Child abuse in Turkey: an experience in overcoming denial and a description of 50 cases

Reliability of Forensic Interview with Child Victim of Sexual Abuse in Turkey

In cases of child sexual abuse, sometimes the only evidence may be the statement of the victim child. It is only recent phenomenon in Turkey that forensic interviews with child victims of sexual abuse prioritize the child victims and they are administered in a careful and delicate way that would not cause secondary traumatization, and they are conducted by professionals educated. Child advocacy centers and forensic interview rooms are formations where forensic interviews are conducted with children who are victims of sexual abuse. In this article, credibility of forensic interviews conducted with sexually abused child victims are covered on the basis of practices in child advocacy centers. From this point of view, the place of child abuse in Turkish law, institutional practices on this issue and the importance of coordination among institutions are mentioned. Subsequently, the importance of forensic interview for the investigation conducted with the child is explained, and basis components of the forensic interview process are listed. Afterwards, the characteristics of widely used protocols for forensic interviews in the world are mentioned and the credibility of victim’s statement effect and elements affecting the trustworthiness are touched upon. Last, the failures experienced in the system which includes forensic interviews in Turkey and suggestions to remedy these are assessed. Forensic interview should be done within the framework of a joint meeting protocol, increasing the frequency of forensic interviewer supervision training and making it compulsory, public prosecutor, judge, law enforcement officer and professionals working in the child protection system should also participate in the training of forensic interview with the child and consideration of all factors in the credibility evaluation of the forensic interview has been the suggestions conveyed in the light of the relevant literature.

Experience with outreach services of a multidisciplinary team for child abuse identification

BACKGROUND/PURPOSE

Identifying child abuse is sometimes challenging due to its various presentations. To facilitate timely identification of critical or complex cases of physical abuse outside our child protection center, we established an outreach multidisciplinary team (OMDT) to support Kaohsiung City Government in 2014. The objective of this study was to describe our experience of OMDT services during a 6-year period and examine its role in assisting law enforcement.

METHODS

We retrospectively analyzed all OMDT cases from January 2014 to January 2020. Clinical characteristics and OMDT reports were reviewed. After inspection by our OMDT, cases were determined as indicating either a high risk or low risk of child abuse. Associations among clinical characteristics, radiographic findings, OMDT decisions and case outcomes including law enforcement and prosecution were examined.

RESULTS

Thirty-two cases (22 [68.8%] males and 10 [31.2%] females; mean age 24.2 months) received OMDT service, of whom 28 (87.5%) were admitted to the pediatric intensive care unit. The victims had an average of 2.2 types of wounds in 3.4 locations. The most common finding on radiography was subdural hemorrhage (18, 56.3%), followed by subarachnoid hemorrhage (31, 31.3%). Law enforcement was activated in 20 (64.5%) cases, and was only associated with the high-risk group as determined by the OMDT (p < 0.05) but not with any other variables.

CONCLUSION

Our experience indicates that an OMDT can play an important role in child protection and activating law enforcement for children with complex or critical physical abuse. We suggest that in Taiwan, OMDT services should be incorporated into child protection centers, National Health Insurance system and governmental child protection policies.

The Role of Traumatic Childhood Experiences in Predicting a Disposition to Risk-Taking and Aggression in Turkish University Students

The purpose of this research was to determine whether or not traumatic childhood experiences in childhood predict a disposition to risk-taking and aggression among university students. The participants consisted of 851 students: 477 (56.1%) females and 374 (43.9%) males attending various faculties at the Karadeniz Technical University in Turkey. The Childhood Trauma Questionnaire, Adolescent Risk-Taking Scale, Aggression Questionnaire, and Personal Information Form were used for data collection. The analysis results revealed a positive correlation between traumatic experiences (physical, sexual, emotional maltreatment, and emotional neglect) and risk-taking and aggression. Physical and sexual abuse and gender are significant predictors of risk-taking. Physical abuse and gender are some of the predictors of aggression. Another finding from the study is that physical and emotional abuse and emotional neglect vary by gender. This study concludes that exposure to traumatic experiences in childhood prepares the foundation for negative behaviors in adulthood.

