Children Rights Journal of Rawalpindi Medical University

Second Issue of the Journal of Children’s Rights- Rawalpindi Medical University

Rai Muhammad Asghar — 2022-08-02

It is with great pleasure that we are presenting the second issue of the Child Rights Journal-Rawalpindi Medical University. The main objective behind the journal is to broaden and deepen the knowledge base around children’s rights and their violations in homes, schools, workplaces, Institutions, and other such settings.
The UN General Assembly adopted the Convention on the Rights of the Child (CRC) in November 1989 and since then has been almost universally ratified. The goal of the CRC is to ensure the establishment of rights and provision for children in the socio-cultural, health, political and economic spheres. All state parties to the CRC, including Pakistan, have pledged to bring all their laws and policies in conformity with the CRC. They are further obliged to strive for the enforcement of these rights across the board without any discrimination or biases. Promoting children’s rights and protecting children against abuse, neglect, and exploitation is a collective responsibility of the state and the society at large. Children’s rights can be realized through protective laws, public awareness of children's rights, and creating an enabling environment, where all children have the opportunities to reach their full potential.
In this issue of the Child Rights Journal, Nabila Chaudhry has undertaken a critical review of “Pakistan’s Policy for Persons with Disabilities and National Plan of Action”. Children with disabilities are uniquely at greater risk for abuse, discrimination, and exploitation due to the fact that they are disabled and that they are children. According to the Convention on the Rights of persons with disabilities, the State Parties shall ensure that children with disabilities have the right to express their views freely on all matters affecting them, their views being given due weight in accordance with their age and maturity, on an equal basis with other children, and to be provided with disability and age-appropriate assistance. Despite the fact that Pakistan has a National Plan of Action for Children and a Plan for Disabled Persons, the fact is that these plans are inadequately funded and thus poorly implemented. The problem has been further compounded after the 18th constitutional amendment and devolution of power to the provinces. It is high time that both the National Plan of Action for Children and the National Plan for Persons with Disabilities be revisited and updated in line with the new realities, including the provision of adequate resources for implementation.

Training Newly Qualified Social Workers: Evaluation of an evidence-based training and coaching programme

Stephen Pizzey — 2022-08-02

Introduction: Child and Family Training (CFT) was commissioned by a large local authority (LA) in England to provide a comprehensive training and coaching programme designed to improve newly qualified social workers’ knowledge, skills, and confidence in child and family assessments, parenting assessments, analysis and decision making in child protection and intervention approaches.
Objective: An evaluation of the CFT pilot training and coaching programme was commissioned at the outset and was designed to understand whether ASYEs’ skills, knowledge, and confidence improve following training and whether the training is integrated effectively into their practice.
Participants: Two groups of newly qualified social workers completed a CFT evidence-based training and coaching programme over a twelve-month period between May 2015 and September 2016.
Method: The following measures were used to evaluate the training and coaching programme: the Self-Efficacy Scale for Social Workers (Pedrazza et al. 2013); the Quality of Assessments Questionnaire (Cox and Bingley Miller 2015; Roberts et al. 2016); and, a Confidence Scale (Roberts 2015).
Results: This evaluation found that practitioners improved their skills, knowledge, and confidence. There were statistically significant changes in practitioners’ ability to carry out good quality assessments. Improvements were made in practitioners’ ability to recognise their own limits, establish good relationships with children and families, and in finding support from other professionals when needed. There were significant improvements in practitioners’ confidence in their ability to make effective high-quality assessments, their decision-making skills regarding safeguarding, and their ability to plan and carry out effective interventions with children and families.
Conclusion: These findings are similar to evaluations of CFT training programmes in other organisations and countries. The programme offers training to practitioners to enable them to use the evidence-based tools and approaches to respond to the needs of children and families from a range of cultures delivered in a variety of settings.

Six months Cruel Numbers 2021: A Distressing Scenario of Pakistan

Rizwana Shahid — 2022-08-02

Objective: To determine the frequency of different child abuse acts reported in Pakistan during January–June 2021.
Materials & Methods: A cross-sectional survey was carried out by retrieving the child abuse data 2021 from Sahil NGO. The data was gathered about all the cases of child abuse reported during January-June 2021 pertinent to their provincial and regional placement, age, and gender distribution. The relationship of the child abuser with the victimized child was also investigated. The data was analyzed using Microsoft Excel 2010. Percentages and frequencies of all variables were computed.
Results: Of the total 1896 child abuse cases reported during Jan-Jun 2021 in Pakistan, sexual abuse was maximally (57.2%) registered followed by the cases of abduction (27.6%), missing children (12.5%), and child marriages (2.7%). About 53% of the victimized children were 6-15 years old girls. The majority (60%) of them belonged to Punjab and 58% were residents of the rural community. Approximately 62.2% of the afflicted children were abused by their acquaintances while 25.6%, 2.9%, 2.3%, and 1.9% of the children were mistreated by strangers, relatives, neighbors, and family members respectively.
Conclusion: Child abuse is an exceedingly growing social issue in the Punjab province.

