There has been a dramatic increase in very young adolescent pregnancies in recent years, with pregnancies documented in children as young as 10 years old, likely from sexual abuse. This article presents a 10-year-old female who initially consulted at the emergency room in her 27th week of pregnancy as a result of recurrent sexual abuse. Prompt assessment, diagnosis, and appropriate referrals to Obstetrics, Pediatric Adolescent Clinic, Psychiatry, and Child Protection Unit rendered optimal management for the patient. Dilemmas encountered in managing the case included preterm labor, large-for-gestational-age baby, immature pelvis, and approach to the appropriate mode of delivery compounded with management of trauma from sexual abuse. A multidisciplinary approach in managing these dilemmas achieved optimal outcomes with the patient delivering a live baby boy, appropriate for gestational age via cesarean section at term.
Child abuse ; pregnancy in adolescence ; preteen pregnancy ; teenage pregnancy ; sexual

Objective: To analyze the association between exposure patterns of adverse childhood experiences (ACEs) and anxiety symptom trajectories in medical college students. Methods: A survey was conducted on first-year students from Anhui Medical College and Anqing Medical College, using the Childhood Abuse Questionnaire, Family Disability Questionnaire, Childhood Adverse Social Experience Item, and Anxiety Self Rating Scale. The baseline survey was conducted from November to December 2019, and two follow-up visits were conducted once every six months until November to December 2020. The latent class analysis (LCA) was used to analyze the exposure patterns of ACEs. The latent class growth analysis (LCGA) was used to analyze the development trajectory of anxiety symptoms. The multiple logistic regression model was used to analyze the correlation between different exposure patterns of ACEs and the trajectory of anxiety symptom trajectories. Results: A total of 3 662 college students aged (19.2±1.0) were surveyed. The LCA showed that the exposure patterns of ACEs could be divided into the "high ACEs" group (13.4%), "high neglect/emotional abuse" group (25.7%), "high family dysfunction" group (6.9%), "high neglect" group (27.1%), and "low ACEs" group (26.3%). The LCGA divided anxiety trajectories into four groups: "high anxiety decline" (7.1%),"anxiety increase "(4.1%), "moderate anxiety"(52.9%), and "low anxiety"(35.9%). Using the low ACEs group as a reference group, compared with the low anxiety trajectory, the high ACEs group, high neglect/emotional abuse group, high family dysfunction group, high neglect group, and medium to high-level anxiety trajectory were all associated with an increased risk (P<0.05). Conclusion: There is heterogeneity in ACEs exposure patterns among medical college students, and ACEs exposure patterns are important influencing factors for anxiety symptom trajectories.
Humans ; Adverse Childhood Experiences ; Anxiety/epidemiology* ; Child Abuse/psychology* ; Students/psychology* ; Surveys and Questionnaires ; Adolescent ; Young Adult

Child ; Humans ; East Asian People ; Quality of Life ; Students ; Child Abuse, Sexual ; Young Adult ; Resilience, Psychological

OBJECTIVES: To study the influence of family structure on depression and anxiety symptoms in adolescents and its mechanism. METHODS: The cluster sampling method was used to select the students from seven middle schools in Shanghai, China. An online questionnaire survey was conducted using a self-made general status questionnaire, Childhood Trauma Questionnaire, Children's Depression Inventory, and Screen for Child Anxiety Related Emotional Disorders. The methods including one-way analysis of variance, chi-square test, binary logistic regression analysis, and mediating effect analysis were used to evaluate depression and anxiety symptoms in adolescents and the difference in childhood trauma and its mediating effect. RESULTS: Compared with the adolescents from nuclear families, the adolescents from three-generation lineal families had a lower risk of depression symptoms (OR=0.794, 95%CI: 0.649-0.972, P<0.05), while those from host families had a higher risk of depression symptoms (OR=4.548, 95%CI: 1.113-18.580, P<0.05). The adolescents from inter-generational families and host families had a significantly higher score on the Childhood Trauma Questionnaire subscale of emotional neglect (P<0.05). Emotional neglect played a mediating role in the influence of inter-generational families and host families on depression symptoms in adolescents. CONCLUSIONS Parents and grandparents have a certain positive effect in family structures. Separation from parents may make adolescents perceive more emotional neglect, which may increase the occurrence of depression symptoms.
Child ; Humans ; Adolescent ; Depression/epidemiology* ; Family Structure ; Child Abuse/psychology* ; China ; Anxiety/epidemiology* ; Surveys and Questionnaires

