«States Parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s) or any other person who has the care of the child.».
Διεθνής Σύμβαση για τα Δικαιώματα του Παιδιού,
ν. 2101/1992, αρ. 19. γιαταInternational Convention on the Rights of the Child
Law. 2021/1992, art. 19, par. 1
According to the International Health Organization (1999) the abuse or the mistreatment of children includes «all the forms of physical or emotional mistreatment, sexual abuse, neglect of care or exploitation for monetary or other goals, which leads to a specific or a possible damage on the child’s life, development and dignity, with in the frame work of a relationship of responsibility, trust and power. »
The National Centre for Social Solidarity (NCSS), within the framework of its responsibilities, offers to children and teenagers that are neglected and/or abused, psychological support and counselling via its specialized helpline. Through the National Child Protection Helpline «1107»*, that operates on a 24/7 basis, children who are victims of abuse or any form of violence, can speak with a Social Worker or Psychologist, by calling the 4-digit number «1107», in order to receive counselling and psychosocial support.
In a case of a formal or anonymous report/complaint for neglect and/or abuse of a child to the National Child Protection Helpline «1107», the competent Public Prosecutor and/or any other service needed (e.g., Social Service, Police etc.) is formally notified immediately, for the handling of this important issue and the most effective way to protect the minor victim that is in danger.
* Τhe National Children Protection Helpline «1107»is free, for the callers using VODAFONE, NOVA, WIND and OTE (landlines). The mobile phone calls through the COSMOTE network are charged with 0,18€ per minute (this price includes VAT 24% and the landline users 5% tax).
FORMS-TYPES OF ABUSE-NEGLECT OF CHILDREN
- Neglect includes «isolate dincidents, as well as a pattern of continuous failure of the parent or another member of the family to take care of-at least in cases the parent is able to do so-one or more of the following developmental and welfare domains of the child’ s life: health, education, emotional development, nutrition, accommodation and safe living conditions. The parents of the neglected children are not necessarily poor, on the contrary they may be affluent». Neglect should not be confused with the family’s lack of resources, on the contrary it is depicted by the lack in at least one domain of resources or possibilities for the child by the parents/carers».
- Physical abuse of a child is defined as «the use of physical violence on a child, which results-or is highly likely to result-in damage to the child’s health or dignity. Physical violence includes practices such a shits, kicks, shakings, bites, strangulations, burns, poisoning and asphyxiation. Most of the times the physical violence that takes place in the house on children is exercised as a form of punishment or infliction of extreme discipline».
- The emotional-psychological abuse includes «isolate dincidents as well as a pattern of continuous failure of the parent or carer to provide to the child an environment developmentally proper and supportive, by applying practices that are negative to the child’ s emotional health and emotional development. Those practices are: limiting the child’s movement, its humiliation, the use of accusations, threats and intimidation, discrimination or ridicule and other non-physical forms of rejection or hostile treatment».
- Sexualabuseisdefinedas«a child’s involvement in an activity that it does not fully understand and for which it is not able to give consent, for which it is not developmentally mature enough or is against the law. The children maybe sexually abused by adults as well as other children, who due to their age or developmental stage, hold a position of responsibility, trust or power in relation to the victim».
SIGNS-INDICATIONS OF POSSIBLE CHILD ABUSE
In order to offer help to a child that is a victim of abuse it is necessary to timely recognize the signs and indications that may be suggestive that the child is abused. Indicatively, the following signs and indications (the list is in no way exhaustive) may lead those who come in touch with children, to detect a case of possible child abuse.
- Sudden changes in the child’s mood, school progress or absenteeism, without the indication of a specific event that may have led to these changes.
- The emergence or worsening of learning difficulties, which are not attributed to a specific learning difficulty or other specific psychological or physical cause.
- Common periods of illness, without adequate care and support of the child to physical or general health problems.
- The child seems to be in a constant worry, excitationandalertness, asifit waits for something bad to happen.
