'Every child born into the world is a new thought of God, an ever fresh & radiant possibility'.
'Children are the bridge to heaven'.
'Every child comes with a message that God is not yet discouraged by humanity'
Our brain always gets entertained by the aforementioned quotes on children. Whenever we see a beautiful healthy baby, we tend to say ''Ohh..So sweet/Cho chweet'' & on the other extreme when we see poor or underprivileged baby, ''Oh My God... '' is the 1st line that our tongue passes. Does our duties & responsibilities get a full stop mark right there?? Do we ever try to have a deep sneak at the so called 'active-healthy' babies or the 'poor-underprivileged' babies? I realize the fact that, the general population must be giving a sarcastic expression especially after going through the 'deep sneak' term. I agree that we don't have enough time to look into the matters behind the babies. But the most blessed professionals who can do this 'deep sneak' job seriously are paediatricians.
According to a report by CPS (Child Protective Services) around the world in the year 2006, 64% of all the child abuse cases comprise of domestic neglect, 2%-Medical neglect, 16%- physical abuse, 8.8%- Sexual abuse, 6.6%- Psychological abuse. Whenever we hear about the term 'Child Abuse', we always draw a picture of sexual abuse in our visual cortex. But as evident from this report, child abuse is much more than sexual abuse. According to dept of Woman & child welfare of the Govt of India in 2007, approximately 53% of children are victims of sexual abuse. We can always use the term 'Iceberg phenomenon' to child abuse because we see a fraction of the real occurrence in our society.
Now let's refocus on the roles of a pediatrician towards the prevention of child abuse. Other than the parents, if someone has the legal access to examine the body parts of a baby, he/she is a pediatrician. Pediatricians are close to the parents. So he/she is positioned in the best possible place to assess the risks & consequences of child abuse. According to a report from AAP (American Academy of Pediatrics), the universal prevention of child maltreatment must begin with an approach that assess the care giver's strength & deficits. So the key term is ''Anticipatory guidance''. A pediatrician must be ready to tackle all the issues which may impose risks of child abuse. So identifying the possible risk factors is a cornerstone for the prevention this issue. For example, a mother suffering from post-partum depression is often a source of negligence for the baby. So the pediatricians must have an eagle's eye on psychological aspects of the parents as any negative change in parent's psychology will definitely affect the child care at home. Another crucial situation is the evaluation of a child with disabilities. Most often, the children with physical/intellectual disabilities become the victim of maltreatment. Here the biggest reason is the parental frustration. Same is the risk, when the baby is a product of unplanned pregnancy. So the pediatricians must look for the aforementioned factors (parental depression, unplanned pregnancy, child with disability) carefully to assess the risks of child abuse.
After doing 5 months of Pediatric rotations in USA, I realize that, the Americans are much more aware of these issues than Indian (Now, don't drag me into the controversy that I am biased in favor of US). Each & every examination room in USA pediatric hospitals has the child abuse report forms hanging on the wall. It is the role of the pediatrician to report any suspected case of abuse. I guess we lack that part in India. There should be more awareness among paediatricians about this issue. Fixed follow-ups of all child patients in regular intervals should be strict in Govt hospitals & careful assessments during these follow-up visits can reduce the risks of child abuse to a great extent. I strongly feel, instead of following the American culture, we must follow at least this useful & important aspect which can keep our babies secured.
Special thanks to Aamir Khan’s 'Satyameva Jayate'' & Prof Howard Dubowitch ( Dept of Child abuse, University of Maryland school of Medicine) as they have inspired me to type about this topic.