Violence against children has been recognized as public health problem by World Health Organization (WHO). The eighth Millennium Development Goals (MGDs) set by the special session of United Nations general assembly in 2015; five out of eight goals are directly related to the wellbeing of children.
Child abuse is not limited to battering only. WHO defines child maltreatment as “the abuse and neglect faced by children under the age of 18 years, includes physical, sexual and emotional abuse”.1 Physical abuse encompasses inflicting temporary or permanent damage to the physical functioning of a child, for example, corporal punishment, beating, choking, biting and intentionally burning.2-4 Sexual abuse is engaging children in sexual activities they cannot understand or consent to, including exposing the child to sexually explicit material or using the child in pornography, and rape.5,6 Emotional abuse is the ongoing emotional maltreatment of a child. It is also called psychological abuse and can significantly damage child’s mental health and development. Emotional abuse involves bullying, deliberately trying to scare, humiliate, isolate, ignore, corrupt or terrorize a child.7
There is ample research evidence confirms the deleterious effect of childhood abuse, effecting psychological and social wellbeing, physical health and educational performance of a child.2,3 In addition to immediate physical and emotional damage, abused children are at high risk of becoming depressed, suicidal, aggressive, or withdrawn. Older children may develop substance abuse or running away from home. As adults, they are more likely to develop marital and sexual difficulties, depression, suicidal behavior or addictions and even they may have shortened life span.8
Similarly maltreated children are more likely to be the perpetrators in future, conforming to the social cycle theory of abuse. Some research shows that 90 percent of maltreating adults were abused as children.9
Children often don’t disclose the abuse explicitly thus the goal of identifying the abuse is usually thwarted. Therefore, it becomes essential to pay attention to subtle or some time drastic changes in child’s mood and behavior. Some time sudden and dramatic changes indicate that something may be wrong.
Children who have been abused or neglected may have different behavioral changes or emotional manifestations. They may include the child being withdrawn, quiet or have a bad temper, anger outburst or disruptive behavior, excessive crying, specific fear of a place or person, nightmares and bedwetting. Drastic changes in academic performance (dropping grades). Changes in sleep patterns (excessive or lack of sleep) and appetite (eating too much or too little) may also be indicators of abuse.1- 3 In majority of cases of child abuse, emotional damage is more severe than any physical damage with long lasting effects.
The magnitude of child abuse is alarming in our region. The largest number of child labour, abuse, prostitution and trafficking has been reported in India, Pakistan, Bangladesh, Bhutan and Nepal. The largest number of working children in the world, fulfilling the criteria of child abuse resides in India. 10There is scarcity of meaningful research in Pakistan; most of the studies looking at this menace are descriptive and inconclusive in nature. The available data show that girls predominate as the victim of abuse11 and there has been steady increase in incidence over the last few years.4
There has been some progress in promulgation of laws recently in Pakistan, addressing the problem of child abuse. In 2016 the 2nd Amendment of the Criminal Law Act was approved by National Assembly, passing the long overdue bill on Child Abuse. This Bill rose the age of criminal responsibility from 7 years to 12 years. It provides protection to children from all forms of physical maltreatment including corporal punishment. Additionally, it widened its definition of child sexual abuse to include and penalize paraphelia like voyeurism, exhibitionism and using the child in pornography, whereas, previously only rape was criminalized.12
Mental Health professionals and also pediatricians play a key role in the path to recovery for children with a history of abuse. Parents and other family members are strongly recommended to seek counseling in order to provide comfort and support to the child.13 Psychological treatment like Abuse-Focused Cognitive Behavioral Therapy (AF-CBT) is one such mode of intervention, designed for children who are victim of abuse.13
In country like ours with limited resources and scarce child mental health services there is dire need to focus on this grievous problem to reform the laws and develop child-protection services. Similarly quality and meaningful research is required to inform policy and raise awareness about child abuse.
Even though these safeguards will go a long way in protecting children, better we ask ourselves, are we doing enough to prevent child abuse?
WHO media centre. Child maltreatment. (On line) 2013. [Cited on: December 27, 2017]. Available from URL: http://www.who.int/mediacentre/factsheets/fs150/en
Espeleta HC, Palasciano-Barton S, Messman-Moore TL. The impact of child abuse severity on adult attachment anxiety and avoidance in college women: the role of emotion dysregulation. J Fam Viol 2017;32(4):399-407. DOI: 10.1007/s10896-016-9816-0
Blakemore T, Herbert JL, Arney F, Parkinson S. The impacts of institutional child sexual abuse: a rapid review of the evidence. Child Abuse Negl 2017 Dec;74:35-48. DOI: 10.1016/j.chiabu.2017.08.006
Wasif S. 10% increase in child abuse cases in Pakistan. [Cited on: December 27, 2017]. Available from URL: https://tribune.com.pk/story/1363150/rise-10-increase-child-abuse-cases-pakistan
Ben-Natan M, Sharon I, Barbashov P, Minasyan Y, Hanukayev I, Kajdan D, et al. Risk factors for child abuse: quantitative correlational design. J Pediatr Nurs 2014 May-Jun;29(3):220-7. DOI: 10.1016/j.pedn.2013.10.009.
McGuire K, London K. Common beliefs about child sexual abuse and disclosure: a college sample. J Child Sex Abus 2017 Feb-Mar;26(2):175-194. DOI: 10.1080/10538712.2017.1281368.
Hamarman S, Pope KH, Czaja SJ. Emotional abuse in children: Variations in legal definitions and rates across the United States. Child Maltreat 2002;7(4):303-11. DOI: 10.1177/107755902237261
Thornberry TP, Henry KL. Intergenerational continuity in maltreatment. J Abnorm Child Psychol 2013 May;41(4):555-69. DOI: 10.1007/s10802-012-9697-5.
Starr RH, Wolfe DA. The effects of child abuse and neglect. New York: The Guilford Press; 1991.
Venkateswarlu D, Kasper J, Mathews R, Reis C, Iacopino V, Wise P. Child labour in India: A health and human rights perspective. Lancet 2003; 362(Suppl):32–3.
Ali A, Hyder AA, Malik FA. Violence against Children: A Challenge for Public Health in Pakistan. J Health Popul Nutr 2007; 25(2):168–78.
Junaidi I. Senate body rejects amendment to child marriage act as 'un-Islamic'. [Cited on: December 27, 2017): Available from URL: https://www.dawn.com/news/1363275.
Cohen JA, Mannarino AP, Murray LK, Igelman R. Psychosocial interventions for maltreated and violence-exposed children. J Soc Issues 2006;62(4):737–66. DOI: 10.1111/j.1540-4560.2006.00485.x