- Physical bruises an dinjuries (e.g., bruises, hits, scrapes, bites, burns, dislocations, fractures and other), that may be repeated and are not sufficiently justified, are not medically treated or are diligently and intentionally covered by clothes.
- The child complains that it hurts, informs of an injury or is not able to move easily.
- The child seems to be scared when it comes to his/her parents communicating with a specialist (therapist, educator, doctor) or seems to be scared of receiving medical help.
- Thechildisonguardordistances itself when an adult tries to get closer.
- The child or teenager has a decreasing school progress, changes in his/her emotions or behavior (e.g., depression, unexplained crying, anxiety, fears, dependencies, limited socialization, tendencies of self-destruction, destruction of others or tendency to flee, changes in nutrition (e.g. overeating or anorexia), changes in sleep (e.g. insomnia or oversleeping, frequent accidents, bad personal hygiene and self-neglect.
Undoubtedly, the early detection and intervention in cases of child neglect and abuse may not allow or decrease the long-term negative consequences for a child that is a victim of any kind of abuse.
SERVICES THAT SOMEONE MAY CONTACT IN CASE OF A SUSPECTED NEGLECT/ABUSE OF ACHILD
- Helplines that may be operated by public or private entities. Indicatively, the NCSS National Child Protection Helpline«1107».
- Social Services and Minors’ Protection Teams of the country’s Municipalities.
- PublicProsecutors’ Offices(aspecializedMinors’ DepartmentoperatesunderthePublicProsecutorinAthens, Patras, Thessaloniki, Heraklion&Peiraeus).
- Services of Juvenile Probation
- GreekPolice (there is a Subdivision for the Protection of Minors in Athens and Thessaloniki).
- GreekPolice–Unit of Minors Internet Protection and Digital Investigation.
- Ombudsman-RightsoftheChild: it offers communication with specialized staff by calling 800.11.32.000 (phone line for minors, free of charge).
CHILD ABUSE PREVENTION
International studies have shown that children under 4-5 years old seem to have more possibilities to become victims of abuse compared to older children (school-age children and teenagers). Babies and toddlers from 0 to 5 years old are in greater abuse danger, since they are more vulnerable, due to the fact that their physical and mental development makes them entirely dependent on adults and are not able to protect themselves against abusive behavior. Furthermore, domestic violence against babies and toddlers is not possible to be detected unless there is a hospital visit or stay since children of those ages do not spend that much time with other social groups and violent incidentsremain within the family environment that is considered a «circle of trust».
The«UnderwearRule»ispartofthe«OneinFive» campaign of the European Council for combating children’s sexual abuse, as it is estimated that one in five children has been a victim of sexual violence, including sexual abuse. Youcanfindoutmoreregardingpreventionandprotectionmeasuresforchildren on: www.coe.int/oneinfive.
The European Council provides relevant material to help the parents teach their children the «Under wear Rule», since it can be a highly effective preventive tool for little children child abuse, who are highly vulnerable. All the relevant material is available on: www.kanonastonesorouxon.organd includes:
- A television spot (animation)
- A book that parents can read to children 3-7 years old
- Posters and cards
Obesity-a modern pandemic
One of the most important epidemiological transitions of the 20th century was the shift of mortality and morbidity from the contagious to the chronic diseases, mainly the cardiovascular ones.
The deaths caused by contagious diseases started to rapidly decrease from the middle of the 19th century in developed countries, and be replaces by chronic degenerative diseases, the so-called “civilization diseases”, which are related to the modern way of life.
In Western countries, the ample availability of food lead not only to the improvement of the total nutritional value and the children’s health, but also to the increase of obesity which was accelerated by the increasingly sedentary way of life.
Therefore, in the new millennium, the Western world had an important increase of the obesity’s prevalence with a simultaneous increase of the chronic diseases related to obesity and their clinical onset in younger ages. Type 2 diabetes, a condition usually associated with middle-aged persons, starts appearing several decades earlier, since obesity hits a greater number of children and teenagers.