Understanding Implementation of Pragmatism and John Dewey’s Educational Philosophy for enabling participation rights in a Special School

Mehek Naeem — 2022-08-02

Introduction: To set a base for a democratic society where the right to participation is meaningful and engaging, John Dewey argued that a school is a social agency for change. For this, the school needs to provide an enabling environment based on a more hands-on, problem-solving, and experimental approach.
Objective: The current study looks at how educational philosophy such as that of John Dewey and pragmatism is implemented in special schools in Lahore.
Materials and Methods: The study design was quantitative. A sample of 32 participants participated in this study from an NGO-based special school in Lahore. The participants included senior teachers who teach in the elementary section of the school, with at least five years of experience teaching children with disabilities. The sample was selected via convenient sampling. The instrument consists of 21 items that look at John Dewey’s philosophy of education.
Results: 59.37% of teachers agreed that the teaching method utilized is based on problem-solving, dialogue, and self-learning. 71.71% of teachers responded that the school gives its students plenty of opportunities to learn via hands-on activities and 74.9% of teachers felt that adequate activities are provided to students so that they can learn through projects.
Conclusion: This study is just preliminary research looking at the implementation of John Dewey’s philosophical approach in special schools. It is important to note that with children with disabilities, there is already a reliance on teaching and learning aids. While it may be seen that there is an inclination towards experimentation and experiential learning, there was a mixed opinion about how this approach can bridge the gap and make better, democratic citizens for the future where the rights of children, especially the right to participation is fulfilled.

Understanding teacher’s perspectives related to Violence against Children in Schools

Mehek Naeem — 2022-08-02

Introduction: Children need to be protected from all forms of violence in schools. Teachers can play a very important role in early identification, management, and referrals. However, for this, it is important to understand teachers' perspectives related to violence against children.
Objectives: The objective of the study is to identify to explore teachers' own experiences related to violence, identify factors contributing to violence against children in schools, and identify gaps in system development and training according to teachers' perspectives.
Materials and Methods: Data was collected via focus group discussion which included note taking and participant observation during discussion. 8 government school teachers (6 males and 2 females) from primary level to high secondary levels from Sheikhupura district participated in the research.
Results: Analysis of the discussion revealed that violence against children is still very common in schools, including harsh psychological and physical punishment and bullying. Some of the factors contributing to violence against children include the influence of the intergenerational cycle of violence, inadequate support, classroom management issues such as high strength of students, and how teachers felt there was no formal training given to them related to issues such as prevention of child abuse and neglect, positive disciplining in school settings.
Conclusion: This study indicates that the teachers should be aware of school and child psychology, mental health awareness, consequences of corporal punishment along with aspects such as the intergenerational cycle of violence, and there needs to be a more systemic approach to protecting students in schools against violence.

Sexual Abuse in Children: Shocking Figures in Pakistan

Sadaf Ijaz — 2022-08-02

Introduction: Sexual abuse is an alarming issue in children of Pakistan1 which has not only physical but also mental implications.2,3 It is common globally but many cases are not reported because of fear, feeling of self-blame, guilt, or many other reasons.4,5,6
Pakistan is still in the infancy period to deal with and protect child abuse cases although legislation has been passed and needs to work a lot on this issue. This article gives an idea of the current situation in Pakistan so that policies can be made and protective measures were done at the grass root level.
Objective: To determine the frequency of sexual abuse in children of Pakistan.
Materials and Methods: A cross-sectional study with retrospective analysis from the data of SAHIL Non–governmental Organization (NGO) for the year 2017.
Results: In the data analyzed a total of 1002 cases of child sexual abuse were reported in 2017 out of which 414 cases (41%) were of sodomy and 588 cases (58.6%) were of rape. Almost all the age groups were the victims in which boys were more affected in the 6-10 years age group while girls were more affected in the 11-15 years of age group. The data shows that 74% of cases were reported from Punjab, 18% from Sindh, 4% from KPK (Khyber Pakhtoon Khwa), and 2% from Islamabad's capital territory. Also, 17% were from urban areas and 83% were from rural areas.
Conclusion: Alarmingly high figures of child sexual abuse are noted in Pakistan mainly in the province of Punjab and serious efforts are needed for its prevention in terms of public legislation as well as awareness of parents and teaching staff.