Characteristics of victims and perpetrators of intrafamilial sexual abuse

BACKGROUND

Intrafamilial sexual abuse (SA) is one of the most traumatic experiences a person can experience and comes with lifelong effects. Considering the increase in the number of children in orphanages due to intrafamilial SA in Turkey, addressing this problem in more detail is crucial. For this reason, this study aims to determine the characteristics of intrafamilial SA cases.

METHOD

In this study, the characteristics of 216 intrafamilial SA cases who were referred to the Ankara Child Advocacy Center between 2010 and 2015 were analyzed retrospectively. The ages of the victims varied between 3 and 17.

RESULTS

The most common identity of the perpetrator was the biological father (50%), biological sibling (14.4%), stepfather (13.9%), and parent's boyfriend (12%). Of the perpetrators, 6.5% were female and 93.5% were male. Of the victims, 3.3% had a history of pregnancy. In addition, one out of four victims (27.3%) had experienced physical violence from their parents, the socioeconomic level of the majority of the families (90.2%) was low, the education levels of their parents were low (high-school-level education and below), and one of two families (52.6%) experienced domestic violence. Furthermore, the perpetrators in the biological intrafamilial SA group exhibited similar behavior with the sociolegal group in terms of penetration, and the age distribution of the victims was similar.

CONCLUSIONS

Consequently, this study has revealed a lot of new information about intrafamilial SA cases. These findings will hopefully be useful in identifying and preventing victims at risk for intrafamilial SA.

Child Abuse and Neglect Among Children Who Drop Out of School: A Study in Izmir, Turkey

Child abuse and neglect (CAN), and dropping out of school have long been recognized as pervasive social problems globally, and Turkey is no exception. This study aims to explore the prevalence and incidence of CAN in children who drop out of school of Turkey, using the ISPCAN Child abuse Screening Tool, Children's Version, which is an appropriate tool for multinational comparisons. Data from a convenience sample of children who drop out of school age 11, 13, and 16 from Izmir were collected either by interviews or by self-completion. The results show that, compared to children who do not drop out of school, children who drop out of school have higher rates of psychological and physical abuse and neglect within the family. This study not only highlights the need for preventive laws for CAN and dropping out of school, but also points to direction for future research.

An investigation of preschool teachers' recognition of possible child abuse and neglect in Izmir, Turkey

Child abuse and neglect have a potentially deleterious impact on children's physical, social, and psychological development. Preschool teachers may play a crucial role in the protection, early detection, and the intervention of child abuse and neglect, as they have the opportunity to establish a close contact with the families and to observe day-to-day changes in pupils' behavior. The main purpose of this study is to investigate preschool teachers' experiences and characteristics in relation to their awareness of possible child abuse and neglect signs. A questionnaire survey was designed and administered to 197 preschool teachers who work for the public preschools in the Izmir province of Turkey. In addition to the questionnaire items, a 34-item Likert-type scale measuring the level of familiarity with possible signs of child abuse and neglect was developed. This scale had an internal consistency of 0.94. The results revealed that 10.65% of preschool teachers had training regarding violence against children and 2.03% of them had training in child abuse and neglect. Overall, 35% of all teachers reported that they had prior experience with pupils who were exposed to child abuse and neglect. Moreover, statistical analyses indicated that being a parent and having training in child abuse and neglect, having experience with maltreated children, and having higher job status were significant factors in preschool teachers' ability to recognize the possible signs of child abuse and neglect. Our results support that teacher training in child abuse and neglect can play an important role in preschool teachers' awareness of the possible signs of child abuse and neglect.

Epidemiological study of negative childhood experiences in three provinces of Turkey

AIM

This study aimed to determine the frequencies of negative childhood experiences in the past years and negative childhood experiences throughout life in 11, 13 and 16 year-age group children who attended school in three separate provinces.

MATERIAL AND METHODS

Approval was obtained from the provincial National Education Directorates and educated investigators applied the ISPCAN child abuse screening tool questionnaire form which measures negative childhood events experienced at home in children. Statistical analysis was performed with chi-square test using SPSS 16.0 program. Approval from the ethics committee was obtained from İzmir Tepecik Education and Research Hospital Chief Physician Office Local Ethics Committee (29/11/2011-29).