According to the World Health Organization (WHO), obesity is defined as the excessive accumulation of fat in a degree that it can affect a person’s health. It is caused by a chronic energy imbalance between the food intake and the energy expenditure.
Nowadays, obesity is recognized as a chronic illness which is due to a combination of genetic, environmental and psychosocial factors, and is one of the most important causes of morbidity and mortality in developed countries and is dangerously increasing in the developing world, that is following the western way of life.
The rapid increase of obesity on a global scale led the World Health Organization to name it in 1997 as a modern pandemic.
According to WHO (2021), obesity today, on a global scale, has almost tripled compared 1975. In 2016, 39% of adults over 18 years old were overweight and 13% were obese.
The scope of childhood obesity
Childhood obesity has been characterized by the WHO as one of the most serious scourges of the 21st century.
The prevalence of excessive weight and obesity in children and teenagers between the ages of 5 and 19 has dramatically increased from just 4% in 1975 to slightly over 18% in 2016.
According to WHO estimates, 38,2 million children under the age of 5 were overweight or obese in 2019, while more than 340 million children and teenagers between the ages of 5 and 19 were overweight or obese.
The epidemic of childhood obesity is increasingly affecting the developing countries, especially in urban areas. In Africa, the number of overweight children under the age of 5 has increased almost by 24% since 2000, while half of the children under the age of 5 being overweight or obese in 2019 lived in Asia.
It is estimated that by the current trends, childhood obesity will soon be the no 1 cause of death that can be prevented, overcoming smoking that is today in no 1.
Unfortunately, Greece seems to be in the 1st place based on available research data on a global level, having the highest percentage (33,4%) of children with central obesity, followed by the USA 32,9%, Portugal with 23,8%, Spain with 21,3% and Australia with 18,3% (Grigorakis et al. 2015).
Obesity may harm all the systems in the body of a child–heart and lungs, muscles and bones, kidneys, as well as hormones controlling the blood’s glucose while it simultaneously affects it socially and psychologically. It is also clear that it makes losing weight extremely difficult at any age.
Preventing obesity in the first years of a child’s life, is the most promising way of combatting the epidemic according to WHO and may be one of the most important challenges of public health in the 21st century.
Body Mass Index
The Term Body Mass Index was developed by Adolphe Quetelet in the 19th century. It is a schematic indication of the body’s fat for adults and it is used to define weight categories that may lead to health problems, aiding prevention and combatting obesity and the related diseases.
It is calculated as the person’s weight in kilos divided by the square root of its height in meters.
BMI=Weight (Kg)/ Height (m)2.
For example, for a person weighing 70Kg and has a height of 1,75m, BMI is calculated as follows:
According to WHO a person is overweight with a BMI higher or equal to 25 and obese when the BMI is higher or equal to 30. For assessing the weight of children, we should take their age under consideration.
The internet has innumerable applications for calculating BMI, such as that of the Center for Disease Control and Prevention, U.S. which has developed a special application for assessing childhood obesity:
BMI Calculator Child and Teen | HealthyWeight | CDC
Covid 19 and Childhood Obesity-two pandemics crossing paths1
The World Health Organization named COVID-19 as a pandemic on the 11th of March 2020. Obesity is recognized as a risk factor for COVID-19 ( Lighteretal., 2020 ).
The crossing of the two diseases and the following environmental changes have made children and adults in a high risk of developing obesity and of its worsening.
The familial environment, home, school and community and their multi-factor interaction have changed to non-recognizable scenarios, increasing the anxiety for children and families.
Obese children face increased biological and psychosocial dangers during COVID-19 and may have more severe complications, including the need for breath support (Zachariahetal., 2020). At the same time, anxiety worsens inflammation and immune response in obese persons and those afflicted by COVID-19.