Pakistan’s National Policy for Persons with Disabilities and National Plan of Action – A Critical Review

Nabila Chauhdry — 2022-08-02

Introduction: Fifteen years have passed since the National Plan of Action (NPA) was developed for the implementation of the National policy for persons with disabilities (NPPWDs). This policy and plan of action provided a much-elaborated road map to ensure that persons with disabilities get access to their basic rights.
Objectives: This study was conducted to a) Find notional shortcomings b) explore developments made & c) identify inherent biases present in both NPPWDs and NPA.
Materials and Methods: A desk review was carried out to identify gaps & discrepancies in National policy and NPA, and to examine developments and grey areas regarding achievements of the objectives. BIAS FREE framework was used to identify inherent biases in the documents.
Results: Findings of the study indicate that there were clear gaps in what Policy theoretically claimed and what its structure portrayed in reality. Based on BIAS FREE framework all three types of inherent biases (H: Maintaining an existing hierarchy, F: Failing to examine differences, and D: Using double standards) were found.
Conclusion: Legislative cover is now available for a few recommendations; these legislations are either result of direct implementation on NPA while few developments are indirect. A reasonable number of objectives remain unachieved.

A Case of Munchausen by Proxy: A form of Child Abuse

Syeda Sobya Owais — 2022-08-02

Munchausen syndrome by proxy (MSBP), also known as medical child abuse, is a special form of child abuse in which a parent or caregiver fabricates an illness in their child in order to meet his or her own emotional needs via the treatment process. MSBP was first described in 1977 by paediatrician Roy Meadows, who identified parents who invented illness stories about their children and even made up physical signs.³ MSBP has been termed as a factitious disorder by proxy in the Diagnosis and Statistical Manual of Mental Disorders, 5th edition (DSM-V).⁴
Since diagnosing MSBP is a difficult task for any health professional, diagnostic criteria have been defined by Meadow and Rosenberg.⁵ Family members or caregivers, usually, the mother of the child can make up for almost any disease, leading to multiple hospital visits, various treatments, and a high recurrence of the illness.
The perpetrator is usually a mother with mental disorders.⁵ Once the diagnosis is made, it is important to start psychiatric treatment as early as possible while separating the child from the perpetrator.

CPU Report

Tanzeela Rani — 2022-08-02

Children are the future of any nation. The healthy development of children is the base of the success and prosperity of any nation. Child rights are the basic human rights of children. The convention on child rights (international agreement adopted in 1989 with 196 signatory parties) includes four main pillars: the right to survival, the right to protection, the right to development, and the right to participation. Each and every child deserves to be given these rights and to be treated equally, fairly, and with dignity.

To promote awareness of child rights and protection, measures are taken at different levels in society. For this noble cause, a CHILD PROTECTION UNIT (CPU) has been established in the Paediatrics department at Benazir Bhutto Hospital Rawalpindi on 27 Feb 2021. It was inaugurated by the Vice Chancellor of Rawalpindi Medical University, Professor Muhammad Umar. This unit has been established in collaboration with PAHCHAAN (Protection And Help of Children Against Abuse and Neglect).

Our child protection unit aims to identify cases of child abuse and neglect. Once identified, these cases are investigated and proper follow-up is done. Medical treatment and psychosocial support is provided and attendants are counselled. Our unit also has a liaison with 12 sister hospitals from Rawalpindi and Islamabad. One focal person is appointed in each hospital who can report cases from the respective hospital.