RESULTS

The study was conducted with 7 540 children in İzmir, Denizli and Zonguldak. The frequency of psychological and physical negative childhood experiences and neglect throughout life was found to be 70.5%, 58.3% and 42.6% in the 11, 13 and 16-year age groups, respectively; the frequencies in the last one year was found to be 62.7%, 46.0% and 37.5%, respectively. Psychological negative childhood experiences were found with a higher rate in children who lived in urban areas compared to children who lived in rural areas. Neglect was found with a higher rate in girls and physical negative childhood experiences were found with a higher rate in boys. The frequency of negative childhood experiences increased proportionally with the age of the child independent of the type of experience.

CONCLUSION

The frequencies of negative childhood experiences for the last one year and for the life-long period were determined using ISPCAN child abuse screening tool in Turkey for the first time in three provinces and in such a large population. The frequency of negative childhood experiences related with child abuse and neglect screened were found to be 42%-70% and it was elucidated that we are confronted with a very significant public health problem and adult health risk in these regions of Turkey.

Child abuse and neglect in Turkey: professional, governmental and non-governmental achievements in improving the national child protection system

Since ratification of the United Nations Convention on the Rights of the Child in 1995, significant efforts were made in Turkey to improve protection of children from abuse and neglect. The government took steps to amend relevant laws. Several state departments recognized the need for professional in-service training of relevant governmental agency staff. University hospitals established numerous hospital-based multidisciplinary child protection centres. The government established an Interministerial Higher Council, which has been overseeing the foundation of 13 child advocacy centres for a multidisciplinary and interagency response to child sexual abuse. In addition to undertaking research, non-governmental organizations contributed to this process by instituting professional and public education. These ground-breaking developments in the last decade give promise of even further improvement in the national child protection system from investigative, child protective and rehabilitative perspectives.

Preliminary validation of the Child Abuse Potential Inventory in Turkey

This study aims to provide preliminary findings on the validity of Child Abuse Potential Inventory (CAP Inventory) on Turkish sample of 23 abuser and 47 nonabuser parents. To investigate validity in two groups, Minnesota Multiphasic Personality Inventory (MMPI) Psychopathic Deviate (MMPI-PD) scale is also used along with CAP. The results show that, with the 200.5 cutoff point, which is the average score of the whole Turkish sample, Abuse Scale correctly classified 83% of the participants in the abuse group and 78.8% of the participants in the control group, which gives 21.2% false-positive result. MMPI-PD to all group and Pearson correlation coefficient analysis is found to be significant for both groups. These results show us high reliability and validity of the abuse scale for Turkey.

Pediatric condition falsification (Munchausen syndrome by Proxy) as a continuum of maternal factitious disorder (Munchausen syndrome)

Pediatric condition falsification (PCF), also known as Munchausen syndrome by Proxy or Medical Child Abuse, is a somewhat rare form of child abuse and neglect. Its association with a history of adult factitious disorder (AFD) or Munchausen syndrome in the perpetrator is also well known. Exogenous insulin injection to cause hypoglycemia both in the context of PCF and AFD has been reported in the literature. However, the coexistence of both conditions via insulin injection in the same family has not been reported in the literature. This paper presents a family, in which the mother was diagnosed with AFD and her three children with PCF perpetrated by their mother via exogenous insulin injection.

International variations in harsh child discipline

BACKGROUND

Although the history of recognition of child abuse in Europe and North America extends over 40 years, recognition and data are lacking in other parts of the world. Cultural differences in child-rearing complicate cross-cultural studies of abuse.

OBJECTIVE

To ascertain rates of harsh and less-harsh parenting behavior in population-based samples.

METHODS

We used parallel surveys of parental discipline of children in samples of mothers in Brazil, Chile, Egypt, India, Philippines, and the United States. Data were collected between 1998 and 2003. The instrument used was a modification of the Parent-Child Conflict Tactics Scale, along with a study-developed survey of demographic characteristics and other parent and child variables. Women (N=14 239) from 19 communities in 6 countries were surveyed. We interviewed mothers aged 15 to 49 years (18-49 years in the United States) who had a child younger than 18 years in her home. Sample selection involved either random sampling or systematic sampling within randomly selected blocks or neighborhoods.

