Child abuse is an important pediatric health problem. But during my daily medical practice for more than 30 years, I have a question; Does child abuse is a practice with some degree of acceptance and appreciation in some communities?

There are many definitions for child abuse, but the simplest one is, it is any intentional action from side of the person who is caring the child that lead to real or potential harms to a child. The person who endanger the life of the child may be one of his parents [1].

There are many types of child abuse including psychological, sexual as well as physical abuse. Child negligence is a part of child abuse.

The child can suffer any of these forms at home, in schools as well as during his daily life among his community [2].

There is a definition postulated by the World Health Organization (WHO) for this problem, including this simple definition and extending these harms to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power [3].

In developed countries, there are great effort to prevent child abuse, and by laws child abuse is a high priority issue.

But, what about the social and cultural acceptance to child abuse?

Some cultures appreciate and accept some forms of child abuse, where cultural, social and sometime religious believes play a major support to these practice.

In this review, I will discuss in brief 4 conditions of this type of child abuse.

Female genital mutilation (FGM) is considered as a violation of the human rights of girls and is an example of child physical as well as sexual abuse. The victims for this uncivilized practice are usually girls between infancy and adolescence. The procedure is common in Africa, the Middle East and Asia where social, cultural and religious factors support and appreciate practicing this procedure [4].

There are many types of FGM. The most common is removal of clitoris. The clitoris is an important sensitive part in female genitalia and is very important in female sexual life responsible for libido and orgasm. Other procedures will remove or damage other parts of the external genitalia of the girl.

FGM has many health problem and hazards for girls. Shortly after the procedure, the female can suffer from pain, bleeding, shock and death. On the other hand, the female future sexual life will be seriously affected. These long life side effects of FGM includes dyspareunia and decreased satisfaction, with subsequent psychological problems, in the form of a poor self-esteem up to profound effects on the mode and behaviors with depression and anxiety. Childbirth can be affected as well, with difficult labor and increase the need for caesarean section [5].

In the cultures where this practice is common, there is a clear discrimination against women. From social point of view, families who do not believe in FGM will be rejected by the community. The procedure considered in these communities as a normal preparation of the growing girls to her future adult sexual life. They believe that the decreased libido of the ladies will add to her moral and increase their chance for marriage. These cultures believe that decreasing libido will limit sexual practice of the growing ladies to marriage and resist extramarital sexual acts.

There is no clear religious opinion to support the procedure, but it is motivated by some religious leaders.

There are many national and international efforts to prevent this practice, but most of these efforts will be of no value because FGM is a deeply-rooted social problem.

The fact which necessitate a real solution towards changing social believes in the concerned communities [6].

Till a next announcement about possible solution for this procedure, we have to consider it as a part of child abuse with an attitude of acceptance among the community.

Tattoo is another socially accepted practice which carry many risks especially in developing countries.

Tattoo in these communities is practiced without any concern to its clinical hazards as a source for transmitting diseases. The dye used is not purified and the sharp object used during the procedure is not sterilized. It is used interchangeable among persons, and so the procedure carry the risk of transmission of blood borne diseases [7].

During wedding and many social celebrations, the families are very happy to do tattoo for their children especially girls, and again, it is another harm directed against females.

The families especially mothers are responsible for this bad practice, which reflect how much believes and trends control and affect the life style of these communities.

Again, this practice is considered one aspect of child abuse which is socially accepted.

The third problem is the working children. In developing countries child work is considered a normal social practice to help and support the family finance [8]. This will lead to school absence and will affect the child education and future welfare.

This is a type of child neglect and abuse, but with social acceptance. The poverty in the community is the real reason for social acceptance of child working and the solutions must be directed to raise the overall community economy and finance.

The fourth problem in many culture is deeply-rooted believes in cautery to cure a lot of medical problems.

Cautery is considered a social problem with cultural and religious backgrounds.

Communities practice cautery believes well in its value.

They believe that cautery of baby abdomen will treat infantile colic. They are also using the cautery to treat chronic pain whatever its origin [9].

Children irrespective of age and sex are the victims for this bad practices from the family.

A problem which is a part of child abuse with social and cultural acceptance.

At the end, we agree that child abuse is simply any intentional harmful action from side of caregiver which leads to real or potential bad effect to a child. But in some types there is social acceptance to practice this abnormal act and the community consider it as a part of normal behavior and a good actions from their side towards their kids.

Finally, we have to gather sincere and concerted efforts on both the local and international levels, as well as providing the appropriate time to recognize the magnitude of the problems, to understand the believes in the concerned community and how to change these knowledge and believes.

By these gathering, we can be on the sound track that enables us to offer optimum care and protection for the child to reduce all forms of child abuse.

Is it a dream? I hope not.