No child’s play

Despite repeated warnings that all routes leading to the hospital would be compromised because of Fiba, people showed up to attend the medical conference. Coming from a multistakeholder meeting in the morning that dealt with health and prevention, the sustained adrenalin to rush to the venue was absolutely not just a byproduct of two cups of caffeine.

First question. So how much time do I have? Delivered in a firm soothing tone, complemented by a bright engaging smile, Dr. Bernadette Madrid posed this question to the audience after having been properly introduced. A friend seated beside me gamely responded in a stage whisper that she was welcome to take the whole afternoon. She had just echoed our thoughts for both the speaker and the topic are of inestimable value.

Second question. What is more common, asthma or child abuse? For some of us in the room employing test sense, the answer to her question was the latter, coming from a place of uncertainty, as asthma is not an infrequent diagnosis in a clinic visit. But before you get off-balance by statistics, let us first get into its definition.

Child abuse, generally referred to as child maltreatment, is complex. Lifted from the website of the World Health Organization: “It is the abuse and neglect that occurs to children under 18 years of age and includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence, and commercial or other exploitation which results 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.”

From a nationwide study done in 2015 to determine, among others, the prevalence of violence against children (VAC) and the youth, out of 3,866 respondents from 172 barangays belonging to the age group of 13-24, “80 percent … experienced any one form of violence in the home, school, workplace, and community. More than three in five suffered physical, psychological, and peer violence while 22.4 percent were victims of sexual abuse. Ten percent were physically neglected, while a fourth felt psychologically neglected by their caregivers. More boys claimed to have been sexually abused and physically neglected, while more girls were bullied and witnessed psychological violence in the home. VAC prevalence was, however, found to be highest among LGBTQ+s compared to heterosexual males and females. Despite the high prevalence, less than 10 percent of the respondents disclosed their experiences of abuse, primarily to friends and parents. About one in 10 ever sought help from a professional.”

Signs. “Any form of bruising is one the most common and often missed signs especially if the patient is in the precruising stage,” meaning that he or she is not yet able to ambulate. This was met by a lot of reaction for did we, at any point in our practice, disregard a telltale sign? She spoke about the TEN-4 acronym that could help the clinician recognize and thereby pursue an evaluation for possible child abuse and differentiate it from being caused by an accident. Spelling it out, it means: bruising to the Trunk, Ear, Neck, while the number 4 represents bruising in infants less than four months old and younger. Any abdominal injury requires an investigation as well. Listening to her speak, one gets a clearer picture and is made to understand that physical examination findings are but superficial, for despite being an obvious manifestation, it truly falls short when imagining the eventual prognosis as one comes into being from deeply rooted psychological and emotional scars.

In the earlier years of training, one experience that stood out was that of a physically battered child needing diagnostics. The mother initially refused to divulge that the father was the perpetrator. Her reason: he was the breadwinner. With no child protection unit in place back then, we referred them to a government hospital to file a medicolegal report but not before seriously warning him that he would have to deal with us in the case of a repeat.

What to do. Fortunately, laws and policies are now in place. For the health professionals: once recognized, we need to record to document, report, and refer to agencies like the Department of Social Welfare and Development, local government units, the National Bureau of Investigation, the Philippine National Police, and the Commission on Human Rights. For the general public: the Children Protection Network Foundation is offering free online courses for anyone interested in immersing in a purpose worth championing.

Child abuse can be likened to being inflicted with a disease as it can both be a cause of morbidity and mortality. While its cause is multifactorial, prevention is possible if we all work together to protect a child’s human rights for it does take a village to raise a child.