Well, to be honest, I had no idea what I was looking at untill Tofu explained it (and even then it took me a couple of minutes to see the figure of the child in the ground). So that's the 1st reason why I didn't vote.
You might think, well just look at the title, it should give you a clue. Well, I seldomly look at a title, an image has to speak for itself without the aid of a title.
Second, I second the statement of Tofu about child abuse. Children are a very sensitive subject to work with. People don't like seeing children being hurt, even if it is fake. If you would have used a grown person, the sensitivity might have taken off (for instance a sort of mafia theme).
Third: as said before, when you're doing these kind of things, you have to be skilled to make it work. Like micose said, there are various artist who get away with these kind of things due to their experience and artistic superiority. I, myself, wouldn't even try such a thing, because I'm just no good enough too pull it off (maybe I am, but I don't have that confidence yet
)
But don't get dissapointed, chop on and get the skills
are you real or fake?
There is a place for "in your face" too. If it is done with amazing skill it will be more accepted for it's artistic qualities (to a point) If you are just going for shock value, don't expect a lot of votes. Just be happy that you were able to annoy, offend, or sicken some people which can be a lot of fun too. 
ok, there may be some little quality-matters too...
