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After having spent the last year involved in the debate about same-sex parenting, I can say the following with great confidence: both sides of the same-sex marriage debate are afraid of naming child abuse by same-sex couples.
Pro-SSM people say gays have been unfairly stereotyped as child abusers, so any discussion of gay child abusers is adding to their oppression. This holds true not only for same-sex parenting, but for any choice to parent a child in a less-than-ideal setting for a less-than-grave reason. To appreciate the heroism in Litvgoet’s breaking of silence, we must first step back and take stock of how much silence there is and how much harm it does. Whereas single parenting and divorce have always been understood as a breakdown of the married mom and dad ideal, same-sex parenting is now being elevated as normal. The fact that a gay father in the New York Times is willing to drop the facade and admit that there is something amiss is cause for hope. Gay parents, trained to deal with those forces, should be aware of the effect on their children. In a recent heart-to-heart talk with Dawn Stefanowicz, a Canadian woman who was raised by her gay father, she and I lamented that many children of same-sex couples will never speak openly about how unfair it was to be denied a mother or father. Mark Regnerus’s study, published a year ago, brought brief attention to adults who were coping with the aftereffects of vexed childhoods under gay parents. Same-sex parenting advocates have the advantage of handpicking their success stories, who are sure to receive fulsome accolades for expressing their joy at having gay parents. The existence of a venomous LGBT lobby capable of all-out emotional warfare against anybody who doubts same-sex parenting is of course a great help to the cause. When I was in France, a pediatric psychiatrist with decades of experience told me that he has been working with a severely traumatized woman who was raised by two homosexuals. Moreover, anyone who supports same-sex parenting in spite of these data is complicit in child abuse. Doug Mainwaring and I have been working on ways to distinguish between gay parents and same-sex parenting. Worst of all is a same-sex parenting home that arose because two homosexuals contrived the situation knowingly, in order to experience parenting. If you come, you will meet my 10-year-old sons, who will likely impress you, given how personable, articulate, polite and bright they are.
Watson’s glib narrative is reflective of the larger genre of same-sex parenting manifestos.
This article was originally published at Public Discourse and is used here with permission.
Robert Oscar Lopez, PhD, is the author of Johnson Park and editor of the websiteEnglish Manif: A Franco-American Flashpoint on Gay Rights Debates.
Death is Overcome: The Power of the Resurrection A Different Kind of Fatherhood for All Men? Thanks be to God for your efforts in organizing this information and getting it out to the public.
Yet another incredible, articulate, refreshingly honest, moving, intelligent, charitable, and well-written article, Mr. Even though God placed in their hearts all that they would need to pursue Him, they chose to pursue the pleasures of the world, the flesh and the devil and God chose to dishonor them. You have chosen eDelivery which means that you are requesting a digital conversion of your physical book order, not the physical book. You have selected the eDelivery option for your book, which means that you are requesting the scan of your physical book order. Converting this book to a digital version uses up one physical copy of the book from our inventory and can not be undone. This process will be queued up immediately after you submit your order to ensure prompt delivery.
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Child Abuse and the External Cause of Death in EstoniaMarika Vali1, 2, Jana Tuusov2, Katrin Lang3 and Kersti Parna3[1] Institute of Pathological Anatomy and Forensic Medicine, University of Tartu, Estonia[2] Estonian Forensic Science Institute, Estonia[3] Department of Public Health, University of Tartu, Estonia1. You must have JavaScript enabled in your browser to utilize the functionality of this website. Quick Overview Our Child Abuse Quick Reference is the perfect field guide for anyone involved in reporting child abuse cases. An ideal field guide for anyone involved in identifying, interpreting, or reporting child abuse cases, this new second edition is completely updated with new chapters and images. This completely revised and expanded quick reference is designed to provide busy practitioners with the information required to rapidly diagnose child maltreatment and recognize children at high risk for any type of abuse—from physical manifestations such as child head trauma to sexual and psychological forms—and neglect. This quick reference serves as an adjunct to the text on Child Maltreatment: A Clinical Guide and Reference. Angelo Giardino is the medical director of Texas Children's Health Plan, a clinical associate professor of pediatrics at Baylor College of Medicine, and an attending physician for the Texas Children's Hospital's forensic pediatrics service at the Children's Assessment Center in Houston, Texas.
