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Study Unit 3 Special health topics


& Rosen)
Incidence of child abuse in S-A

Chapter 11 Weinstein

(Question 23 Tut 501 & Exam

There are a number of possible reasons for this increasing incidence of child abuse:
Increased reporting of child abuse and neglect due t improved public awareness of the problem
Family poverty forcing children into prostitution- called survival sex
The HIV/Aids epidemic in S-A which has resulted in the myth that sex with a virgin will cure or
prevent aids.
More factors:
- Stress, such as financial/work-related stress
- Job losses
- Absence of good parenting skills
- Drug/alcohol related problems
- Lack of patience
- Parents lead chaotic lives and dont spend time with their children. Children are left with caregivers
and often go home with public transport.

Classification of child maltreatment

There are various classifications of child abuse:
(Question 22 Tut 501)
(Page 376- 378 Weinstein & Rosen)
Physical abuse
It is non-accidental injury or threat of injury caused by the childs caregiver.
Emotional abuse
Or Psychological maltreatment- any act that results in impairing a childs psychological growth and
development. Emotional abuse underlies all forms of abuse and neglect. Examples- speech disorders, lags in
physical development, failure t thrive and eating disorders.
Sexual abuse
Is characterised as any contact or interaction between a child and a adult in which the child is used fr sexual
gratification or stimulation of the adult.

There are various classifications of child neglect:

Physical neglect
Lack of food, shelter and clothing, failure to provide adequate and appropriate nutrition and safe, sanitary
shelter, inadequate clothing that is appropriate for the weather, poor hygiene.
Emotional neglect
Refusal or failure t provide psychological care (such as failure to help the child develop a positive selfimage or t give positive feedback and reassurance), chronic/harmful exposure of the child to spouse abuse,
permission for the child to use drugs or alcohol.
Educational neglect
Failure t ensure that the child attends school regularly and/or inattention to special educational needs
Child neglect
Caregivers failure to provide for a childs physical, educational, emotional and medical needs.
Discuss the signs and symptoms of the following:
(Question 24 Tut 501- Pages 376-378Weinstein & Rosen)
Physical abuse:
- Repeated/unexplained injuries- burns and bruises
- Wears inappropriate clothing to hide bruises

Unusually fearful of adults

Withdrawn/anxious/uncommunicative and disruptive
Appears malnourished

Physical neglect:
Arrives at school dirty
In need of dental care
Frequently hungry begs or steal food at school
Chronically tired
Inappropriate clothing or footwear

Emotional abuse:
Generally unhappy- seldom smile
Aggressive, disruptive, shy r withdrawn
React without emotions

Emotional neglect:
- Poor academic performance
- Frequently absent/late
- Use any means to gain attention
- Engages in behaviour such as stealing, abuse f drugs
- Seldom participate in extra-curricular activities
Sexual abuse:
- Rapid weight loss/gain
- Sudden failure in school performance
- Fascination with body parts talks about sexual activity
- Complains of pain/itching in genital area
How would you identify an abused child at schools
(Question25 Tut 501- Answer- Symptoms)
Major changes in behaviour
Rapid weight loss/gain
Frequent late/absent from school
Frequently hungry
Dress inappropriately for weather conditions
Chronically tired

Factors contributing towards child abuse and neglect:

(Question 26 Tut 501- Answer page 30-36 Tut 501)
The role of the teacher:
1. Identification of the abused child
The teacher must be able to recognize all the physical and behavioural symptoms which indicate abuse
2. Identification of the abusive adult
The teacher should be on the lookout for behavioural characteristics of a parent which could indicate that
their child was at risk of abuse.
3. Written records
The teacher should keep written records of all observations regarding suspected or actual abuse.
4. Reporting child abuse
The following procedures are important to ensure that the correct legal course can be taken:
Record the childs version of the event, in his own words as soon as possible.
In the case of sexual abuse, the first report is important evidence. If this report is given to the
teacher, he should make a written note of it so that it could be accurately recalled in the case of legal

The teacher should report her suspicions to the principal of the school as well as to a social worker,
medical doctor, nurse or police officer so that a proper investigation can be undertaken.
The teacher should never confront the parents herself as this could anger them, possibly increase the
abuse and destroy the parent-teacher relationship.

