No Domestic violence....... Make woman safe at home ...

Domestic violence is the willful intimidation, physical assault, battery, sexual assault, and/or other abusive behavior as part of a systematic pattern of power and control perpetrated by one intimate partner against another. It includes physical violence, sexual violence, psychological violence, and emotional abuse. The frequency and severity of domestic violence can vary dramatically; however, the one constant component of domestic violence is one partner’s consistent efforts to maintain power and controle ver the other.

In 1994, 1995, and again in 2000, Michigan changed the laws that deal with domestic violence to make it easier for the victims of abuse to get protection through the legal system.

• The abuser may begin making threats, calling the other person names, and slamming doors or breaking dishes. This is a form of emotional abuse that is sometimes used to make the person feel bad or weak.
• Physical abuse that starts with a slap might lead to kicking, shoving, and choking over time.
• As a way to control the person, the abuser may make violent threats against the person's children, other family members, or pets.
• Abusers may also control or withhold money to make the person feel weak and dependent. This is called financial abuse.
• Domestic violence also includes sexual abuse, such as forcing to have sex against her wish.

Woman with multiple presentation with multiple injuries bruise burn facial injuries teeth break and eye injuries are a typical presentation of severe grade home violence. She may be presenting with depression or vague symptoms, sleep disorder diarrhea eating disorders may be associated with long term home violence. Confidentiality at the beginning and  Previous marriages, suicidal ideas  and psycho social history are important peace of information.

Admission may require if injuries are alarming. management of injuries and ensure her safety as well as psychological aspect of management is included. Always suspicion of home violence is the way to find more cases.If patient wishes we can help with the involvement of police. If her life is under threat it is gps responsibility to make sure her safety

Refering Social and other support groups, negotiation with  Family meetings with her consent liaise with  Domestic violence resource center/ social worker and documenting for future use and regular followup are inclueded in the management process.

Free legal services are available.Telephone numbers GP, Police , women protection service  domestic violence 24 hour help line will secure her adequately. It is our and  society responsibility to protect woman for home violence.

How do you suspect child abuse ?

Child abuse is more than bruises and broken bones. While physical abuse might be the most visible, other types of abuse, such as emotional abuse and neglect, also leave deep, lasting scars. The earlier abused children get help, the greater chance they have to heal and break the cycle—rather than perpetuate it. By learning about common signs of abuse and what you can do to intervene, you can make a huge difference in a child’s life.

It is true that abused children are more likely to repeat the cycle as adults, unconsciously repeating what they experienced as children. On the other hand, many adult survivors of child abuse have a strong motivation to protect their children against what they went through and become excellent parents.

How do you suspect a child being abused ?

Child abuse is not always obvious. But by learning some of the common warning signs of abuse and neglect, you can catch the problem as early as possible and get both the child and the abuser the help that they need

Warning signs of emotional abuse in children

• Excessively withdrawn, fearful, or anxious about doing something wrong.
• Shows extremes in behavior (extremely compliant or extremely demanding; extremely passive or extremely aggressive).
• Doesn’t seem to be attached to the parent or caregiver.
• Acts either inappropriately adult (taking care of other children) or inappropriately infantile (rocking, thumb-sucking, throwing tantrums).

Warning signs of physical abuse in children

• Frequent injuries or unexplained bruises, welts, or cuts.
• Injuries of different ages and different kinds.
• Delay presentation
• Injuries appear to have a pattern such as marks from a hand or belt.
• Shies away from touch, flinches at sudden movements, or seems afraid to go home.
• Wears inappropriate clothing to cover up injuries, such as long-sleeved shirts on hot days.

Warning signs of neglect in children

• Clothes are ill-fitting, filthy, or inappropriate for the weather.
• Hygiene is consistently bad (unbathed, matted and unwashed hair, noticeable body odor).
• Untreated illnesses and physical injuries.
• Is frequently unsupervised or left alone or allowed to play in unsafe situations and environments.
• Is frequently late or missing from school.

Warning signs of sexual abuse in children

• Trouble walking or sitting.
• Displays knowledge or interest in sexual acts inappropriate to his or her age, or even seductive behavior.
• Makes strong efforts to avoid a specific person, without an obvious reason.
• Doesn’t want to change clothes in front of others or participate in physical activities.
• An STD or pregnancy, especially under the age of 14.
• Runs away from home.

 Risk factors of child abuse are domestic violence, Alcohol and drug abuse, Untreated mental illnesses, Multiple marriage and social situations.

Tips for talking to an abused child

Avoid denial and remain calm. A common reaction to news as unpleasant and shocking as child abuse is denial. However, if you display denial to a child, or show shock or disgust at what they are saying, the child may be afraid to continue and will shut down. As hard as it may be, remain as calm and reassuring as you can.

Don’t interrogate. Let the child explain to you in his or her own words what happened, but don’t interrogate the child or ask leading questions. This may confuse and fluster the child and make it harder for them to continue their story.

Reassure the child that they did nothing wrong. It takes a lot for a child to come forward about abuse. Reassure him or her that you take what is said seriously, and that it is not the child’s fault.

Management of child abuse is multidisplinary approach. It is mandatory to report.
Child may need admission for most of cases and assessment by Judicial medical officer. Blood investigations, x rays photography and accurate documentation is necessary. If home not safe organize relative or holster care in case where admission not necessary.
Management of injuries and complications with appropriate counselling and referral and then   ( Case Conference ) to assess all situation participated by pediatrician, psychiatrist ,Judicial medical officer, police officer, social worker , myself , police officer, nursing officer
Financial support, social worker, family counselor as well as checking other children whether they are safe also important. Avoid stigmatization and long term followup is also necessary.