Sexual activities imposed on children represent an abuse of the caregiver's power over the child. The sequence of activities often progresses from noncontact to contact over a period of time during which the child's trust in the caregiver is misused and betrayed. Pediatricians are often in trusted relationships with patients and families and are in an ideal position to offer essential support to the child and family. Thus, pediatricians need to be knowledgeable about available community resources, such as consultants and referral centers for the evaluation and treatment of sexual maltreatment.
Essential update: New AAP guidelines on child sexual abuse
New guidelines regarding child sexual abuse were issued by the American Academy of Pediatrics (AAP) in July 2013. They provide recommendations such as how to talk to parents, how to interview children, what to include in the medical record, what to cover during a physical examination of the child, when tests should be ordered, and how to protect the child’s mental and emotional well-being.
The guidelines enumerate 5 important issues that must be resolved when the issue of possible child sexual abuse arises during an office visit:
- The pediatrician must determine whether the child is at any risk for additional harm if he or she returns home; if the child may be put at risk, this constitutes a child protection emergency, and child protective services or law enforcement should be contacted at once
- In the absence of imminent risk, the physician must determine if there is evidence of suspected abuse that would require him or her to contact law enforcement or child protection
- The pediatrician should assess the child for possible mental health problems and seek emergency mental health care for the child, who may suffer posttraumatic stress disorder (PTSD) and depression or who may be the focus of family anger because of the disclosure
- Pediatricians must perform a thorough physical examination to determine whether the child has been injured, though examination may be deferred if the suspected abuse was in the distant past and the child is without symptoms
- Finally, if the abuse was recent and involved exchange of bodily fluids, the child should be immediately referred to those capable of gathering forensic evidence, such as a specialty clinic or an emergency department; many states require that such evidence be collected if the suspected abuse occurred in the last 72 hours, though the rise of DNA testing may extend the value of forensic evidence even beyond 72 hours
