Abuse and neglect in the surgically ill child

Child abuse and neglect are a global phenomenon often symptomatic of underlying psychosocial family problems, which may represent a transferred aggression from one or both disturbed parents onto the child. Although the scope has been widely explored in Africa, little has been written on children presenting with surgical lesions. We report 31 children abused by their parents on accounts of frustrations engendered by the children's surgical conditions in Lagos. 26 (83.9%) of these children had major congenital defects while only 5 (16.1%) had acquired lesions. The commonest form of abuse was child abandonment, seen in 9 (29%) of cases. Neglect was recorded in 7 (23%) cases while 2 children were mutilated because of surgical lesions. Three patients were starved, 3 children with colostomy were evicted by landlords while 2 were locked up by parents out of shame. One child died of infanticide. Reasons for abuse included financial constraints, hopelessness and shame associated with grotesque lesions, broken homes and maternal pregnancy. Doctors and nurses engaged in the care of gross congenital anomalies and other major surgical lesions should anticipate this problem and evolve appropriate strategies to deal with it. The social worker should be involved early enough in the management. Provision of adequate social safety nets, affordable medical care and specific legal protection for children will curtail this ugly trend in our society.