Randell Alexander is a professor of pediatrics at the University of Florida and the Morehouse School of Medicine. When told by everyone in the vicinity that what’s happening is normal and no cause to be aggrieved (even worse, a reason to be grateful), the natural instinct of the child is to blame herself for revealing the effects of mistreatment, in addition to the primal trauma of the mistreatment itself. The issue is so raw and painful that even critics of same-sex parenting are scared to go there. So to intentionally deprive any child of her mother or father, except in cases like divorce for grave reasons or the death of a parent, is itself a form of abuse. It’s abuse, for example, for a single parent to adopt a child when many other equally good two-parent homes are available. It is harder for them when she walks out, not only because of the sad goodbye of a beloved adult, but also because it triggers the difficult and painful question of why she walked out in the first place. Were changing views of same-sex parenting based on a natural, organic process of cultural adaptation, that would be fine, but instead views are being coercively changed through a same-sex marriage movement–most recently by Supreme Court judicial fiat. The child’s lost biological parent(s) must keep a distance or disappear to allow two gay adults to play the role of parent. What these questions do touches on a vulnerability in the children’s identity, the identity of the motherless child. The data we have, thanks to the work of scholars like Regnerus, make it all the more clear that it’s abusive to force children to live without a mother or father simply to satisfy adult desires. A gay parent in a male-female marriage or a single gay parent is better, in our view, than a same-sex couple raising a child, because the elements of abuse are missing in the first two scenarios.
In the second scenario, there is no charade of replacement, no pretenses that one or two unrelated homosexual parents are to receive the equivalent love and respect that a child would show to his mom and dad.
These are cases in which divorce was initiated by a gay spouse, with the explicit goal of setting up a new gay parenting household, and then custody was transferred (often in an ugly family court process). For a movement like the LGBT lobby, which grew out of a desire for openness, the silences imposed on children of same-sex couples are criminally hypocritical.
He is launching CREFA, or Children's Rights and Ethical Family Alternatives, a new project to discuss the ethics of LGBT family-building, with Doug Mainwaring. I often try to express something along this lines to pro-SSM people, but you have done it very powerfully and succinctly.
Children have a right to know and love, and to be known and loved by both their biological parents. It seems to me much of this problem can be addressed by prohibiting the use of all donor sperm and ova. Homicide mortality rates per 100 000 by age group, 2001–2009 (Statistics Estonia, 2011)Table 1.
Introduction Violence against children cuts across boundaries of geography, race, class, religion and culture. You may have heard Shy's name before, as she is the co-founder of the charity Phoenix Survivors. She's not an avid reader, in fact, she said she hadn't read a book before this one for a very long time, but she couldn't put it down once she'd started. Medical practitioners, other health care professionals, social service workers, law enforcement officials, EMS personnel, and others who deal with abused children are given the vital information needed to handle these cases.
Professionals dealing with child maltreatment and its effects on a daily basis will find great value in this child abuse book.
He currently serves as chief of the Division of Child Protection and Forensic Pediatrics and interim chief of the Division of Developmental Pediatrics at the University of Florida-Jacksonville.
The situation is much worse if outsiders who intervene, such as doctors, school officials, cousins, or legal authorities, side with the guardians. So a general pattern emerges: even when you critique same-sex parenting, you must never do so in terms that sound accusatory or equate homosexuality with child abuse.
It’s abuse for parents to divorce simply for reasons related to their own emotional happiness. It takes great courage to admit that there is a lack in his daughter’s world, which cannot be filled with political dogma or crusades against homophobia.
The child still feels the loss, but learns to remain silent about it because her loss has become a taboo, a site of repression, rather than a site for healing and reconstruction. Like all the saccharine, smiling liberals who have driven me crazy since I was a two-year-old raised by a lesbian mom, he acknowledges the child’s pain just enough to occasion a later disappointment when he and his allies will likely refuse to rectify it. For many kids of same-sex couples, this was a familiar experience: we only count when we make gay people look good. Same-sex parenting has been efficient at traumatizing the inhabitants of its dark side, rendering them frightened and mute, so nobody will ever know about it. My hunch, however, is that it might be time simply to drop all the masks, put away our strategies, and just state the uncensored truth. Certainly this can not always happen, but no adult has a right to put their own desires for a child ahead of the rights of children to a loving relationship with both their biological parents. Having departed from the Eternal Truth and rejecting the voice of Christ’s Church, they descend into ignorance and perversion because they eschewed what God made known to them so that they could freely practice those prohibitions which St. They have become mentally ill, resembling eccentric personalities with odd mental, emotional and physical behaviors. Injury and violence are serious threats to the health and well-being of children worldwide. This independent voluntary organisation advocates on behalf of the victims of child sexual abuse, and for the families of children murdered by child molesters. I knew to expect it to be quite shocking and disturbing, which we'd be warned about when she bought the book over, but also because I'd heard of the author, Shy Keenan, before and that she'd been to hell & back. This review is presented in bulleted outlines, lists, tables, and photographs to quickly locate essential points to consider in this handy pocket volume. No other quick reference so completely sums up the need-to-know facts in such a readily available format.