5. Helping abused/neglected children

There are several critical things which a teacher should provide to support and help an abused child so that
the child develops a sense of well-being to progress beyond the abuse such as:
Predictable routines
Consistent behaviour
Safe boundaries
God communication skills
More ways of dealing with abused/neglected children:
Provide an early snack for those children who come to school hungry
Allow the child who has had insufficient sleep at home an extra rest period if necessary.
Provide enriched educational experiences for children who may be educationally deprived.
Plan an activity which encourages the development of self-help and self-care skills.
For younger learners- provide sensopathic activities (clay, mud, water, finger-paint and play dough)
for physical activity so that their feelings of success and competence are enhanced.

Child education regarding sexual abuse:

Question- Answer- page 34 Tut 501)

Question 27-Tut 501 & Exam

Ways in which children can be prepared to avoid potentially abusive situations:

Children should be taught that some parts of their body are private. They need to know that no one
has the right to touch these areas, even when wearing clothes- except a teacher, parent or health
professional who is helping with a medical examination.
Children should be helped to identify and differentiate between different types of touching:
Good touches- hugs, kisses and handshakes which make them feel positive about themselves.
Confusing touches which make the children, feel uncomfortable.
Bad touches hitting, prolonged or excessive tickling or touches to private parts of the body.
Children should be taught to say no to unwanted touches
Children must be encouraged to communicate openly.
Teacher should use games and stories to reinforce prevention concepts.
Overt and Covert forms of teacher maltreatment
- These have the effect of denying the child the opportunity to develp a good self-image and humiliate
and embarrass the child:
Covert forms of maltreatment by preschool teachers:
Insistence that children learn to be independent in some areas and dependent in others- when a
teacher is in a hurry and do things for children which they are capable of doing themselves.
Overemphasising academic skills- and school-readiness activities before the child is
developmentally ready for these.
Relying excessively on packaged educational materials- such as workbooks that rob the child of
the opportunity to discover and experiment with natural materials
Restricting the use of materials- which have an intrinsic interest for children, such as water, mud
paint and woodwork and the like because they are too messy, to noisy or too dangerous.

Blaming certain children- for behaviour which is overlooked in a favourite child.

Overt forms of maltreatment:
Direct verbal attack- How can you be so stupid.
Physical coercion- pulling, pushing or shaking a child.

The emotional effects f hospitalisation on the young child:
(Question 29- Page 39-42 Tut 501)
Factors that affect the childs experience f hospitalisation:
1. Age
2. The childs perception of illness, medical procedures and the hospital: a childs
understanding of illness is mainly determined by his cognitive maturation and concepts such
as the cause of illness, the need for treatment and the role of health personnel- it is not
understood by young children.
3. Fear of pain and death: physical pain is a common stressor for any person, because of the
unpleasant sensory, physical, emotional and motor responses which it caused.
The following are common fears in children:
0-3 months: loud noises, loss of support(being dropped)
4-12 months: strangers, strange objects, height, pain
1-3 years: strangers, pain, the unknown, loud machinery, the dark
4-6 years: the unknown, ghosts, separation from family, strange routines, death
4. Separation from family and parents
3 Classic stages in childrens reactions to separation from their mother:
A phase of protest.
During this phase the child is miserable, confused, angry and frightened of the strange surroundings. The
child will refuse all comfort by hospital staff because of the strong conscious need for his or her mother.
A phase of despair:
During this time the child cries uninterruptedly and gradually becomes withdrawn and apathetic. The child
appears to be a state of mourning for the parents whom the child feels abandoned. When the parents visit,
the child will cry pitifully when they leave.
The child will normally avoid interaction with other staff members during this phase.
A phase of denial.
This occurs if separation is repeated and prolonged. It will appear as if the child has adjusted to the
unfamiliar surroundings and will interact with persons around him or her.
When parents visit, the child will show disinterest and little distress when they leave and will appear to be
more attached to hospital staff.

The outcome of the effect of separation depends upon many factors such as:
The age of the child at the time of hospitalisation
The quality of the mother-child relationship before hospitalisation
Whether it is an acute or chronic illness
The amount of appropriate preparation which has been given
The length of the hospital experience

The unfamiliar hospital environment:

