1. Child Abuse Health Impact Jinan Usta MD

2. Health problems The psychological and medical squeal of abuse can appear immediately or later, sometimes later

3. Child abuse- injuries Skin: bruising, cuts, wounds, redness or bulla Brain: micro hemorrhages, bleeds Eyes: retinal hemorrhages, conjunctival hemorrhages, orbital swelling Abdomen: acute abdomen, hematuria Skeleton: fractures multiple or in various stages of healing Sudden death

5. Chronic: –Pains: headache, back, abdomen…. –Chronic illnesses: arthralgias, hypertension, diabetes, asthma- bad control – GU/GI symptoms.. –Psychosomatic symptoms: fatigue, dizziness. –Immune system deficiency

6. Indirect health consequences of abuse Increase injurious health behaviors Reduce preventive health behaviors Problems managing co morbid state

7. Lifetime Health Impact Smoking Alcoholism Substance abuse Obesity Depression

8. Lifetime Health Impact Pulmonary disease Hepatitis Heart disease Diabetes Suicide

9. Mental health problems Difficulty to concentrate, poor school performance Eating disorders Withdrawal, low self esteem Anxiety, fear, sleeplessness, nightmares Obsessive compulsive- perfectionist Depression, guilt, suicide Borderline, excessive daydreaming, Dissociative symptoms Drug addiction, substance abuse

10. Behavioral problems Aggressiveness: violence is acceptable way to assert one’ s view, or to discharge stress Hyperactivity and regressive behaviors Avoidance, mistrust

11. Cognitive problems The world is a dangerous place, chronic perception of helplessness and powerlessness, low self esteem Impaired sense of self: difficulty protecting self or setting boundaries

12. Relationship problems Violence is an inherent part of a loving relationship Intimacy dysfunction: difficulty in self disclosure or expressing warmth in intimate relationships, high need for closeness

13. Role of the health care provider Victims of abuse are frequent visitors to the health care system Importance of detection by screening, providing guidance and counseling and assistance The approach is very delicate and sensitive- can endanger the child

15. Role of the health care provider Provide ways to discipline the child- THERE ARE SO MANY WAYS TO DISCIPLINE A CHILD - COROPORAL PUNISHMENT EVEN FOR THE SAKE OF DISCIPLINE IS CHILD ABUSE

16. Recommendations Encourage all primary health care professionals to screen for abuse Train health care professionals in skills needed to support the abused child and his family

17. Recommendations Incorporate screening for child abuse in all school health programs Introduce, within the school curricula, the teaching of child’s rights Conduct series of workshops teaching discipline for parents and teachers