Speakers highlight various issues related to Child Abuse in Pakistan which remains under-reported


 Seminar on Child Abuse at KEMU

Speakers highlight various issues related to Child Abuse in Pakistan which remains under-reported

LAHORE: Academic Department of Psychiatry & Behavioural Sciences & Department of Child & Family Psychiatry, King Edward Medical University recently organized a seminar on “Child First & Always: No excuse for Child Abuse”. Dr Nazish Imran, Head & Associate Professor in Child & Family Psychiatry Department in her welcome address stated that Child abuse is an unfortunate reality for many children in our community. The objective of the seminar is to increase the awareness about Child Abuse. It is not a psychiatric diagnosis; rather a phenomenon affecting children and young people. It is a major environmental risk factor for non-optimal development of children, both physically and psychologically.

Dr. Nazish Imran along with Prof. Aftab Asif presenting flower Bouquet to the speakers at the seminar
on Child Abuse organized by Academic Department of Psychiatry & Behavioural Sciences &
Department of Child & Family Psychiatry, King Edward Medical University recently

Prof. Aftab Asif, Chairman Academic Department of Psychiatry & Behavioural Sciences highlighted that last few decades have witnessed an increase in our awareness of problems faced by children exposed to any traumatic experience. He described in detail the establishment of Psychotrauma Centre in Psychiatry Department in KEMU after APS incident and the work done by faculty in assessing children referred from Peshawar as well as conducting various workshops with school teachers, first aid responders, media and law enforcement agencies to teach them Psychological first aid principles. Psychiatry Department further played significant role in the assessment and therapy of victims of child abuse scandal in Kasur in 2015 and more recently Investigation officers sought faculty help during investigation in Zainab abduction, sexual assault and murder case in Kasur.

Prof. Dr Muhammad Sharif Chairman, Paediatric Surgery Department, KEMU talked about Spectrum of Child Abuse Cases presenting at Paediatrics Surgery Unit. He highlighted that Child abuse is worldwide problem that effects all level of society. WHO recognizes physical abuse, sexual abuse, emotional abuse, neglect and exploitation as different types of child abuse. He then used real case scenarios to explain about Head trauma and thoracoabdominal injuries, burns, fractures, Jadoo and Jinn related issues in society. Use of injections unnecessarily by healthcare professionals as important types of abuses seen in clinical settings. He concluded that incidence of child abuse is under reported because professional contact or recognition is often required to identify abuse at first place. Physician must recognize not only abuse that has already occurred but also factors indicating a high potential for abuse. When history, magnitude and mechanism of trauma does not correlate with clinical findings, high index of suspicions should be kept in mind regarding diagnosis of child abuse.

Prof. Dr. Muhammad Haroon Hamid, Chairman, Dept. of Pediatric Medicine, KEMU Lahore, General Secretary, Pakistan Pediatric Association (Punjab)is also a member, International Society of Prevention of Child Abuse & Neglect (ISPCAN) and Member of Child Rights Committee, PPA. His presentation was “From Battered Baby Syndrome to Safeguarding Children”. He started by giving a historical view of how terminologies regarding child abuse have changed over the years from battered baby to child protection and latest focus being on “safeguarding children”. Safeguarding Children, he stated is the process of protecting children from abuse or neglect, preventing impairment of their health and development, and ensuring they are growing up in circumstances consistent with the provision of safe and effective care that enables children to have optimum life chances and enter adulthood successfully”. It is a much broader concept including child protection, antibullying, attendance, behavior management, health and safety, staff conduct, whistle blowing, e safety, curriculum and staff conduct etc. He also focused on Status of Child Rights in Pakistan. There is no authentic data from Pakistan. Some alarming figures from the country shows that about nine children out of every hundred born do not live to see their 5th birthday, about seven do not see their first. Almost four out of every 10 children are undernourished. Less than 2/3 children receive their primary vaccination. About half the children do not have access to safe drinking water or sanitation. Almost one third children never attend a primary school, and of those who do only half are able to complete five classes. Deficient Legislations, virtually no implementation, lack of Commitment, total lack of coordination with stakeholders and Child Protection not being a priority for Government were considered as some of the factors responsible for current scenario of child rights in Pakistan. He concluded his talk by emphasising that each one of us has to play a role. Multidisciplinary approach is needed. Creating awareness among public is important alongside role of Healthcare providers, teachers, parents, NGOs.

Prof. Aftab Asif, Muhammad Sharif, Dr. Nazish Imran, Prof. Dr. Muhammad Haroon Hamid, Dr. Sheheryar
Jovindah and others speaking at the seminar on Child Abuse organized by Academic Department
of Psychiatry & Behavioural Sciences & Department of Child & Family Psychiatry, KEMU recently.

Dr. Saira Afzal, Prof. and Head of Community Medicine Department gave public health view of child abuse. She along with her team including Dr. Fareeha gave details of a project they did regarding child abuse in Lahore.

Dr Sheheryar Jovindah, Consultant Child & Adolescent Psychiatrist at Shaukat Khanum Cancer Hospital, Lahore mentioned that Child abuse has been found to be associated with the development of a wide variety of mental health and social problems in childhood and adulthood. He began his presentation by mentioning the level of severity of abuse. Assessment framework Child’s developmental needs include Child’s health, Education, Identity, Social presentation, Self-care skills, Family and social relationships. Victims of child abuse have difficulties in regulation of emotions. Internalizing responses include sense of being overwhelmed and intruded upon, blanking out, deleting, blunting response, Intrusive thoughts of fragments of abuse recollected, Flashbacks resulting in Anxiety, Panic disorder, frozenness, Avoidance of people, places, things that remind of abuse and Clinging to “safe” figures including the abuser. Externalizing responses include Hyper arousal, Re-enactment towards others, Violent fantasies, Explosive outbursts, Intimidating, fighting style of relating, Grievances, Anger may be eroticized, Closeness evokes desires to intrude, attack, sexualize. Abuse also leads to insecure attachments and negatively affects sense of self with Guilt, shame, stigma, thus Self harm becomes a distraction from emotional pain. Dr. Shehryar further stated that High risk of Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder PTSD, Borderline Personality Disorder, Substance Misuse, Depression, Anxiety, Somatisation Disorders, Dissociation and Attachment Disorders and Suicidal tendencies, Deliberate Self harm are some of the long-term effects of abuse on mental and physical health. Parenting capacity also needs to be assessed as part of comprehensive evaluation of victims. Towards the end he focused on management of abused children with overall objectives as to stop abuse, ensure adequate caretaking, Encourage positive interpersonal relationships for child and family members, Management of psychological symptoms and psychiatric disorders. Details of therapeutic work with victims of child abuse and their families was discussed as well.

The presentations were followed by an interactive question answer session which was highly appreciated by the audience. The meeting was attended by staff at Mayo Hospital Psychiatry, Pediatrics Departments, residents and consultants from Psychiatry departments of Jinnah, Ganga ram Hospitals, Guests from Psychology Departments of Punjab University, Government College University and Fountain house Lahore. The seminar was formally concluded by presentation of bouquets to all speakers.