The following aspects have been found to improve the childs ability to cope with the strange hospital
familiarizing the child with the hospital environment and allowing the child to explore the area
allowing the child to handle and investigate common medical equipment
providing the child with honest replies to any questions, yet answering simply so that the child understands
the explanation given
verbally acknowledging that the child is entitled to feel scared, yet reassuring him or her about these fears
and clearing up any misconceptions
explaining treatments accurately, but without undue emphasis on pain or discomfort
Definition of regression: (Question 31 Tut 501)
A coping mechanism whereby the individual reverts temporarily to an earlier, previously abandoned
developmental stage of behaviour in order to retain or regain mastery of a stressful, anxiety-producing or
frustrating situation, thus achieving self-gratification and protection.
Four reasons why a child uses regression to cope with the stress of hospitalisation:
The factor of individual differences which will determine if a specific child uses regression because of a
low frustration tolerance or if the child fails to regress because of a previous opportunity to practice coping
with the stress of hospitalization.
The age factor which makes it more likely that the child between the age of two and six years will regress
rather than the older child
The parental-child relationship which affects the childs ability to cope with stress
The degree of stress experienced
Signs of regression

wanting to be dressed, fed or bathed again
thumb sucking
temper tantrums

Responsibility of the teacher in a hospital environment:

(Question 30 Answer- page 43 Tut 501)

Have discussions with other team members so that she or he can make a meaningful contribution to
the childs recovery.
Activities can be provided for hospitalised children

The teacher can arrange for a nurse/doctor to come to the school and tell children more about what
happens at a hospital.
The teacher can arrange outings to the hospital.
Parents experience anxiety due to the following factors:
Lack of information about their childs illness
Lack of support from health personnel
Because they are unfamiliar with the hospital environment and apparatus
Because the cost of hospitalization often incurs great financial hardship for a family


It can be defined as a condition which interferes with the daily functioning of a person for more than 3
months in a year, or which causes hospitalisation for extended periods. This may be a limiting definition
because a person can have a chronic illness like high blood pressure without feeling ill or hospitalised.
(Question 36 Tut 501 Answer page 45)
The teacher should be supportive to both child and parents with regard to the learners needs for
medication during school hours, extra rest periods, specific toileting needs, absences from school, extra help
with school work, embarrassment about physical appearance and the like.
The teacher should maintain confidentiality of any information given to him/her regarding the childs
condition - written parental permission is required to divulge any information to other staff.
The teacher should determine from the parents the learners own understanding and knowledge of
his/her illness (eg some HIV-infected learners will not be aware of their own illness status) and it is NOT
the responsibility of the teacher to inform the child of this.
The teacher should modify the school programme so that, for example, longer rest periods or dietary
adaptations are made possible if required.
The teacher must ensure that the school and classroom environment makes allowances for the childs
specific chronic disease. For example, wheelchair-bound learners should have easy access to the classroom
and classroom activities, while the level of specific allergens (such as pet hair, chalk dust, pollen or moulds)
should be eliminated if there are asthmatic or allergic children in the class.
The teacher should be aware of the effects of any medications which could cause alterations in the
learners behaviour such as drowsiness, hyperactivity and the like.
The teacher should be able to cope with any specific health emergencies related to a specific chronic
illness such as a severe asthma attack or hypoglycaemia due to low blood sugar levels in a diabetic learner.
Children with a chronic disease or disability should be treated the same as healthy children


The very young child has a poor concept of time and space and thus finds it difficult to distinguish between
fantasy and reality. This makes it difficult for the child to distinguish between a permanent and temporary
By the age of four years, most children are interested in death and will talk about these issues without
having a real understanding the finality of death. The child will often describe death as being asleep and
thus believes that the deceased person can return to life.
Between the ages of five to eight, most children begin to realise that death is permanent but do
not view death as a frightening reality which could affect themselves personally.
From the age of eight to ten years, most children begin to grasp the abstract concept that all living things
die and that death is irreversible and will affect them one day.
From nine to eleven years children most children are able to accept death as a part of life and become very
interested in what happens after death.
Grief has 3 main phases:
The protest phase
During this phase the individual is usually reluctant to acknowledge and accept the loss and may appear
dazed or show behavioural symptoms such as fear of being alone, sleep disturbances, changes in appetite or
depression. At this time it is best to maintain the childs normal routine and the teacher should give the child
extra reassurance during the school day.
The teacher should ensure that there are sufficient activities and opportunities to keep busy. The child
should also be given the opportunity to talk, but should not be forced into doing this.
A secure environment will have the most therapeutic effect during the next few months.
The stage of despair and grief
The child may show some overt emotions such as sadness, crying and loneliness.
Some children may regress to a more infantile stage of behaviour or may experience anger and guilt.
Children may also show other signs of being unable to settle at school.
The teacher should provide the child with emotional support and should provide opportunities for
discussions about the deceased person. The teacher should also accept the childs feelings of hopelessness
and should reassure the child that it is a normal reaction to feel upset.
During this stage children come to terms with their loss and begin to view the situation more realistically
and look to the future. It is important to encourage the child to speak of the deceased person and to be
allowed to recall both positive and negative feelings about that person.
A child in your class has recently died from a chronic illness. Explain how you will deal with this
situation in the classroom situation?