RESULTS

Nearly all parents used nonviolent discipline and verbal or psychological punishment. Physical punishment was used in at least 55% of the families. Spanking rates (with open hand on buttocks) ranged from a low of 15% in an educated community in India to a high of 76% in a Philippine community. Similarly, there was a wide range in the rates of children who were hit with objects (9%-74% [median: 39%]) or beaten by their parents (0.1%-28.5%). Extremely harsh methods of physical punishment, such as burning or smothering, were rare in all countries. It is concerning that >or=20% of parents in 9 communities admitted shaking children younger than 2 years.

CONCLUSIONS

Physical and verbal punishments of children are common in high-, middle-, and low-income communities around the world. The forms and rates of punishment vary among countries and among communities within countries. A median of 16% of children experienced harsh or potentially abusive physical discipline in the previous year.

Prevalence of childhood physical abuse in a representative sample of college students in Samsun, Turkey

The main objective of this article is to obtain the prevalence of childhood physical abuse experiences in college students.This cross-sectional study was performed on a gender-stratified random sample of 988 participants studying at Ondokuz Mayis University, with self-reported anonymous questionnaires. It included questions on physical abuse in childhood, on whom and why the violence was inflicted, and on the reactions exhibited. Of the 988 participants, 527 (53.3%) had a history of childhood physical abuse (64.0% in men and 41.6% in women). The prevalence of being subject to physical violence was 1.5 times higher in men. Mothers more frequently inflicted violence on daughters and fathers on sons. According to participants, most frequent reasons for physical violence were "loss of perpetrator's self-control" and "establishment of discipline at home." The most frequent statement observed among the participants was humiliation after subjection to physical violence. It is concluded that the first (and the most) important preventive measure is to protect and strengthen the social, economic, and judicial status of the Turkish family. Second, it should by all means be prevented that violence remains legal in some social conditions like child abuse.

Child sexual abuse: seven years in practice

The purpose of this study was to determine the socio-demographic characteristics of sexually abused children. The records of 101 cases of child sexual abuse (CSA) were retrospectively evaluated. Socio-demographic characteristics of the victims, type of sexual abuse, and psychiatric diagnosis were studied. Of the victims, 56.4% (n = 57) were female and 43.6% (n = 44) were male. The mean age was 9.57 +/- 3.5, with a range of 4-17 years. Ninety-three (92.1%) of the victims had been admitted as part of the legal process. The majority (66.3%) of the victims had been abused by an acquaintance, while 33.7% had been abused by a stranger. Anal or vaginal penetration was reported in 48.5% of the cases. Post-traumatic stress disorder was the most common (54.5%) psychiatric diagnosis established after sexual abuse. Descriptive data related to the abused children and an understanding of the consequences of CSA will help authorities in planning prevention.

Characteristics associated with maltreatment types in children referred to a hospital protection team

OBJECTIVE

The aim of this paper is to describe characteristics associated with maltreatment types in children referred to the child protection team at the University Children's Hospital Zürich. Since 2003, the child protection team has registered data on each case in a standardized form.

METHODS

To examine differences in gender, age, nationality, and socioeconomic status by type of maltreatment, regression analyses were conducted for the 1,484 cases that were referred from 2003 to 2006.

RESULTS

The most common types of referred maltreatment were sexual (38%) and physical maltreatment (31%) with mean ages of 8.4 and 7 years, respectively. Compared to physical maltreatment, where gender distribution was equal, there was a higher risk for girls to become victims of sexual maltreatment. Younger children were at higher risk for neglect (mean age 5 years). Low socioeconomic status increased the risk for physical as compared to sexual maltreatment. However, whether the child was of Swiss or of foreign nationality was not associated with an increased risk for any type of maltreatment when controlling for socioeconomic status.

CONCLUSION

As this study is one of a few to analyze characteristics in child maltreatment referred to a hospital child protection team, further research is needed. To improve international comparability, thorough documentation of the cases is encouraged.

