There are different types of recognised patterns of abuse, like physical, emotional, sexual and neglect, but these commonly overlap. Physical and sexual abuse are more common in our country.

Research and evaluation division of BRAC did a study on child abuse among working children in rural Bangladesh. They did the study in 150 villages. As per their findings - the prevalence of child abuse and exploitation was widespread in Bangladeshi villages as 2.3% of all children were physically abused, 2% were financially exploited, 1.7% were forced to involve in inappropriate activities and 3% were forced to work for long hours.

The prevalence of physical assault was much higher among younger children. They found poverty was significantly associated with child abuse.

Concern is increasing in Bangladesh over child abuse, neglect and exploitation. Another study done in Child Development Center, Dhaka Shishu Hospital. They also expressed their concern about child abuse in our country.

Physical abuse: The following features arouse the suspicion of non accidental injury.

1. Delay in seeking medical help.

2. A previous history of abuse in child or a sibling.

3. Inconsistency between history and injury.

4. Lack of or vague explanation for the injury from care taker/ parents/attendants.

5. Differing explanations over time.

6. Child said to have contributed to the injury in a manner not possible at their current stage of development.

7. Parents behavior gives cause for concern - disinterested or unexpectedly hostile.

8. Child's relationship with parents seems abnormal - child is frightened withdrawn, or shows frozen watchfulness.

Emotional abuse and neglect are more difficult to identify. Features which may suggest this type of abuse are general neglect, poor hygiene, improper clothing's, failure to thrive etc.

Sexual abuse are more common in girls then boys and about half of the cases occur in children less then five years of age.

Proper history taking, injury survey, skeletal survey, x-ray of injured limb and other relevant investigation helps to diagnose child abuse.

To stop this child abuse raising public awareness is mandatory. A network of concerned organisations should be created to work against the child abuse, neglect and exploitations that Bangladesh has pledged to overcome by signing the UN convention on the rights of the child.

Child abuse is an invisible big problem of our society, we have to fight against it unitedly.

Dr M Karim Khan is an Associate Professor of Department of Pediatrics of Community Based Medical College (CBMC), Mymensingh. [E mail- mkarim_khan@yahoo.com]