(Question 33 Tut 501 Answer page 47 Tut 501)

The teacher should:

Ensure that there are sufficient activities and opportunities to keep busy.
The child should also be given the opportunity to talk, but should not be forced into doing this.
A secure environment will have the most therapeutic effect during the next few months.
Provide the child with emotional support and should provide opportunities for discussions about the
deceased person.
The teacher should also accept the childs feelings of hopelessness and should reassure the child that it is
a normal reaction to feel upset.
It is important to encourage the child to speak of the deceased person and to be allowed to recall both
positive and negative feelings about that person.

Discuss the following statement, children react to death according to their developmental stages.
(Question 35 Tut 501 Answer Page 402 Weinstein & Rosen)
Stage 1

Before the age of 5, children view death as reversible.

They recognized that the disease is gone and view the death more as separation or abandonment.
Children this age is literal

Stage 2

From ages 5/6 to age 9 death becomes personalised

Death is the bogeyman or a skeleton that comes down to take people away
This is a terrifying time for children

Stage 3

After the age of 9

Children are more aware that death is irreversible and will happen to everyone

Discuss the common sources of stress:

(Question 32 Tut 501- Answer Page 276 279 Weinstein & Rosen) (Exam Question)
1. Home and family stress

Parents divorce
Parents that are ill
Accidents, injuries or hospitalization of a family member
Addition of a sibling
Separation from parents due to divorce
Both parents working- leaving little time and attention for the child

How to cope with such stress:


Be sensitive to their feelings

Encourage them to communicate about their feelings
Be good role models

2. Stress in school

First day of school

School adjustment
Teacher disapproval
Fear of riding the school bus
First report card
Not fitting in with other children
Competition in school- not being good enough
Anxiety because of stressful subjects

How to cope with such stress:


Give the child reassurance so his/her fears of being abandoned in this new environment will
Make the class atmosphere warm and welcoming for the child class not overcrowded
Get appropriate books, supplies and resources should be sufficient to meet variety of needs
Teachers should help children with socialization, security and individual attention and help with selfesteem
Give positive feedback to children
Motivate children to develop learning skills in different ways and make it clear that they understand
that they dont have t develop at the same pace
Having children work together in groups toward an explicit goal can reduce the sense of competition
and thereby stress
Make a subject fun for a child that finds stress in a specific subject

The HIV (Human Immunodeficiency Virus) is spread through:

(Tut 501)

Unprotected heterosexual or homosexual intercourse with an infected person (including rape or sexual
Direct contact with blood which is infected with the HIV (eg blood transfusions, surgery, and organ
By maternal transmission (from mother-to-child) during pregnancy, childbirth or breastfeeding.
37 Tut 501)


The teacher should take the following precautions:

Keep all sores or cuts on your hands covered with a waterproof plaster.
Do not sharing items which may become contaminated with blood (such as toothbrushes or razors).
Take universal precautions when treating any bleeding wound or dealing with any bloodcontaminated body fluids or articles.
40 Tut 501)


All blood, blood products and blood-stained body fluids must be regarded as potentially infectious.
NB: This does not apply to faeces, nasal secretions, sputum,sweat, tears, urine and vomitus unless they
contain visible blood!
Any person must use every possible method to prevent direct contact with blood or blood-contaminated
fluids eg using waterproof gloves or plastic bags to protect hands.
Non-porous gloves should also be worn during the clean up of blood spills.
Thorough hand washing must be done after the gloves are removed or after any accidental blood contact.
Disinfect all spills of blood or blood-stained body fluids
Only handle any blood-contaminated clothes and cloths with gloves and soaking these items in the bleach
(hypochlorite) solution before washing them with hot water and soap.
Always put up a notice warning parents and staff about any chickenpox (or other communicable disease)
outbreaks in the school as persons with a low immunity are particularly sensitive to some infections.
A teacher should not discriminate against any person
Absolute confidentiality is required if you are given information regarding a person's HIV status
Written consent of the parent is required before you may divulge confidential
It is to discriminate in any way against HIV-positive persons.
Remember that in the new constitution children have:
the right to health care
the right to freedom from discrimination
the right to education
the right to parental care