Giardino completed his residency and fellowship training in pediatrics at the Children's Hospital of Philadelphia.
In addition, he is the statewide medical director of child protections teams for the Department of Health's Children's Medical Services and is part of the International Advisory Board for the National Center on Shaken Baby Syndrome. Emotional abuse is particularly difficult because it is invisible and therefore ripe for denial.
It’s abuse for LGBT couples to create children through IVF and then deprive them of a mother or father. Every child has a mother and father, and when that figure is missing, there is a narrative that is experienced as pain, loss, and at times shame. The media have to engage in a massive propaganda campaign, complete with Disney productions featuring lesbian moms, to stifle any objections or worries. We have to give our kids the chance to give voice to that vulnerability, and to acknowledge the sad and complicated feelings of being different. Or where two homosexuals began a lifelong relationship with the intent of adopting and then sought adoption on-demand.
Be well in your efforts and know many of us will be praying and arguing along side you for the greater good. That is the explanation that is provided in the Bible and this is the explanation that you will never hear main-stream Christian ministers, and lukewarm priests provide.
A retrospective analysis of child disability and the likelihood of sexual abuse among those attending Norwegian hospitals.
Nielsen, 2008Influence of sociodemographic factors on the risk of unintentional childhood home injuries. Shy run's this organisation with Sara Payne, mother of Sarah Payne, who was murdered at just 8 years old by a peodophile. I wasn't wrong.The cover of the book features a picture of a little girl's face on the front and some quotes about the book. The sections present an up-to-date assessment of the scope of the problem, all the details needed to perform assessment and treatment, the essentials regarding investigation and prosecution, and a handy summary of educational and prevention approaches to child abuse. He has also served as vice chair of the US Advisory Board on Child Abuse and Neglect, on the American Academy of Pediatrics Committee on Child Abuse and Neglect, and the boards of the American Professional Society on the Abuse of Children (APSAC) and Prevent Child Abuse America.
Or worst of all, two gay men engaged in a surrogacy contract with a woman who sold them her baby. I believe that those who are the chosen elite, the politicians, are more responsible, more culpable, because they are leading the charge of destroying civilization.
A small proportion of violence against children leads to death, but most often the violence does not even leave visible marks. Andrus, 1998Infant rat model of the shaken baby syndrome: pre-liminary characterisation and evidence for the role of free radicals in cortical hemorrhaging and progressive neuronal degeneration. Shy is not the author's original name, rather it is a nickname which she aquired as a young child, due to her apparent shy and quiet nature.

Giardino became the assistant, and then the associate, medical director at Health Partners of Philadelphia, where he had primary responsibility for utilization management, intensive case management, and health care data analysis. You’ll go back to being an unloved being with nobody willing to put up with you any more. Wicked men consume depravity because, having themselves chosen to disobey that which they were taught was good, they embraced the vices one by one and became disabled. Violence can have severe implications for children’s development and in the most severe cases, it can lead to death or injury.
Barlow, 1999Epidemiology and the prevention of traffic injuries to urban children and adolescents. Vali, 2010Deaths of infants subject to a forensic autopsy in Estonia from 2001 to 2005: what can we learn from additional information? Quite a lot to live up to in a sense, because it's not just about the content, but the way in which it's written, which, having read it, I can honestly say was brilliant.
Alexander has served on state child death review committees in Iowa, Georgia, and Florida, as well as on two regional child death review committees. God has ordained that those who eschew His truth will be turned over to their disorder (sodomy). However, it can also affect children’s health, their ability to learn or even their willingness to go to school at all. The reader is left with the impression that she has adopted the name Shy, as a way of leaving her past experiences behind her, firmly where they belong.
It couldn't have been easy for her to retell her childhood or adolescence but she did so with dignity and honesty, leaving no stone unturned. He is an active researcher who lectures widely and testifies frequently in major child abuse cases throughout the country.
