child protective
services may not be able to intervene without
evidence of harm or mental injury to the child.
Emotional abuse is almost always present when
other forms are identified
 What are the major types of
child abuse and neglect
In many states, abandonment and parental
substance abuse are also defined as forms of child
abuse or neglect

A child is considered to be abandoned when the

parent’s identity or whereabouts are unknown, the
child has been left alone in circumstances where
the child suffers serious harm, or the failure has
failed to maintain contact with the child or provide
reasonable support for specified period of time
 Recognition of physical child
abuse
 General approach:
 ABC’s of pediatric trauma
 The primary goal is the child’s safety
 Carefully document injuries, with legal implication in
mind
 Do not attempt to identify perpetrator or assign guilt
or blame
 Reporting of suspected abuse is required
 Admit child when abuse is suspected and initiate
social services process
 Recognition of physical child
abuse
Suspect abuse if:
 FTT
 Delay in obtaining care
 Multiple previous injury
 Absent or uninterested caregiver
 Fluctuating or conflicting histories
 History not consistent with injury, developmental
level of victim, or alleged child perpetrator
 Recognition of physical child
abuse
Suspect abuse if physical finding:
 Bruises:
 Pinch marks: paired ovals
 Slap marks: parallel stripes
 Cord marks: loops, stripes
 Bites: adult mouth intercanine distance >3 cm
 Head:
 Multipel or bilateral skull fractures
 Skull fractures in fall <4 feet
 Retinal hemorrhage
 Shaken baby syndrome: <2 years old without external trauma
with retinal and subarachnoid hemorrhages
 Tin ear syndrome: unilateral ear bruising, ipsilateral cerebral
edema, and retinal hemorrhage
 Recognition of physical child
abuse
Suspect abuse if physical finding:
 Chest:
 Rib fractures: multiple, bilateral, posterior, different ages
 Trunk encirclement bruises
 Extremity fractures
 Metaphyseal “chip” or “bucket handle”
 diaphysea;l spiral<9 month of age
 Transverse midshaft long bone
 Femur fracture <2 years of age
 Acromion process of spatula
 Proximal humerus
 Recognition of physical child
abuse
Suspect abuse if physical finding:
 Burns:
 Circumferentialm uniform, depth, multiple, no splash
 Buttock, perineum, back, dorsal hand, stocking glove
 Cigarette burns: round, 4-8 mm diameter
 Perineum:
 Contusion, hymenal disruption
Epidemiology
UNICEF:

Annually, 4 million children age <15

years suffering from abuse worlwide
Physical abuse in Indonesia
Risk Factor
 Prematurity, dissability,
learning behaviour,
etc
Prior history of
abuse while
childhood,
Poverty, less social Children unhappy
support, etc marriage,
domestic
violence, young
age mother, single
parents, low
Social Parents education, etc
Social pediatric
management
 Recording and reporting
 Professional team: trained and skilled
pediatrician, social worker, nurse,
psychologist, data recorder
Reporting pathway
Prognosis
 Poor
 5% abusive child were killed
 25% had serious injury
 CNS injury: mental retarded, learning and
behaviour problems, deafness, motoric
delay
 Later in life: substance abuser, antisocial
adults, child abuser
Our Role
 Identification of high risk people

 Identification of cases

 Reporting
 Pedoman Rujukan Kasus
Kekerasan Terhadap Anak
 Pemerintah wajib menyediakan fasilitas dan
menyelenggarakan upaya kesehatan yang
komprehensif bagi anak, agar setiap anak
memperoleh derajat kesehatan yang optimal sejak
dalam kandungan (pasal 44, UU no 23 tahun 2002
tentang perlindungan anak)
 Pedoman Rujukan Kasus
Kekerasan Terhadap Anak
 Konvensi Hak Anak PBByang diratifikasi oleh
pemerintah Indonesia dengan keputusan presiden
no 36 tahun 1990, meliputi 4 prinsip dasar, yaitu:
 Non diskriminasi
 Kepentingan terbaik bagi anak
 Hak kelangsungan hidup dan tumbuh kembang
 Penghargaan pendapat anak
 Pedoman Rujukan Kasus
Kekerasan Terhadap Anak
 UUD 1945 pasal 288 tentang Hak Anak
 Pasal 28B ayat(2): setiap anak berhak atas kelangsungan
hidup, tumbuh dan berkembang serta berhak atas
perlindungan dan kekerasan dan diskriminasi
 Pasal 28H ayat (1): setiap orang berhak hidup sejahtera
lahir dan batin, bertempat tinggal dan mendapatkan
lingkungan hidup baik dan sehat serta berhak
memperoleh pelayanan kesehatan
 Pedoman Rujukan Kasus
Kekerasan Terhadap Anak
 UU no 4 tahun 1979 tentang kesejahteraan anak
 uU no 23 tahun 1992 tentang kesehatan
 Pasal 4: setiap orang mempunyai hak yang sama dalam memper9oleh
derajat kesehatan yang optimal
 Pasal 9: pemerintah bertanggung jawab untuk meningkatkan derajat
kesehatan masyarakat
 Pasal 17 ayat (1): kesehatan anak diselenggarakan untuk mewujudkan
pertumbuhan dan perkembangan anak
 Pedoman Rujukan Kasus
Kekerasan Terhadap Anak
 UU no 39/1999 tentang hak azasi manusia
 Pasal 62L setiap anak berhak untuk memperoleh
pelayanan kesehatan dan jaminan sosial secara layak,
sesuai dengan kebutuhan fisik dan mental spiritualnya
 UU no 23 tahun 2002 tentang perlindungan anak
 Pasal 44 ayat (1): pemerintah wajib menyediakan fasilitas dan
menyelenggarakan kesehatan yang komprehensif bagi anak, agar setiap
anak memperoleh derajat kesehatan yang optimal sejak dalam
kandungan
 Pasal 44 ayat (2): penyediaan fasilitas dan penyelenggaraan upaya
kesehatan secara komprehensif sebagaimana dimaksud dalam ayat (1)
didukung oleh peran serta masyarakat
 Pasal 44 ayat (3): upaya kesehatan yang komprehensif sebagaimana
dimaksud pada ayat (1) meliputi upaya promotif, preventif, kuratif, dan
rehabilitatif, baik untuk pelayanan kesehatan dasar maupun rujukan
 Pedoman Rujukan Kasus
Kekerasan Terhadap Anak
 UU no 23 tahun 2004 tentang lelerasan dalam
rumah tangga
 Pasal 4: penghapusan kekerasan dalam rumah tangga bertujuan
a. Mencegah segala bentuk kekerasan dalam rumah tangga
b. Melindungi korban kekerasan dalam rumah tangga
c. Menindak pelaku kekerasan dalam ruah tangga
d. Melahirkan keutuhan rumah tangga yang harmonis dan sejahtera
Thank You for Your
Attention

“So long as little children are

allowed to suffer, there is no
true love in this world”
Duncan