The answers in the COVID-19 pandemic caused important changes in the way of life and the nutritional habits. As COVID-19 affected the whole world, many countries used the schools closing as part of the social distancing policies to part of the social distancing policies to decelerate the transmission and ease the health systems. It is estimated that 138 countries have closed their schools, affecting 80% of children all over the world (VanLancker&Parolin, 2020).
When schools closed children lost a safety net of accessing nutritional food, a safe place with obligatory body activity, as well as their social networks and daily activities program. It is expected that closing a school due to COVID-19 will have harmful social and health consequences for children, especially those living in poor conditions.
Factors affecting are the following:
Lack of family experience to ease learning and access to resources
Worsening of the parents’ finances
Changes in the availability and the consumption of healthy foods
Isolation from the peers and interruption of daily habits
Changes in body activity
Decrease of contact with art, music, reading and physical education
Limitation of learning to online activities
COVID-19 increases obesity risk factors due to increased stress and limited body activity that is related to environmental, school and social changes.
Online learning lacks physical education, breaks and normal levels of movement for children and teenagers. The children being in the house and isolated, the access to chances and environments encouraging body activity is decreased.
According to a research regarding the «Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the US»2 important changes were noted in the body activity levels and the sedentary behavior of children in the US as a reaction to COVID-19. In total, the COVID-19 limitations seemed to have a greater impact on body activities and sedentary lifestyle of older children and especially girls, which even though short-term, there is an indication that they may become permanent, leading to a higher risk for obesity, diabetes and cardiovascular diseases in children.
At the same time, the increased time spent at home causes boredom to children (Dubeyetal., 2020) and loneliness. Social isolation threatens the feeling of security to children and worsens the existing anxiety.
The negative effects of childhood obesity and COVID-19 call for the support of families and children. The care of children and their families needs a systematic assessment of their health and their biological and psychosocial needs aiming at the decrease of the negative effects of obesity and COVID-19.
Parental care regarding proper nutrition and body activity is essential for the prevention and the combat of childhood obesity. The parents can also support school initiatives regarding the combat of childhood obesity.
At the same time, the Internet has many audiovisual resources which can be used to support obese children and their parents to achieve a healthier way of life.
The main directions for the prevention of childhood obesity regard mainly the systematic preparations of meals, limited exposure to screens, water intake, sleep quality, encouraging body activity, limiting sugar, soft drinks and fatty snacks.
Strategies for better nutrition are possible while families spend more time at home. The preparation of meals can be a family activity, with the participation of children in searching for recipes and the preparations of vegetables, fruits and high in fibers foods. On the other hand, the lack of meal preparations may lead to ready foods or non-nutritional snacks. (Lappan, Parra-Cardona, Carolan, &Weatherspoon, 2020).
At the same time, policy interventions are needed for the provision of proper supervision to limit the advertisement of the food industry for products high in salt, fat and sugar.
The COVID-19 limitations have decreased many chances for healthy food and body activity for children. Doctors, families and communities should create and prioritize alternative, safe choices. The effects of the COVID-19 pandemic in childhood obesity should be taken under consideration in the creation of an effective health policy in the future.
Finally, the cases of causative obesity or serious psychological nutrition diseases should be treated with the proper care by specialized professionals. Most hospitals in Greece have obesity offices and each pediatrist has material to aim or refer to the proper health professionals.
The ministry of Health has created rich audiovisual material aiming at the prevention of childhood obesity, as well as nutritional Guides special for each stage of development of children, which are available on:
Browne N. T, Snethen J. A., Smith Greenberg C., Frenn M., Kilanowski F J., Gance-Cleveland B/ , Burke J P., Lewandowski L. (2020) , When Pandemics Collide: The Impact of COVID-19 on Childhood Obesity, Journal of PediatrNurs. 2021 January-February; 56: 90–98, Published online 2020 Nov.
