July 7, 2010


New guidelines for doctors on reporting child abuse

New Delhi: The Indian Academy of Paediatricians (IAP) has formulated new guidelines for pediatricians and other doctors on how to recognise and respond to child abuse, particularly sexual abuse

This has been done to help doctors treat abused children effectively and to keep an eye on suspicious cases.

The guidelines, prepared by IAP in consultation with National Commission for Protection of Child Rights (NCPCR) and Unicef, have been drawn from United Kingdom’s child rights law.

Under new rules, doctors will be required to report all cases of abuse, including suspicious ones, to the police, NGOs and child helplines. Doctors are protected by law in case of erroneous reporting, as long as it is in good faith. But they can be penalised if they fail to report under the proposed Prevention of Offences against Children (POC) law, which includes a two-year jail term.

“There are no uniform guidelines for pediatricians regarding their response to child abuse even though they are often the first contact of a child who has suffered abuse. These guidelines will train them how to document, record and report instances of abuse. The aim is to assist the criminal justice system,” said Mumbai-based Dr Samir Dalwai. He was part of the program which formulated these guidelines.
The basic rules include admission to hospital in cases of serious injuries but a child may be also admitted in case it is felt there is an immediate threat to his safety at home.

Doctors are to watch out for and record nonverbal cues as ‘watchful frozenness’, sad mood, avoidance of eye contact, etc. In case of sexual abuse doctors have to specifically record if there is resistance to examination, dissociation [going to sleep during examination], general demeanour, pallor, bruises, vitamin deficiencies.
In case of sexual abuse, STD screening, including low and high vaginal swabs in post-pubertal girls and urethral swabs in boys is recommended. Serology for HIV, Hepatitis B and syphilis are to be done in cases of acute sexual assault, penetrative abuse, vaginal/ urethral discharge and STD in abuser. Besides, there are contentious issues of giving STD prophylaxis and emergency contraception to an adolescent with acute sexual assault.

In India, results from a government study on child abuseindicated that two out of every three children suffer physical abuse (88.6% by their parents), 53.2% children face one or more forms of sexual abuse, and every second child reported facing emotional abuse. Unfortunately, most children do not report the matter to anyone.

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