The World Health Organization (WHO) estimates that 40 million children below the age of 15 suffer from abuse and neglect, and require health and social care. Karen is the young troubled girl in the book, whilst Shy is the young woman who tries to look to the future and piece her life back together. Giardino began the Child Abuse and Neglect Team for Children with Special Health Care Needs, which was funded by a three-year grant from a local philanthropist.
Liberalism is a condition by which those who deny the truth of God are turned over to a disabled mind and hence they support and spout the lies of the one who is in direct opposition to the Word of God. In 1998, a UNICEF report quantified the large East-West gap in European child mortality from external causes (injuries and violence). Broken is a truly shocking story, because it is a true account of a young girls horrific experience of sadistic abuse over a lengthy period of time.
Her real name is Karen, and this book details her childhood of abuse and of how she escaped it and got to where she is now. In 1998, he was appointed associate chair of clinical operations in the Department of Pediatrics at the Children's Hospital of Philadelphia (CHOP), and in June of 1999, he was asked to chair the CHOP Quality Committee.
This is not just a theory but it is a fact supported by the teachings of the Apostles in the Bible. In the past decade, much has changed in central and Eastern Europe, economically, politically and socially. Vali, 2011Fatal Traffic Injuries Among Children and Adolescents in Three Cities (Capital Budapest, Vilnius, and Tallinn). Some positive changes are seen in child injury rates in this region, and hopefully the East-West gap in European child mortality will diminish.Violence against children is defined as any form of violence, whether physical, mental and sexual, abandonment or negligence, ill-treatment or exploitation that puts their lives in danger or negatively impacts their lives, physical or psychological health dignity, or development. Obviously, I don't think children should be ignorant about abuse and what really goes on, but the details are very explicit and quite disturbing to say the least. In this chapter we present recent trends and current situation of child injury mortality in Estonia. She was born to young, wayward parents who were seemingly unwilling and unable to be good parents, having their first child removed by extended family.
To give you a rough background to her story, Karen grew up in Birkenhead with her mother, Jennifer, her sister, Sandy, and her stepfather. We also describe the forensic medical system, examination of the child and the expert report, and give an overview of cases physical and sexual child abuse in Estonia.
Although her real father was around in the early years she rarely saw him, so her stepfather was seen as her father, whom she referred to as a child as 'Shiny Head', but whose real name was Stanley Claridge. In Estonia forensic medical doctors are a medical experts in physical and sexual abuse assisting Law Enforcement, but they are also involved in investigating all child deaths due to external factors.
When her parents seperated, her mother moved in with her new 'step-father' the peodophile Sidney Claridge. In addition to her immediate family, we're introduced to grandparents, such as Nanny Wallbridge, friends of the family, and various uncles (some of which weren't actually related uncles at all). In all cases including child abuse, an examination by a forensic medical doctor is done only when requested by a police officer, prosecutor or court. Shy describes her mother as someone who was a manipulative, theiving, lying woman, who's sole purpose in life revolved around shoplifting and scaming the authorities, whilst spending all her free time in the local bingo hall. To throw more names into the mix, we hear about the various services and workers she comes into contact with. In cases where the child is less than 16 years of age, a parent, police officer, teacher, social worker or careworker must be present during the examination.
Nevertheless, Shy's desperation to get her mother to notice and love her throughout the book is apparent. It's strange that with so many people in the picture such events could have happened and happened for so long.At first Karen tells her story through the eyes of her as a child, showing us how her innocence was brutally betrayed. The examination of a child is carried out at the forensic department or at the hospital if the child is admitted for inpatient treatment.
The reader feels a deep empathy with Shy at one point when she describes over hearing her mother tell Sidney that she wishes Shy was dead and that she 'hates her.' Shy attempts to tell her mother about Sidney's abuse of her, but her mother refuses to believe her and beats her up.
Later in the book, it becomes evident that her mother is clearly aware of the sexual abuse which is taking place, but she turns a blind eye. Her mother was no better as she also initiated abuse and left her own daughter partially deaf and with hearing problems, with several trips to ER for various injuries she inflicted upon her. The examination of the child and the expert report In suspected child abuse cases an examination is performed. The reader finds it hard to understand how a mother can allow this to happen without concern. The abuse Karen was dealt is far too horrendous to detail here, but the level of sexual abuse she suffered truly shocked me. The aim of the examination is to find out the primary injury, but also to carry out physical examination of the child and record. During the examination the forensic medical doctor describes the signs and symptoms that could point primarily to the presence of injuries or the complication of injuries. From the age of four years old, shy is raped and sexually abused practically every single day.