Dubey S., Biswas P., Ghosh R., Chatterjee S., Dubey M.J., Chatterjee S.…Lavie C.J. Psychosocial impact of COVID-19. Diabetes & Metabolic Syndrome. 2020;14(5):779–788. doi: 10.1016/j.dsx.2020.05.035. Advance online publication. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Dunton, GF, Do, B. & Wang, SD, (2020). Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the US (BMC Public Health 20, 1351 (2020). Διαθέσιμοσε: https://doi.org/10.1186/s12889-020-09429-3, ανακτήθηκεστις 3 Απριλίου 2021
Grigorakis, D. A., Georgoulis, M., Psarra, G., Tambalis, K. D., Panagiotakos, D. B., &Sidossis, L. S. (2015). Prevalence and lifestyle determinants of central obesity in children. European Journal of Nutrition Eur J Nutr.
Καραβανάκη-Καρανάσιου Κ, Ο ρόλος της παιδικής και εφηβικής παχυσαρκίας στη νοσηρότητα και θνητότητα στην ενήλικο ζωή, Ελληνική Ιατρική Εταιρεία Παχυσαρκίας (ΕΙΕΠ). Διαθέσιμοσε: http://goo.gl/eTJCpm, ανακτήθηκεστις 20 Απριλίου 2021
Lappan S.N., Parra-Cardona J.R., Carolan M., Weatherspoon L. Risk and protective factors associated with childhood obesity in a sample of low-income, single female, parent/guardian households: Implications for family therapists. Family Process. 2020;59(2):597–617. doi: 10.1111/famp.12440. [PubMed] [CrossRef] [Google Scholar]
Lighter J., Phillips M., Hochman S., Sterling S., Johnson D., Francois F., Stachel A., Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission. Clinical Infectious Diseases. 2020 doi: 10.1093/cid/ciaa415. Advance online publication. [PMC free article] [PubMed] [CrossRef] [Google Scholar
Park H.K., Kim J., Shim Y.S. Association between sleep duration and body composition in girls ten to eighteen years of age: A population-based study. Childhood Obesity. 2020;16(4):281–290. doi: 10.1089/chi.2019.0191. [PubMed] [CrossRef] [Google Scholar]
Van Lancker W., Parolin Z. COVID-19, school closures, and child poverty: A social crisis in the making. The Lancet Public Health. 2020;5(5):e243–e244. doi: 10.1016/S2468-2667(20)30084-0. [PMC free article] [PubMed] [CrossRef] [Google Scholar
World Health Organisation (2020) Non communicable diseases: Childhood overweight and obesity, 19 October 2020 | Q&A, διαθέσιμοσεhttps://www.who.int/, ανακτήθηκεστις 20 Απριλίου 2021
Zachariah P., Johnson C.L., Halabi K.C., Ahn D., Sen A.I., Fischer A.Columbia Pediatric COVID-19 Management Group Epidemiology, clinical features, and disease severity in patients with Coronavirus Disease 2019 (COVID-19) in a children’s hospital in New York City, New York. JAMA Pediatrics. 2020:e202430. doi: 10.1001/jamapediatrics.2020.2430. Advance online publication. [PMC free article] [PubMed] [CrossRef] [Google Scholar
1«When Pandemics Collide: The Impact of COVID-19 on Childhood Obesity» τωνNancy T Browne , Julia A Snethen , Cindy Smith Greenberg, Marilyn Frenn , Jill F Kilanowski , Bonnie Gance-Cleveland 6 , Pamela J Burke, Linda Lewandowski, Journal ofPediatrNurs. 2021 January-February; 56: 90–98, Published online 2020 Nov 11. doi: 10.1016/j.pedn.2020.11.004, PMCID: PMC7657263, PMID: 33293199
2Dunton, GF, Do, B. &Wang, SD, Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the US BMC 20, 1351 (2020). https://doi.org/10.1186/s12889-020-09429-3