MBBS doctors should be trained to identify child abuse, say mental health experts

Psychologists and experts working with children and victims of child abuse say six in 10 cases go undetected due to such “misdiagnosis”.

Identifying child abuse is important, say psychologists. (Creative Commons)

What’s worse, they say, is that even to this day no formal training is included in the MBBS curriculum on the identification of sexual abuse in a child.

“Incorporating identification strategies and having diagnostic tools to detect physical child abuse are the first steps towards sensitising healthcare professionals towards child sexual abuse,“ said Dr Alok Kulkarni, mental wellness expert and a senior consulting psychiatrist at the Manas Institute of Mental Health in Hubballi in Karnataka.

Dismissing bruises is dangerous

Child rights activists want doctors to look beyond bruises on children’s bodies to spot child abuse.

They said doctors tend to either dismiss bruises thinking that they could have been caused when the child was playing, or might not even look for other signs of abuse.

“Sexual abuse need not include only physical contact between the perpetrator and the child. The viewing of a child unclothed for sexual gratification or making the child look at the offender unclothed, or even making the child watch pornography or forcing oral sex on the child can all be forms of abuse,” said Ashwini NV, the founder of the Mukta Foundation, which works with women and children who were victims of abuse.

“It is important the doctors learn to identify these through child’s behaviour. Many a time, abuse manifests as physical symptoms like fever, bedwetting, vomiting, or sweating,” she added.

Critical to have diagnostic tools

Meanwhile, researchers from Italy have stressed the need for at least a questionnaire aiming to detect child abuse. They found that there is not a single worldwide questionnaire for early diagnosis.

They proposed scoring systems to identify abuse early on and reduce undiagnosed cases. They worked on how an orthopaedic surgeon’s role was essential in noticing signs and symptoms of physical abuse.

Doctors’ role in identifying child abuse victims is very important. (Creative Commons)

Kulkarni stressed that it was critical to have diagnostic tools to detect physical child abuse as they lead to faster recognition of abuse, and justice can be meted out at the earliest. He said it leads to the initiation of interventions early on.

Meanwhile, Dr Shabiya Saldana, cofounder of the Enfold Trust, said one cannot separate physical, emotional, and sexual abuse.

“Often they are all present, or two out of three. In any case, how can there be physical or sexual abuse without some degree of emotional trauma, if not immediately but later?” she asked.

Look for specific signs

Saldana explained that there are very specific signs and symptoms. The ability to detect them relies on a few factors, she said.

The first was the awareness in medical staff — doctors, nurses, emergency helpline staff — as the eye can’t see what the mind doesn’t know. Secondly, there should be time and privacy to be able to question and examine a patient, she said.

“Many violence cases are missed as the emergency or triage room is busy and noisy, with medical staff unable to spend the time needed with a patient to elicit a history or examine in detail,” explained Saldana.

Thirdly, there should be support from social workers or activists who can track down and interact with the suspected victims she said.

Sensitive issue, needs more focus

Meanwhile, psychiatrists and psychologists explained that child abuse was a very sensitive issue and needed to be handled very carefully.

“Children are very sensitive individuals. Physical abuse can have long-term mental, emotional, behavioural, and cognitive ramifications. Clinical depression, anxiety, and post-traumatic stress disorder (PTSD) are some of the common sequelae of physical child abuse,” said Kulkarni.

Doctors also claim that such abuse can lead to a psychotic breakdown in those who have genetic vulnerabilities to them.

Children usually tend to feel guilty about being abused and blame themselves as responsible for it. Some even end up taking their own lives.

“The state and central governments should consider some policies, workshops, guidelines, and questionnaires to identify child abuse of any form,” said Dr Hema Akalwadi, a counsellor in Bengaluru dealing with children’s sexuality and gender issues.

“MBBS doctors, nurses, and healthcare workers should be trained to identify such signs. Child abuse should become part of all MBBS curricula,” she said.