The most shocking thing is that this young girl, with visible scars (let alone the invisible ones), was ignored and in fact blamed for the problems. According to these so-called experts, who happily believed every word that came out of her evil stepfather's mouth, Karen was to blame.
In these cases the doctors must document and describe the injuries and sometimes the full examination is performed at the hospital. It later emerges that Sidney is selling her to other men, and she finds herself being gang raped by 'faces' on a regular basis on ships and on people's houses. Labelled a promiscuous, sex-driven girl who causes all the problems, she was shipped from institution to institution, never receiving any help. As in other countries, the medical doctor may lack knowledge to detect and record injuries, so the forensic examination is needed. I found it particuarly hard to fathom how so many individuals can have such little regard and care for another human being. In fact, those that were entrusted to care for her also abused her, which was disgraceful and sickening to read about. From incorrectly completed medical documents the forensic doctor can not decide what kind of injuries the victim has, nor the timeline or the cause of injuries.
It is not only the sexual abuse, which is bad enough, it is the lack of consideration for the pain and suffering that Shy goes through, in addition to the mental and emotional abuse that Shy is subjected to.
Throughout this time, true family members came into the picture, though none initially were fully aware of what was truly happening. The task of the forensic medical doctor is to find the injuries, timing and causes of injuries and answer all questions that may rise during the proceedings. To cut a long story short, she was eventually taken under the wing of 2 family members, where she found some solace and support, and eventually made her own escape from the torture at home. In all cases involving child abuse, an examination by a forensic medical doctor is done only when requested by a police officer, prosecutor or court. In case the child is less than 16 years of age, a parent, police officer, teacher, social worker or careworker must be present during the examination. Gobsmackingly, the health professionals believe this without any tests, and she is locked up as a mental patient and given epileptic drugs to sedate her. Sidney uses this to his full advantage and for months she finds herself permenantly unconcious, often waking up in the middle of being sexually assulted in strange houses. Growing into a strong woman made Karen move forward with her life, campaigning for the protection of children and eventually joining up with Sarah Payne (which I had previously read about in the news) and becoming the advocate for Pheonix Survivors.
A forensic doctor can use also the opinion of other medical specialists and this will be also mentioned in the examination. In physical abuse cases involving children often a paediatrician is involved in the examination. Immediately after, Sidney and his friend rape Shy, and his friend assaults her sexually with a bottle. Whilst the content is very hard-hitting, harsh and extremely evocative, it's easy to read in the sense that it's wonderfully written. In recent years, special rooms have been created for questioning and examining children at the police stations throughout Estonia. The reader is left with the feeling that these men must surely have a 'missing link' to see Shy as a sexual object, almost as if she has no feelings or thoughts of her own. It's not a sob story, neither is it a story filled with anger or bitterness; it's an honest account, detailing events and emotions personally and in a way that's easy to understand (although I don't many will fully comprehend what she's been through). Police officers with special training, prosecutors and other specialists use these rooms when dealing with children.
A quote on the back reads: 'Broken is the most hard-hitting memoir of overcoming abuse you will ever read.
At the end of the book, Shy recollects how she becomes concerned for the safety of other children who Sidney and his friends are abusing. Child abuseChild abuse is a worldwide problem affecting children from birth to 18 years of age. Her story makes constant reference to numerous times where she has told professionals and authorities of the abuse, but to no avail. I would definitely agree and would recommend this - it's an eye-opener to a dark world, but a world I would rather know about than be ignorant towards.
It is particuarly disturbing to see how she is treated by social services at the time, who believe Sidney's version that Shy is making sexual advances towards him, and that he has to fight her off! Many studies have shown a consistent pattern regarding the abuse and neglect inflicted on children of both genders. Even when Sidney is finally convicted he is initially given a lenient sentence and her sister, who he is also abusing, is allowed to stay with him at the home.
In 2002, Sidney and two other's are convicted thanks to an undercover documentary which Shy undertook with Newsnight. This shows Sidney confessing to his crimes, and this time the authorities were forced to act.
Boys, on the other hand, are more likely to experience physical trauma (other than sexual abuse). When focusing solely on cause of death, studies indicate fathers are more likely to kill their child via physical abuse, while mothers kill by neglect (for example, starvation).In most cases, the abuser is someone known to the child – a parent, family member, teacher, or regular careworker.