Social and emotional outcomes of child sexual abuse: a clinical sample in Turkey

Childhood sexual abuse is a traumatic life event that may cause psychiatric disorders such as posttraumatic stress disorder and depression. During 2003-2004, 20 sexually abused children were referred to the Child and Adolescent Psychiatry Clinic of Ege University in Izmir, Turkey. Two years later, the psychological adjustment of these children (M age = 9.4 years, SD = 3.63 years, range = 5 to 16 years) is evaluated. Semistructured interviews, a form for the sociodemographic characteristics, are used for evaluations by a child psychiatrist who is blind to the first evaluation. It is determined that sexually abused children have more psychiatric disorders within the first year than 2 years later. However, some behavior problems occur at both short-term and long-term follow-ups.

Establishment of interdisciplinary child protection teams in Turkey 2002-2006: identifying the strongest link can make a difference!

OBJECTIVES

The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome.

METHODS

A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software.

RESULTS

Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period.

CONCLUSIONS

A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear.

PRACTICE IMPLICATIONS

Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.

A survey of rate of victimization and attitudes towards physical violence among school-aged children in Turkey

BACKGROUND

Violence of any type is a serious issue in the lives of many children from all racial, cultural and economic backgrounds, and is a topic of enormous societal concern in any society. The purpose of this study was to examine the rate of exposure to violence as victims, and attitudes towards physical violence among school-aged children in eastern Turkey.

METHODS

All the basic education schools in Elazig, a typical eastern Anatolian city, were included. A total of 3725 fifth and sixth graders were asked to answer survey questions about the rate of physical violence exposure in their everyday lives and whether they thought the violence was an 'acceptable' behaviour.

RESULTS

The mean age of participants was 12.8 years with 46.8% boys and 53.2% girls, and their socio-economic status ranged from low-income to upper middle class. Seventy-four per cent of school-aged children reported exposure to at least one case of physical violence in their lives, and 43.4% reported experiencing physical violence within previous 12 months. Higher rates of exposure to physical violence were reported by boys than girls (P = 0.0001). Of the victims, 33.8% regarded physical violence as an acceptable or inevitable way of solution or responding to life events.

CONCLUSIONS

Results from the self-report of the receiving end of violent behaviours indicate that physical violent victimization is at an alarmingly high rate among children of eastern Turkey, and a significant per cent of these victims approves violence as a way of solution.

Attitudes of Turkish parents, pediatric residents, and medical students toward child disciplinary practices

OBJECTIVE

The aims of the study were to: determine the attitudes of parents, pediatric residents, and medical students from a Turkish population toward childhood disciplinary methods; ascertain the association of participants' abusive childhood history with their attitudes toward discipline; and assess their attitudes about disciplinary actions, which should be reported as abuse.

METHOD

A cross-sectional survey was conducted in Ankara University School of Medicine, Department of Social Pediatrics. Sixty-five parents, 39 pediatric residents, and 106 medical students completed a questionnaire (Survey of Standards of Discipline). This questionnaire was designed to measure sociodemographic characteristics, attitudes toward childhood disciplinary practices, and abusive childhood experiences. There were 43 different disciplinary acts in this questionnaire. The participants were expected to give responses to these acts in three categories: (a) acceptable as discipline; (b) unacceptable as discipline; and (c) unacceptable as discipline-would report to authorities as child abuse. Based on the responses to this questionnaire, we developed the Severity Scale. Using this scale, physical severity scores, verbal severity scores, and total severity scores were measured for each participant.

RESULTS

None of the participants accepted life-threatening practices as discipline, but some declared certain abusive disciplinary practices as acceptable. Some forceful disciplinary methods were not considered as reportable by participants. All severity scores of both residents and students were found to be higher than those of the parents (for verbal severity scores p=.042). Also, both verbal and physical severity scores of parents with one child were higher than those of parents with two children (for verbal severity scores p=.044). Ninety-one participants (43.3%) indicated that beating was an acceptable form of discipline. Of parents, 66.9% reported abusive childhood history by their own criteria. Of medical students with an abusive childhood experience, 56.5% accepted beating as appropriate (p=.001). Both verbal and physical severity scores were found to be higher in participants with abusive childhood history.