Objective: This study aimed to compare the clinical profile of prepubertal and pubertal female child sexual abuse. Methods: A cross-sectional analytical study involving 43 sexually abused children was done. Each patient was categorized as prepubertal or pubertal based on the Tanner stage. Medical history was gathered using a structured interview and physical examination done with proper documentation after obtaining consent. Blind review by child protection specialists was done on genital images. Descriptive statistics were utilized for all variables. Results: This study showed 11.97% and 22.22% prevalence for prepubertal and pubertal child sexual abuse, respectively. Most prepubertal children disclosed digital vaginal penetration by the father and non-relative household members, while most pubertal children reported penile-vaginal penetration by the boyfriend. Fondling was common to both groups. The majority were repeated abuse and usually happened at the perpetrator’s house. Behavioral changes and genital symptoms were common in prepubertal children. Findings of hymenal trauma were found in 25% of prepubertal girls and half of the pubertal adolescents. The interobserver variability of these hymenal findings was fair. The prevalence of sexually transmitted infections (STIs) was low, none for the prepubertal children, and only 6% of the adolescent had STI, which was Hepatitis B. Conclusion The clinical profile of sexually abused prepubertal children differed from that of pubertal adolescents. There was a higher incidence of hymenal trauma and STIs in adolescents.
Child Abuse, Sexual

Objectives: Suicidal ideation is a serious concern even among the pediatric population. This study aimed to determine its prevalence among victims of child sexual abuse and the factors that may contribute to its occurrence. Methods: A cross-sectional analytic study was done using medical records of 393 victims of child sexual abuse seen at the PGH CPU from 2017–2019. A logistic regression analysis was performed to assess the associations of age, sex, closest relation to perpetrator, mode, and chronicity of sexual abuse to the presence of suicidal ideation. Results: The prevalence of suicidal ideation among victims of child sexual abuse is 28%. The factors that were found to have a statistically significant association with suicidal ideation were age and closest relation to perpetrator. For each additional year from 6 to 17 years of age, the odds of having suicidal ideation increased by a factor of 1.33 (95% CI 1.19, 1.49; p<0.001). Victims who were abused by an immediate family member had increased odds of suicidal ideation by a factor of 2.12 (95% CI 1.12, 4.03; p=0.021). Conclusion Suicide is prevalent among victims of child sexual abuse. A high index of suspicion should be given to older adolescents and those whose perpetrators are immediate family members.
Suicidal Ideation ; Child Abuse ; Sex Offenses ; Mental Health

Objectives: There is limited information on the demographics of female perpetrators of child abuse hence its profile was described utilizing the records collected at the University of the Philippines – Philippine General Hospital Child Protection Unit from January 2008-December 2018. Methods: A retrospective review of the electronic records using the Child Protection Management Information System (CPMIS) database was done using descriptive and inferential analyses. Total enumeration was done for the descriptive analysis and categorical data was analyzed using frequencies and percentages. Inferential analysis using chi-squared analysis or Fisher’s exact probability test was used using a minimum sample size computed using power analysis Results: A total of 983 female perpetrators were reported, mostly belonging to the age group of 25-34 years old (23%). They were more frequently a close relative to the victim (47.3%). Half (50%) of the perpetrators had history of substance abuse, and 65.5% witnessed family violence. Criminal history (99.8%) and occupation (46.7%) were mostly unknown. The types of abuse committed were mostly physical (36%) followed by sexual abuse (34.9%). Inferential analysis of the data suggested that the demographic variables associated with physical abuse were age group, relationship, and history of substance abuse. Meanwhile, age group, relationship, and occupation were associated with sexual abuse. Conclusion Although we see a greater number of male perpetrators, it cannot be denied that female perpetrators can also cause harm to the vulnerable population. It is alarming to note that majority of them are close relatives to the victim. Data from the study can help raise awareness and increase vigilance on possible at-risk population.
Child Abuse