The issue of abused children is an important public health problem since intra-family violence, including child abuse, is a so-called inside-family problem that is usually not discussed in public. The risk of child abuse is higher in families where there are often conflicts between family members, low parental involvement in the family and cold or hostile relationships between children and their parents. She describes 'flashing lights' rather than cameras which are being used to film her abuse.
Those parents who had been abused during their own childhood were more likely than others to abuse their own children. She also describes people's faces rather than uses names, which emphasises the fact that so many people are treating her like an object instead of a person. We found that family sociopathy (alcohol problems) and some family members disability or handicap problems might predict child maltreatment; low family income and poor parental warmth are associated with risk for child neglect. For instance, she talks about 'shiny head' and 'angry face.' The drudgery and misery of her life is played out well, however she does talk about her year's stay at her grandparents house at Patley Bridge which she loves.
Therefore the number of cases concerning child abuse is relatively low in comparison with other countries.In Estonia the issue of abused children has been under discussion since 1990. This also gives the reader a period of respite from the shocking and depressing state of her daily life. The end of the book highlights how Shy has moved on and is providing her support to other victims of abuse.

As elsewhere, national statistics are not available, as the nature of the problem makes it hidden in the society and difficult to detect and record.
She is keen to describe her adult self as 'loving and loved' by her family, although she states that parts of her soul will always be 'broken' due to the horrific experiences she endured. The pupils from different types of schools who have participated in such studies confess that they have encountered emotional, physical, and sexual abuse as well as negligence. The most common types of abuse according to these inquiries were verbal sexual abuse, negligence of education, emotional abuse, mental sexual abuse, and negligence of health. I think the reason is because of the level of abuse documented, but also the frequency and duration of it.
In the case of Shy's story, multiple people were involved in her abuse, although it was lead by her step father.
The other issue which is hard to fathom, is how the authorities (Police, social services, health professionals) all ignored all of the warning signs and refused to act.
An older child may use drugs or alcohol, try to run away or abuse others.However, when comparing the findings of studies performed in pupils from ordinary Estonian schools with those for children with special needs, the incidence of negligence and sexual abuse are far more common in the latter ones.
It can be also said that the problem of abused children has gained more attention in the recent years. One can only hope that the authorities and systems in place to protect children have substantially moved on and improved today. For example, this is reflected in the discussions about whether to hit children is acceptable or not. Nevertheless, when you think that it was only in 2002 when Shy managed to get her abuser to confess after being brushed off by the authorities, it is clear that poor practice is only too recent. Still, these discussions have not reached the point as to where to draw the line between an accident and child abuse. Yes, it can be a little depressing, however it will make you realise that no matter how unhappy you are your life could have been far worse than it is. It will also make you have a greater sympathy, awareness and understanding of the victims of sexual abuse and why some victims behave in the way that they do as young children and young adults.
Physical abusePhysical abuse is physical aggression directed at a child by an adult, but this is very often neglected and without adequate attention. It is of paramount importance that the specialists of different fields think in the same way in the event of child abuse, and also understand the ways of acquiring injuries in the same way.The physical signs of child abuse is sometimes called battered child syndrome. Physical child abuse or non-accidental child trauma refers to fractures and other signs of injury that occur when a child is hit in anger.According to the data by the Estonian Forensic Institute about 50 children less than 14 years of age annually need physical examination. Most of the cases are related to violence at school or at home, but children are also injured in traffic accidents. During recent years the number of detailed examinations of physically abused children has decreased by 50%.
The number of children injured in traffic accidents has also decreased (with only a handful of cases each year). Among the prevailing injuries are bruises, abrasions and other mild injuries; head, face and extremities are the most frequently affected regions. Often the reason is discord in the family, single mothers, underaged pregnancies, low educational level of the parents and poor living conditions (Lang et al., 2010). This prevents them from thinking about what happens as a result of their actions.The causes of hospitalisation have been studied in the case of traumas to children in Estonia, and it appears that the main cause of hospitalisation for children of this age are contusions, bone fractures and wounds associated with a fall. Apart from the falls the others cases of suspected abuse include burns, the occurrence of different objects in throat, and unclear cases.According to the questionnaire study carried out in Estonian schools during 2001–2009, 45% of children suffer from school violence but most of them do not inform their parents or the police about it. One of the causes of physical abuse in small children is definitely the shaking of babies, i.e.
