Child Sexual Abuse: Consequences and Implications

Gail Hornor, RNC, MS, PNP

Disclosures

J Pediatr Health Care. 2010;24(6):358-364. 

In This Article

Implications for Practice

Recognition of sexual abuse is crucial for PNPs. Prompt recognition of sexual abuse coupled with reporting of concerns to the appropriate CPS agency can assure safety for the child. All well-child appointments should include a few developmentally appropriate screening questions for sexual abuse. Children and parents should be separated for the screening questions if possible. See the Box 1 for examples of questions to ask children and parents concerning sexual abuse. The well-child examination always should include a thorough ano-genital inspection. The PNP should provide education regarding private parts and that no one should touch, tickle, kiss, or hurt their private parts. One should explain to the child that it is only all right to be examining their genitals today because they are having a check-up and their parent is present. Screening parents for a history of child sexual abuse provides valuable information regarding potential increased risk of sexual abuse for the child, especially if the child has contact with the individual who sexually abused their parent, but also should alert the PNP to potential negative effects on parenting.

If a child discloses a history of sexual abuse or has a physical examination finding that is concerning for sexual abuse, the PNP must report concerns of suspected sexual abuse to the appropriate CPS agency and/or law enforcement agency. CPS is then responsible for the determination of a safety plan for the child and deciding if the child can be discharged home with the accompanying parent/adult. An open, honest discussion should ensue between the PNP and the parent regarding the sexual abuse concerns and the need to report to CPS. Caution should be heeded in this discussion if there are concerns regarding parental support of the allegation or especially if the child has been accompanied to the visit by the alleged perpetrator. PNPs should rely on the guidance of CPS and/or law enforcement when confronted with such a situation.

Only a small portion of child sexual abuse is ever identified; therefore, PNPs must consider the possibility of sexual abuse when a child or adolescent presents with a behavioral or psychiatric disorder that can develop as a result of sexual abuse. I certainly am not implying that every child diagnosed with ADHD or depression has been sexually abused or should be reported to CPS. Rather, when a child presents with depression, suicidal ideation, substance abuse, or PTSD, the possibility of sexual abuse should be explored. These children should be asked a few screening questions regarding sexual abuse.

Every child is an individual, and not every child who is sexually abused will require ongoing mental health therapy. Infants and toddlers who are sexually abused would not be expected to have lasting memories of their sexual abuse and obviously are too young for mental health therapy. Preschool-aged, school-aged, and adolescent children who have been sexually abused should be referred to a mental health therapist with expertise in working with children who have been sexually abused for an assessment to determine the need for ongoing therapy. Asymptomatic children can benefit from therapeutic intervention and education designed to prevent repeated sexual abuse, to normalize and clarify their feelings, and to educate regarding healthy sexual/personal boundaries. The majority of sexually abused children are moderately to seriously symptomatic at some point (Putman, 2003). King, Tonge, and Mullen (2000), as well as Celano, Hazzard, Webb, and McCall (1996), found trauma-focused cognitive-based therapy for the symptomatic child coupled with similar treatment for the non-offending parent to be the most effective treatment for child sexual abuse.

Families of both asymptomatic and symptomatic children should be assessed for the presence of other risk factors such as substance abuse, mental illness, domestic violence, or other dysfunction. Identified risk factors must be addressed and appropriate treatment initiated. Recovery for children can be facilitated by optimizing the strengths of their families and identifying and then addressing their weaknesses.

Noll and colleagues (2008) suggest revisiting mental health therapy at various development points, especially if the developmental task becomes reminiscent of the sexual abuse. Potential trauma invoking developmental changes include forming romantic relationships, becoming sexually active, and becoming a parent.

Child sexual abuse can result in serious sequelae, especially if unrecognized and untreated. Astute recognition and reporting of sexual abuse by the PNP is vital. Routine screening for sexual abuse by the PNP and all primary care providers should be a standard of care. Realizing that sexual abuse can result in a variety of behavioral and psychiatric symptoms prior to or following disclosure of sexual abuse is essential for the PNP. Appropriate mental health referrals are critical. The PNP plays an essential role in keeping children safe and helping children and their families heal following the trauma of sexual abuse.

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