Mobilizing students: A novel solution to tackle child abuse in Pakistan

Maria Khan — 2022-08-02

Child abuse is rampant in Pakistan.1 Brushed under the carpet, it may not always present to the legal system.2 But it is more likely to present to the healthcare system. Here, the lack of awareness, stigma, fear of accountability, and practically no reporting forensic system4 and the fact that healthcare workers are not mandated to report such incidents in place makes healthcare workers misdiagnose or ignore signs of child abuse. Such knowledge must be incorporated at an early level in healthcare education to break this cycle, however, dissipating any such knowledge is merely a mechanical exercise. A novel solution to this gap has emerged from a tertiary care hospital: Child Protection Services (CPS).3

CPS is an organization aimed at tackling child abuse, consisting of healthcare workers and medical students advocating for child rights. This organization has a subgroup which is essentially a student society powered by nursing and medical students, who participate not only as general members but are organized into society wings such as the research and community wing. They have leadership roles at each level of the hierarchy, from the head of the society to the wing leadership. Interested undergraduate students can apply to the society, are shortlisted via their CVs and interviews, and assigned to the wing of their choice. Their work and contribution earn them promotion to leadership positions.

CPS serves to raise awareness amongst students about the importance of child abuse as a social and healthcare issue by its simple presence. It helps harness students’ interests in this subject and gives them a chance to interact with like-minded individuals to advocate this cause. The function of the society is even greater; the society generates meaningful research about child abuse, connects students with faculty mentors who are experts in this area, and raises awareness in the community. This includes campaigns in schools, increasing the knowledge of key stakeholders, such as school teachers, and so on.

Child abuse must be reintroduced into the medical curriculum, not only as the forensic and paediatric clinical caveat, but as a social issue, it is and stands to be until groups such as the healthcare workforce are mobilized to advocate for laws, policies, and robust frameworks for reporting child abuse. An example can be via a workshop4 so that the whole picture of child abuse is seen instead of being scattered across disciplines. We must be ready to manage and treat patients who have suffered child abuse, with or without a reporting system- the two stand independently. We must, therefore, ensure that not only are diagnosis and management adequately taught but that the importance of the issue and the moral responsibility of students as individuals in society and as healthcare workers is reflected via our curriculum and via co-curricular, such as that of CPS.