Such shaking usually takes place when the infant is crying inconsolably and the frustrated caregiver loses control. Many times the caregiver did not intend to harm the baby.When an infant or toddler is shaken, the brain bounces back and forth against the skull. This can cause bruising of the brain (cerebral contusion), swelling, pressure, and bleeding in the brain. The large veins along the outside of the brain may tear, leading to further bleeding, swelling, and increased pressure. This can easily cause permanent brain damage or death.Excessive shaking causes the rupture of cortical and bridging veins in the brain, possibly resulting in subdural haematoma, or less frequently subarachnoid haematoma and brain oedema.
Subdural haematoma is the most common intracranial pathology observed in cases of SBS, and it is seen in approximately 80% of children with this syndrome. In the United States 750–3750 cases of SBS are diagnosed each year, whereas in Estonia only 2–3 cases per year. The incidence rate of SBS is 40.5 cases per 100 000 children below one year of age in Estonia.
The study performed by Talvik and co-authors revealed that the majority of the families of these children had economical difficulties (75% of the families received only social benefits, but no salary at the time of injury) (Talvik et al., 2002). These facts suggest that a poor socio-economic situation is one important factor contributing to violence against children. This is confirmed by the data from other research that the people who abuse children have frequently low educational status and more frequently drug and alcohol abusers. In this situation, a parent will purposely either invent symptoms and falsify records (for example, fever) resulting in unnecessary tests, hospitalizations, and even surgical procedures. This psychiatric illness of the parent(s) requires a high index of suspicion, and its consideration is part of the investigation of any child with recurrent complaints that are not supported by physical or laboratory findings. Sexual abuse Sexual abuse of children is forcing or persuading a child to participate in sexual acts without the child’s understanding of the situation. It also includes incest, paedophilia, exhibitionism and molestation, but also sexual intercourse – urogenital, anogenital or vaginal intercourse with a child. It is difficult to determine how often child sexual abuse occurs, because it is more secret than physical abuse. Many cases of abuse are not reported.Children become the victims of sexual violence usually at home and from people, who they actually know, most often stepfathers and fathers. It has the same type of risk factors as physical child abuse, including: alcohol and drug abuse and family troubles. Abusers often have a history of physical or sexual abuse themselves (Johnson, 2007).In sexual abuse cases, the most important factor is a timely and correct gynaecological examination, but also a correctly taken analysis (sperm). The importance of interviewing the child cannot be underestimated, what they say should be recorded in their own words.
All other parts of the examination are the same as in the case of physical abuse including a complete general examination, recording growth and sexual maturity. The colposcopic investigation of the anogenital region in girls and anal region of boys is very important, as injuries to the mucosa are not easy to see and with the attached camera, it provides documentation of the examination’s findings.
The possibility to use a colposcope is available in all four forensic departments in Estonia. Both specialists (gynaecologist, forensic doctor) attend the examination if this is possible, but this is not mandatory. In Estonia forensic doctors are capable of carrying out gynaecological examinations without the presence of a gynaecologist.
If the parents want to have the examination but the child is against this, then the child’s wish is taken into account. It is advised that the physical and gynaecological examination is performed by a forensic doctor, but if it is not possible, the doctor on duty has to do it following the same principals.
In cases of sexual abuse, cooperation between the police, social worker, paediatrician and the forensic doctor is very important.
Similarly to the data reported in published papers, the victims of sexual abuse in Estonia are usually younger than 12 years of age, most frequently between three and seven years of age, and two to three times more likely to be handicapped children (Kvam, 2000).
During the past two years (2008–2009) Estonian forensic medical doctors performed in total 27 examinations on sexually abused children aged 0-14 years, and the majority of them were girls (girls vs. In Estonia the cases of vaginal and anogenital intercourse are the most frequent, and the cases of incest are also not uncommon. In the cases of sexual abuse it is often hard to evaluate the examination’s findings, because injuries usually heal within a short time period and abnormal findings of the anogenital region may be caused by other factors (blunt force trauma, infection).
The problem concerning Estonian forensic doctors is the small number of reported cases giving them very little experience of the problem. The most pronounced difference between Estonia and other countries in child deaths resulting from injuries are in infant deaths.
External causes of death form about one third of all deaths in children 0–14 years old in Estonia. During the last few years a decrease has been observed both in the general mortality and injury-related mortality of children (Table 1; Figure 1).
