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About 6 decades ago there was little information or emphasis on child abuse and neglect in Nigeria and indeed in Africa because of overwhelming problem of childhood infections, nutrition and their synergistic effects, as a result of unfavourable socioeconomic, cultural, educational, and political facilities. However today our world is not only filled with children with pertussis, polio, diphtheria but with child abuse alongside which is often regarded as silent killer in children.

CHILD ABUSE
Child abuse occurs when the parent, guardian, or other person responsible for the child’s welfare inflicts the child physically, mentally, sexually or emotionally. United Nations Convention on the rights of the child defines a child as a human being below the age of 18 years.

TYPES OF CHILD ABUSE
Physical abuse.
Sexual abuse.
Psychological abuse.
Neglect.
Emotional abuse.

Child sexual abuse (CSA) is a form of child abuse in which an adult or older adolescent abuses a child for sexual stimulation. Sexual abuse refers to the participation of a child in a sexual act aimed towards the physical gratification or the financial profit of the person committing the act. CSA does not need to include physical contact. Sexual abuse in children occur throughout the world. It has become a silent epidemic as well as a public health issue with negative long-term effect. Up to one-third of adolescent girls report their first sexual experience as being forced.
UNICEF reported in 2015 that one in 4 girls and one in 10 boys in Nigeria experience sexual violence before age 18.

FORMS OF CHILD SEXUAL ABUSE
1. Asking or pressuring a child to engage in Sexual activities (regardless of the outcome)
2. Indecent exposure of the genitals to a child- exhibitionism
3. Displaying pornography to a child
4. Actual sexual contact with a child
5. Physical contact with the child’s genitals
6. Viewing of the child’s genitals without physical contact
7. Using a child to produce child pornography, sharing pornographic images.
8. Making the child engaged in prostitution that is sexual exploitation.
9. Sexualized talk with the child.
10. Sex trafficking
11. Sexual perversions are conditions in which sexual excitement is associated with acts or imagery that are considered unusual within the culture.

TYPES OF CHILD SEXUAL ABUSE
Exhibitionism: Display of sexual organ by an adult
Fetishism
Frotteurism: In this case, the adult rubs his or her sexual organ against a child in order for him to gain sexual satisfaction.
Masochism:
Paedophilia
Sadism
Voyeurism: This is an act of deriving sexual pleasure from watching others when they are naked.

FACTORS THAT PREDISPOSES A CHILD TO SEXUAL ABUSE
Social circumstances such as street hawking.
Attendant at day care, children in foster homes.
Poverty.
Physical disabilities.
Dysfunctional homes.
Substance abuse and alcoholism in the parents.
Parental mental health issues
Female
History of neglect.
Learning disabilities.
Homelessness.
Children under alcohol or drug influence.
Absence of one or both biological parents.
Child marriages.

IMPACT OF CHILD SEXUAL ABUSE
Disrupts the healthy development of the child.
It affects victims, physical, psychological and behaviourally.
Regressive behaviors (thumb sucking, bed wetting)
Poorer school performance.
Symptom of anxiety and other mental health challenges.
Depression.
Low self-esteem.
Promiscuity.
Running away.
Predispose to deviant behaviours.
Increases risk of STIs and HIV and other health challenges.
Increases risk of alcoholism, drug abuse, prostitution, and other risky behaviours.
Change in eating habit
Sleep disturbances.
Aggressive behaviour, behavioural changes.
Unwanted pregnancy.
Social stigmatisation.
GIT disorder
Gynaecological disorder

WARNING SIGNS THAT YOUR CHILD MIGHT HAVE BEEN SEXUALLY ABUSED
1. Any injury, soreness, redness, swelling or itching around the genital or anal area.
2. Sexually transmitted infections.
3. Pregnancy.
4. Inappropriate sexual play with self or others.
5. Inappropriate sexually explicit drawings.
6. Knowledge of sexual acts that is age inappropriate.
7. Seductive behaviour.
8. Excessive masturbation.
9. Unusual fear of certain places or persons.
10. Personality changes.
11. Change in appetite.
12. Self mutilation.
13. Inability to concentrate.
14. Locking doors
15. Depression.
16. Suicidal tendencies.
17. Nightmares.
18. Not wanting friends to visit at home.
19. Not wanting to go home or getting home to early.
20. Running away.
21. Withdrawal behaviour.
22. Mood swing.