Objectives: This study used a descriptive, qualitative design to explore the local understanding of child discipline and analyze the important link between parental discipline and child abuse. Methods: Focus group discussions and key informant interviews were conducted with parents, children, local leaders, and professionals in 6 rural communities in the Philippines. The respondents were asked which corrective behaviors they would consider acceptable or abusive to children by showing them a list of disciplinary acts. Results: The results showed an adequate understanding of the purpose and intent of child discipline. Children are generally disciplined to teach them good values, mold and shape their characters and equip them with a moral sense of right and wrong. Child discipline is considered already harmful if: the child sustains physical injuries and psychological pain; the disciplinary action is not commensurate to the offense committed by the child and is used frequently and repetitively, without any valid reason; when sensitive body parts such as the head are involved, and when the disciplinary action is not appropriate to the age, gender, physical and mental status of the child. Among the various types of disciplinary acts, counseling, beating or spanking, and withdrawing or reducing school allowance were considered most acceptable. Hanging, burning, and scalding were the most unacceptable or abusive disciplinary behaviors. Compared to parents, professionals, and local leaders, children were more lenient as they regarded certain inappropriate behaviors by adults as somewhat tolerable. Conclusion Despite having an adequate understanding of the purpose and intent of child discipline, there is still a need to educate parents, children, and local leaders about when a disciplinary act becomes harmful to children. Community stakeholders should also be informed about how and where to report the abuse once it is identified.
Child Abuse

Child Abuse ; Child, Preschool ; Humans

Objective: To investigate the associations between adverse childhood experiences (ACE) and substance use behaviors among lesbians to provide a scientific basis for high-risk population identification and formulation of targeted intervention measures. Methods: Lesbians who participated in routine AIDS voluntary counseling, testing services, activities, and peer recommendations were recruited from July to December 2018, with the help of LesPark in Beijing. Convenient sampling method was used. Demographic characteristics, ACE, and substance use behaviors of subjects were investigated using an online platform powered by www.wjx.cn. Subsequently, the associations between ACE and adulthood substance use behaviors were evaluated using the logistic regression model. The SPSS 22.0 was used for statistical analysis. Results: A total of 294 lesbians were recruited in the study, 81.3% (239/294) of them were lesbians, and 18.7% (55/294) were bisexuals. Besides, 55.8% (164/294) of subjects reported they had had ACE, with proportions of lesbians experiencing abuse, neglect, and family dysfunction as 33.3% (98/294), 24.5% (72/294), and 32.7% (96/294), respectively. 55.1% (162/294) of the lesbians reported they had smoked in the past 30 days, 11.2% (33/294) reported having drug-use behavior in the past three months, and 22.8% (67/294) claimed drinking alcohol weekly. Multivariate logistic regression analysis showed that lesbians with ACE were at high risks to smoke (OR=1.87, 95%CI: 1.13-3.08), drink (OR=2.13, 95%CI: 1.18-3.84), and use drugs (OR=3.33, 95%CI: 1.29-8.61) in adulthood. Moreover, lesbians with childhood family dysfunction were at higher risk of smoking cigarettes (OR=2.60, 95%CI: 1.46-4.62) and drinking alcohol (OR=2.65, 95%CI: 1.44-4.87). At the same time, those with abuse experience were at higher risk of drug use (OR=3.17, 95%CI: 1.26-7.96). Conclusions: Substance use behaviors, including cigarette smoking, drinking alcohol, and drugs use, were common among lesbians. Positive associations were found between ACE and adulthood substance use behaviors.
Adult ; Adverse Childhood Experiences ; Child ; Child Abuse/psychology* ; Female ; Humans ; Risk Factors ; Sexual and Gender Minorities ; Substance-Related Disorders/psychology*