CONCLUSIONS

Abusive childhood history and lack of education regarding appropriate discipline techniques are linked to the acceptance of certain physical discipline practices. Turkey's cultural and traditional norms may be associated with the use of physical punishment, and in some cases, physical abuse. The lack of awareness of abusive discipline methods among physicians constitutes problems for child protection and must be addressed. Thus, educational programs on child disciplinary practices are required to provide an increased awareness of child abuse among health professional trainees and parents in Turkey.

Pyoderma Gangrenosum in a Battered Child

Pyoderma gangrenosum is an uncommon cutaneous ulceration, which continues to be a difficult disorder to diagnose and treat. A pediatric case of pyoderma gangrenosum with no associated systemic disorder is presented. The disease was precipitated by physical trauma. The disease was controlled with systemic corticosteroid therapy and then the wound was successfully covered with a split-thickness skin graft from the thigh without any healing problem at the donor site. Although pathergy is well described in the etiopathogenesis of the disease, this is the first case reported that was precipitated after physical assault.

Sexual abuse among female high school students in Istanbul, Turkey

OBJECTIVE

The objective of the study was to determine the prevalence of sexual abuse in female adolescents in Istanbul, Turkey from data collected as part of a school-based population study on health and health behaviors.

METHOD

A stratified cluster sampling procedure was used for this cross-sectional study. The study sample included 1,955 randomly selected 9th through 11th grade female students attending 26 randomly-selected high schools in Istanbul. A self-report questionnaire was administered anonymously in the classroom. Information on sexual abuse history was collected through the questions investigating "touching" and "intercourse."

RESULTS

Of 1,955 female students, 1,871 (95.7%) provided answers to the questions addressing unwanted sexual experience. Of these, 250 (13.4%) reported sexually abusive experiences. Two hundred and thirteen (11.3%) students reported that someone touched their private parts in a way they did not like; 91 (4.9%) reported they were forced to have sexual intercourse; 54 (3.0%) reported both types of sexual abuse. Incest was reported by 1.8% of the subjects. Ninety-three percent of the perpetrators were reported to be male.

CONCLUSIONS

This is the first reported school-based study to determine the prevalence of sexual abuse in Turkey. The results show that at least 13.4% of female high school students disclosed having experienced sexual abuse during childhood.

Trans-metatarsal amputation as a complication of child sexual abuse

A case of chronic physical abuse and acute sexual abuse via anal penetration complicated with disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), and subsequent bilateral trans-metatarsal amputation is reported. A 13-year-old male presented with old cigarette burns on his chest and acute anal laceration. Four days after laceration repair, he developed DIC and ARDS. The child had to undergo bilateral trans-metatarsal amputation. Due to the systemic defects of the child protection system in Turkey, sexual and physical abuse were recognized by medical personnel 45 days after admission, child protective services never got involved, and prosecution failed to punish the perpetrator(s) of this extreme victimization. This is the only reported case of bilateral trans-metatarsal amputation due to sexual abuse complicated with DIC and ARDS. Social and medico-legal management of sexual abuse is suboptimal in Turkey. Within that context, professionals should be trained on how to recognize, assess, diagnose and manage victims of child abuse and neglect.

Medical neglect of a child: challenges for pediatricians in developing countries

OBJECTIVE

To conceptualize the underlying causes of the medical neglect of children in a developing country and to provide suggestions for the management of neglect by pediatricians.

METHODS

A case history of a 4-year-old boy from Turkey with neglect of the required treatment for acute lymphoblastic leukemia is used to examine the causes and management of medical neglect.

RESULTS

Although epidemiological studies on child neglect are lacking, this case exemplifies how in DEVELOPING countries, reasons for neglect or non-compliance with medical recommendations and the roles and actions taken by the health care and the social service systems may differ from western populations. Common to both western and developing countries, the characteristics of the child, family, and society may be reasons for medical neglect. However, cultural fatalistic beliefs profoundly present in the developing world may also contribute to the medical neglect of a child. Identification of the neglect, a comprehensive, multidisciplinary assessment emphasizing the strengths within the family and the society, and the determination of the pediatric team to act in the best interest of the child may result in resolution of the neglect even in circumstances where resources within systems are not sufficient.

CONCLUSIONS

In developing countries, increased emphasis on child neglect, its prompt recognition and management within the pediatric profession as well as at a health care and social service system levels are needed to address this prevalent and potentially fatal child health problem.