HOW TO PREVENT CHILD SEXUAL ABUSE
1. Public enlightenment Should be done at school, social clubs, churches, mosques.
2. Through parental talk to their child about sex and healthy relationship.
3. Bill that would toughen legislature on sexual violence should be passed.
4. Education of teachers to receive specific training in preventing, recognising or responding to child sexual abuse.
5. Girl child education.
6. Addressing gender inequalities and poverty.

MANAGEMENT OF SURVIVORS
Treat medical complications
Medical and psycho social evaluation to address traumatic responses to Child sexual abuse.
Counselling, taking them through the healing process, one step at a time.

ROLES OF PAEDIATRICIAN
1. Responsibility to identify child sexual abuse.
2. Help ensure their protection to health.
3. Play role in prevention, treatment and advocacy.
4. Paediatricians must be competent to address these issues in impacted children and family under their care.
5. Advocate in local, state and national and international levels for safer environments in which our children can grow and thrive.
6. Counselling of children and patient who are victim of child sexual abuse.
7. Help them gain access to support services.
8. Educating parents and children on child sexual abuse.

FURTHER READING
Ahern, E.C., Lyon, T.D., & Quas, J.A. (2011). Young children’s emerging ability to make false statements. Developmental Psychology, 47, 61-66.
Cavanagh Johnson, Toni (2009). Helping Children With Sexual Behavioral Problems: A Guidebook for Professionals and Caregivers. Institute on Violence, Abuse and Trauma. San Diego, CA.
Cromer, L. D, & Goldsmith, R.E. (2010). Child Sexual Abuse Myths: Attitudes, Beliefs and Individual Differences. Journal of Child Sexual Abuse. 19, 618-647.
Finklehor, D. (1994). Current Information on the Scope and Nature of Child Sexual Abuse. Sexual Abuse of Children, 4(2), 31-53
Fontes, L.A., & Plummer, C. (2010). Cultural Issues in Disclosures of Child Sexual Abuse. Journal of Child Sexual Abuse, 19, 491-518.
Lipian, M.S., Mills, M.J., & Brantman, A. (2004). Assessing the verity of children’s allegations of abuse: A psychiatric overview. International Journal of Law and Psychiatry, 27(3), 249-263.
London, K., Bruck, M., Wright, D.B, Ceci, S.J. (2008). Review of the contemporary literature on how children report sexual abuse to others: Finding, methodological issues, and implication for forensic interviewers. Memory, 16(1), 29-47.
Malloy, L.C., Lyon, T.D., & Quas, J.A. (2007). Filial dependency and recantation of child sexual abuse allegations. Journal of the Academy of Child and Adolescent Psychiatry, 46(2), 162-170.
Malloy, L.C., & Lyon, T.D. (2006). Caregiver support and child sexual abuse: Why does it matter? Journal of Child Sexual Abuse, 15(4), 97-103.
Mather, Cynthia L., & Debye, Kristina E. (1994). How Long Does it Hurt? A guide to recovering from incest and sexual abuse for teenagers, their friends and their families. Jossey-Bass. San Francisco, CA.
Sorensen, T., Snow, B. (1991). How Children Tell: The Process of Disclosure in Child Sexual Abuse. Child Welfare League of America, 3-15.
Summit, R.C. (1983). The child sexual abuse accommodation syndrome. Child Abuse and Neglect, 7, 177-193.

NOTE: The credit of this publication goes without reservation to Dr. Adeniyi Udoka P. (Paediatrician par excellence at OOUTH)

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Dr. Olusola Adeyemo (M.B.Ch.B.; Adv. Dip in Nutri.)

Dr. Adeyemo Olusola is a medical graduate of Olabisi Onabanjo University, Ogun State, Nigeria with certificate in advanced diploma in Principles of Nutrition, Management and Leadership, Dublin and Certificate in Global Health from London School of Hygiene and Tropical Medicine. He is an avid reader of books from different oasis of life, expert in Medical Statistics; an award winner at both local and international level. "So many a time, I have seen people died avoidable death because of lack of knowledge or information leaving them all to fate. A healthy society cannot be detached from informed one hence need to establish healthgist.net. We hope you'll have a wonderful stay on our site."

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