The definition of a “child” in the UN Convention on the Rights of the Child states “For the purpose of the present Convention, a ‘child’ means every human being below the age of eighteen years, unless, under the law applicable to the child, majority is attained earlier.”
Children have the right to have their consent and confidentiality respected. Except in emergencies, they should not be given medical treatment without a parent or guardian present. Similarly, a detailed account of the cause of injuries should only be taken from a child in the presence of a parent or guardian or, if they are not available, someone else representing the child’s best interests.
Older children may be tortured to suppress political activity. They should be treated in the same way as young adults, and the approach needs to be very sympathetic. Torture of younger children is generally performed to put pressure on parents. Where possible, the family should be treated together and the child’s injuries should be documented and managed by pediatric specialists.
A child in particular needs to be in an environment in which he or she feels comfortable before being willing to disclose sensitive information. In discussing traumatic events, a child may prefer to draw a picture and then to explain it. Children’s attention spans can be quite short, so it may be necessary to break the interview frequently.
Children may also be victims of rape and sexual assault. Even older children may be unaware of what happened to them, and may not be able to give a coherent account of their experience. Using drawings and, if available, dolls may help them explain where they do not have the necessary language or understanding. It is even more important that the examination is by someone who is experienced in this field.
Many cases of torture of children have been documented by human rights organisations, and it is feared that those cases form only the tip of the iceberg. Yet there is a general disbelief that torture can be perpetrated against children. Torture and sexual abuse of children is wide- spread, particularly in conflicts dominated by ethnicity. The girl child is doubly susceptible to violence, because of her gender and because of her age.
Children may be secondary torture victims because of the violence or torture perpetrated against one or more of their relatives. They may also be primary victims. Since there are many reports on how children have been subjected to the same torture methods as adults, it may be expected that they present similar physical symptoms as adults. Still, very little is known about the physical consequences of torture that are typical for children.
Children should be examined in a way appropriate for their age. Nevertheless, the health professional should realize that for many of the world’s children, childhood ends long before they reach the age of eighteen, the age when according to most international standards they become adults. Their stories of the violence suffered by them should be respected and taken seriously. However, they may often prefer to stay silent, move away and hide and bury their experiences.
Children may react to trauma with depression, sleep disturbances, nightmares, anxiety, fears, learning problems, post-traumatic stress disorder, enuresis, or less frequently encopresis etc. Regressive enuresis (occurs after children were previously dry) may be triggered by stressful events. Physical examination and urinalysis are indicated to exclude organic damages, but organic pathology may be found in only a very small number of cases. Possible differential diagnoses are urinary tract infections (especially girls) and diabetes mellitus. Encopresis is less common than enuresis. It is a problem that in most cases develops as a result of long-standing constipation. It may represent emotional problems. As in the case of enuresis, organic defects are rarely found, but should be excluded.
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