Advertising to Children- Ethical Aspects

Aisha Mehnaz — 2022-08-02

A number of advertisements being aired these days either involve children or are shown to children which is unrealistic and often unethical. Advertising agencies allure children to demand from their parents, items they neither understand nor needed to buy in the first place. Unable to differentiate between reality and fantasy, children start believing in what is shown to them.
On average young children and youth watch more than 30,000 to 40,000 adv. per year on television, in addition, they are further exposed to advertisements through print media like magazines, dailies, pamphlets, etc. Attractive advertisements on billboards and posters on public vehicles are in addition. Internet and social media sites are enticing more children with their slick promotional strategies.
This mammoth exposure is significantly contributing to poor health and nutritional issues in children like obesity and emotional problems. In most countries selling to children and youth is a business strategy. Since it is easier to lure children toward branded items, advertisers find innovative and creative ideas that instantly appeal to young minds. Research has shown that young children are cognitively and psychologically immature and cannot differentiate right from wrong, hence they are defenseless and thus are an easy target. In a number of countries like Sweden and Norway advertising to children, less than 12 years of age are forbidden by law. In some countries, Children Television Act (1990) allows only 10.5min/hour on weekends and 12 mins./hour on weekdays. No such TV act exists in Pakistan. In the USA in 1998, the children online privacy protection act (Publ no.105-277) states that commercial webs cannot collect information from children <13 years and are directed to provide notice on the sites to parents about the collection, use, and disclosure of children personal information and must obtain parental consent prior to advertisement,
Of the number of advertisements, children are exposed to more than 50% are about highly processed food, sugary cereals, fast food, and high caloric snacks and beverages. A good example is an advertisement that promotes a type of spaghetti. All nutritionist agrees that it has no nutritive value but the attractive advertisement is so alluring that children compel their parents into buying the product often throwing tantrums if their desire is not full filled. In most circumstances, parents succumb to their persistent demands.
These instant foods are highly processed because they are made to last a longer shelf life. Their nutritive content is low but fat, calories and sodium are high. Most items are coated with artificial colors, flavors, and preservatives.
The salt used is mostly monosodium glutamate (MSG) which is a chemical preservative derived from the petroleum industry and is added for its taste-enhancing properties. Regular intake of these food items can cause health issues including dependency.
The justification most parents give for buying and giving non-nutritive food is that children refuse to eat home-cooked food and remain hungry until their demands are met, so they have no option but to give in to their demands. This paves for more such demands from the children. Often this leads to Mal(bad) nutrition which can lead to weight loss or obesity. The essential micronutrients like vitamins and minerals necessary for optimal growth of the body are largely missing in a tinned or packaged food item.
Children especially in our country are suffering from various kinds of malnutrition and related micronutrient deficiencies, insufficient knowledge of parents regarding balanced food and unhealthy food advertisement are playing a major part. Often ready to prepare tinned food was shown to be superior to home-cooked food. The manufacturing companies are spending more than twice on marketing as compared to what they should spend on research about their product and their impact on children.
Advertisers need to be careful not to send wrong messages targeting children to indulge in unhealthy eating habits
Another devastating effect of advertising is emotional trauma to children, promoting a certain hair oil or shampoo, or skin product claiming that it will increase their popularity among their peers often leads to a lack of confidence and self-esteem among children who unfortunately do not possess a silky hair or flawless skin. Children in their innocence and ignorance make fun of their peers prompted by the false claim made by the product owners. Thus advertising to children at an impressionistic age has a downside which is considered unethical by most child rights activists.
Well-advertised products attract everyone even adults. Often the product advertised is so appealing that one ends up buying the product, most of the time it may not be a necessity. Children especially do not have the capacity to process the information in their minds and weigh the necessity of obtaining the product.
Advertisements are often so fascinating sometimes that children and youth form an opinion based on what is being portrayed. Soft drinks, for instance, are shown to be the reason behind the growing strength, vitality, and happiness. They start to believe that those who drink a particular soft drink or vitality drink are going to gain more strength, will perform better in exams and sports, and will make them more popular among friends. Little do they know that on the contrary over-indulgence in such energy-dense drinks can lead to obesity and other health issues.
Another detrimental effect of advertisement is the risk of infection. Our advertisers promote children playing with dirt as a sign of healthy recreation and later promote their products to easily wash off the dirt. Little that they realize that children could get sick while playing with dirt and are exposed to infections including worm infestations. Such advertisements do not issue a warning that washing hands thoroughly after playing and or wearing protective gloves is essential before indulging in such activities.
Another category of advertisement particularly appealing to adolescents are where their famous hero is shown to be playing stunts like jumping around on bicycles or taking a dive from a cliff, a number of accidents and even deaths have occurred in adolescents while trying these stunts. There is often no warning at the end of the adv. (like in smoking advertisements.) as a result kids are restless to show off the aerobatics to their friends. Adolescents’ health is also directly affected by advertisements. Which promotes smoking and drugs, especially so in our country where almost any drug is available over the counter.
The responsibility primarily lies with the government and the regulatory authorities to scrutinize the product advertised for children or products with an impact on children’s physical and or emotional health but parental guidance is equally important. In order for children to understand and differentiate between reality and fiction, the guidance of the parents is of utmost importance. Parents need to talk to their children and made them see through the content of the advertisement. With good reasoning, they can make children understand the gimmick of the advertising industry. Parents need to explain to the children to differentiate between healthy and unhealthy food and teach them basic values in life. Making fun or ridiculing other children for not wearing the proper attire or a physical shortcoming like a dark complexion or fizzy hair can damage their relationship and others' self-esteem which is far more harmful than using the particular product. This way the child will learn to be more empathetic, considerate, and responsible.
Parents are definitely accountable for what their children need, but more important is teaching their kids true values in life.
The advertisement companies need to be more responsible especially when advertisements are targeting children.
It is imperative that advertisements that are unethical be removed and banned completely. Only the products that impose no harm should be allowed to be advertised. A committee comprising of Pediatricians, Nutritionists, and Child Psychologists besides technical persons should be constituted to screen the advertisement before any product with untoward effects on children is aired on electronic media or printed in print media.
The constant rise in the number of fast-food restaurant chains, junk eating, and decrease in healthy cooking at home has a drastic effect on our lifestyle. Obesity, heart diseases, diabetes, and renal problems are on the rise More and more children are becoming obese. Obesity is closely linked with PCOS in young girls which may lead to infertility with its ensuing emotional and marital issues. Obesity in children often leads to obesity in adults with its ensuing health problems like coronary heart diseases, diabetes, and hypertension which are expensive to treat and lead to an increase in the medical budget
If the current trend of unhealthy eating among kids and a sedentary lifestyle is not checked Childhood obesity and the Prevalence of type 1 and 2 diabetes will rise which will leads to major health problems later as they grow, already adult onset Diabetes has involved a considerable population of Pakistan, obese children will add to already dangerous prevalence of DM.
A number of countries like Hungary have imposed a fat tax on food high in sugar and fat. It will be highly beneficial to a country like Pakistan if we impose taxes on food products that are known to be dangerous to health.