How can teachers prevent HIV transmissions during sport? (Question 38-tut 102
page 35-36)

The only possible risk of HIV transmission is during contact sports where injuries can occur. Even here the
risk is extremely small if the following rules are applied.
First-aid kits with rubber gloves should be available during every sports session or match.
No one should play a sport with uncovered wounds or flesh injuries.
If a graze or injury occurs during play the injured player should be called off the field, given first aid and
only allowed back with their injury clean and covered.
Blood-stained clothes should be changed.
Educators and learners with HIV are advised first to discuss with a doctor any possible risks to their health
and of transmission during the sport.
Stop the bleeding as quickly as possible
If a colleague or learner is bleeding, the first action must be to try to stop the bleeding by applying pressure
directly over the area with the nearest available cloth or towel.
Unless the injured person is unconscious or very severely injured, they should be helped to do this
If someone has a nosebleed he or she should be shown how to apply pressure to the bridge of his or her
nose himself or herself.
Cleaning wounds
Once the bleeding has been stopped, injured people should be helped to wash their grazes or wounds in
clean water with antiseptic, if it is available. If not, use household bleach diluted in water (1 part bleach, 9
parts water).
Wounds must then be covered with a waterproof dressing or plaster.
Learners and educators must learn to keep all wounds, sores, grazes or lesions (where the skin is split)
covered at all times.

(Question 39 Tut 501 Answer Tut 102)
1. Non-discrimination and equality with regard to learners, students and educators with HIV/aids
- No learner, student or educator with HIV/AIDS may be unfairly discriminated against directly or
- Educators should be alert to unfair accusations against any person suspected to have HIV/AIDS.
2. HIV/Aids testing & admission of learners to a school & students to and institution, or the
appointment of educators.
- No learner or student may be denied admission to or continued attendance at a school or an institution
on account of his or her HIV/AIDS status or perceived HIV/AIDS status.
- No educator may be denied the right to be appointed in a post, to teach or to be promoted on account of
his or her HIV/AIDS status or perceived HIV/AIDS status. HIV/AIDS status may not be a reason for
dismissal of an educator
3. Attendance at schools and institutions by learners r students with HIV/Aids
- Learners and students with HIV have the right to attend any school or institution.
- The needs of learners and students with HIV/AIDS with regard to their right to basic education should
as far as is reasonably practicable be accommodated in the school or institution.

4. Disclosure of HIV/Aids-related information and confidentiality.

- No learner or student (or parent on behalf of a learner or student), or educator, is compelled to disclose
his or her HIV/AIDS status to the school or institution or employer.
5. A safe school and institution environment.
- The MEC should make provision for all schools and institutions to implement universal precautions to
eliminate the risk of transmission of all blood-borne pathogens, including HIV, effectively in the school
or institution environment.
6. Prevention of HIV Transmission during play and sport.
- Adequate wound management, in the form of the application of universal precautions, is essential to
contain the risk of HIV transmission during contact play and contact sport.
- No learner, student or educator may participate in contact play or contact sport with an open wound,
sore, break in the skin, graze or open skin lesion.
7. Education on HIV/Aids.
- A continuing life-skills and HIV/AIDS education programme must be implemented at all schools and
institutions for all learners, students, educators and other staff members.
- Measures must also be implemented at hostels.

8. Duties and responsibilities of learners, students, educators and parents.

All learners, students and educators should respect the rights of other learners, students and educators.

9. Refusal to study with or teach a learner or with HIV, / to work or be taught by an educator with HIV
- Refusal to study with a learner or student, or to work with or be taught by an educator or other staff
member with, or perceived to have HIV/AIDS, should be preempted by providing accurate and
understandable information on HIV/AIDS to all educators, staff members, learners, students and their

Stages of HIV infection to Aids:


(Page 163-164 Weinstein)

Stage 1 Primary HIV Infection.

Symptoms such as fewer, swollen glands and fatigue
Stage 2 Chronic Asymptomatic Infection.
Evidence of chronically swollen lymph nodes and increasing of infections
Stage 3 Chronic Symptomatic Infection.
Fungus infection in the mouth, infections of the skin, feelings of discomfort, weakness and weight loss
Stage 4 Clinical Aids.
Diagnosed after one or more of 26 diseases have been manifested in a HIV infected person