A 5-year-old boy from a well- to-do family was brought by his father
and stepmother with fracture right tibia, severe malnutrition,
multiple abrasions, bruises, scars, hemiparesis, psychomotor
retardation and old fractures in both ulnas and right humerus. A
convincing explanation regarding the mechanism of injuries was not
forthcoming. Skeletal survey, bone scan and MRI showed 15 fractures
involving ribs, metacarpals, mandible, ulnas, right humerus and right
tibia of varying ages and old subdural hematomas. Brittle bones
disease and neuropathy were excluded by appropriate investigations.
The child showed remarkable improvement in nutrition and psychomotor
status when shifted to his grandparents’ house on our advice. A
medicolegal report and involvement of social organizations yielded no
action and he again deteriorated when he was reallocated back to his
parents four months later. It required the intervention of the court
and human rights organizations to grant custody of the child to the
parents of the (deceased) biological mother after which he is doing
well.
The legal position of abused children in our
country is ambiguous. The cases that reach hospital represent the very
tip of the iceberg. A pediatrician’s role in the management of such
cases is also not clearly defined and remarkable commitment is
required to ensure that the child receives the necessary protection
and support(1). Social organizations are also at a loss to deal with
such situations without legal backing.
The CANCL group of the Indian Academy of Pediatrics
is a positive step towards addressing the problems of these
unfortunate victims of household violence(2). It would be appropriate
if clear guidelines are provided to the pediatrician and other
agencies such as police and social organizations (through enactment of
legislation) in the management of suspected /confirmed cases of child
abuse.
R.G. Holla,
Arvind Gupta,
Department of Pediatrics,
Army Hospital (R & R),
Delhi Cantt 110 010, India.
E-mail: [email protected]
1. Nair MKC. Child abuse. Indian Pediatr 2004:
41; 319-320.
2. Srivastava RN. IAP and Child Abuse and Neglect and Child
Labour (CANCL), Editorial. Indian Pediatr 2003; 40: 1127 -1129.