From the beginning of 2006 infant mortality has decreased, but less significant progress has been observed for childhood and adolescent deaths. During 2001–2009, 391 children aged 0–14 were autopsied by forensic doctors at the Forensic Science Institute and 310 (79.2%) of causes of death were attributed to the external causes. The primary external causes of child death in Estonia are various kinds of mechanical suffocation (strangulation, aspiration of foreign bodies or gastric content, drowning, compression).
In Estonia asphyxia formed 40.3% of unintentional deaths, followed by mechanical injuries (transport and falls) and poisonings.
Strangulation was registered as the cause of death in six cases, with an additional 18 other cases in which the intent was impossible to identify. Although the number of traffic accidents has decreased considerably in Estonia in recent years, including also the number of accidents involving children, transport accidents still prevail among mechanical injuries, constituting 25.8% of external causes of death. Most of the victims were from the oldest age group (between 15 and 19 years of age), and 78% were passengers in motor vehicles, 19% pedestrians (most of the cases represent accidents in the home environment where the car reversed over a child) and only one child died as the result of a bike accident. Similar results were also reported in an article comparing the injuries to children who died from traffic accidents in three capital cities (Budapest, Vilnius, and Tallinn) (Toro et al., 2011).
Poisonings constitute about 7.7 % of all cases of unintentional deaths, and they are mainly caused by carbon monoxide (CO) and medicinal products. Poisonings with medicinal products are usually observed in children one to four years of age who happen to get access to the drugs at home. These include three cases of poisoning with aethazine tablets, and poisoning with dimedrole and amitriptyline. In addition opiate poisoning occurred in a 14-year-old boy and one case of poisoning with unknown gas (presumably butane) was also registered. The rest of the cases represent poisoning with CO in association with fires (seven boys and ten girls).When looking at the causes of unintentional death by age group, it can be concluded that the decrease in children’s mortality has mainly occurred on account of the age group of children below one year of age (Figure 2). Analysing the cause of death and manners of death, the main causes of death in children below one year of age include head traumas and suffocation, although the manner of death remains unclear in many cases. Unclear causes are also apparent in children aged one to four years, but the prevailing causes of death are accidents. The reason for this is a limited availability of accompanying data and therefore forensic doctors have not enough medical data to decide about the form of violence used. Accidents prevail also in the age groups five to nine years and 10–14 years, the latter group also includes the occasional case of suicide. For example: A two-and-a-half month old infant was found in a pram, the forensic doctor has found an epidural and subdural haematoma. A forensic doctor finds as the cause of death either asphyxia or head trauma, but this is not enough to establish the exact cause of the injury and determine the manner of death, because of insufficient preliminary data.
The number of youth suicides has decreased in recent years but Estonia still is among the countries with the highest risk of suicide in the world. Suicides were registered in 16 cases in the study years, and the majority of cases were boys (12 cases).
Most of the children committing suicide were aged between 10–14 years, but some children were younger (Figure 3).
13 cases of homicide were registered in the study years, and most of these were children below one year of age (eight cases).
Two cases include knife injuries, where also the other members of the family were killed (father and one other relative in one case).
Conclusion Reduction of death through injury should be included in the current public health agenda and given a high priority in many countries, including Estonia. It is important to identify the potentially preventable cases and detect risk factors (single parents, young mothers, low educational level, bad living conditions etc), as well as to analyze the incidence and circumstances of different types of violence. Deaths related to child abuse are preventable and it is therefore important to estimate the amount of such deaths, but also to study the circumstances leading to these deaths. Deaths related to child abuse occurred more often in families that had problems with alcohol abuse, unemployment etc. This would enable not only to correctly classify the manner of death in suspicious cases, but also to eventually reduce the numbers of violent deaths among children.
For adequate assessment of the level of child abuse, it is important to know, who and how evaluates the injuries inflicted on a child, as well as who are the members of the investigation team. Close cooperation between various specialists is essential for the correct diagnosis.Rates of child mortality from injuries have fallen across Europe. In the former Soviet countries, this is likely to reflect improvements in living conditions since the transition. Child deaths from injuries are avoidable and measures to reduce them would have a significant impact upon the overall burden of child mortality in Europe.It is important to identify the potentially preventable cases and detect risk factors (single parents, young mothers, low educational level, bad living conditions etc), as well as to analyze the incidence and circumstances of different types of violence.

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