AAP Statement: Protecting Children From Abuse by Providers

Laurie Barclay, MD

June 28, 2011

June 28, 2011 — The American Academy of Pediatrics (AAP) prohibits child sexual abuse or exploitation by healthcare providers and offers recommendations to prevent such abuse, according to a policy statement reported online June 27 in Pediatrics.

"Sexual abuse or exploitation of children is never acceptable," write Cindy W. Christian, MD, and colleagues from the Committee on Child Abuse and Neglect, 2010-2011. "Such behavior by health care providers is particularly concerning because of the trust that children and their families place on adults in the health care profession. The [AAP] strongly endorses the social and moral prohibition against sexual abuse or exploitation of children by health care providers."

AAP Recommendations

Specific AAP recommendations for healthcare providers to protect, to promote health and well-being, and to earn and maintain the trust of their patients include the following:

  1. Because pediatricians must protect and foster their patients' health, sexual encounters with patients are destructive and are strictly forbidden.

  2. Pediatricians and healthcare providers should be advised that most sexual offenses against children are committed by adults with a primary sexual orientation toward other adults. However, risk for premeditated and multiple-victim child offenses is greater in adults with a primary sexual attraction to children. Sexual offenses are committed by heterosexuals and by homosexuals. Any sexual abuse of children by medical providers "is a profound betrayal of their responsibility for patient well-being, trust, and medical ethics."

  3. Medical trainees should be educated regarding appropriate provider–patient boundaries and appropriate use of chaperones during examinations and procedures.

  4. By checking formal state registries and contacting previous employers, medical facilities for children should screen potential employees for previous abuse of a child.

  5. Pediatricians should be trained regarding the indications for and techniques of the genital examination. During annual checkups, routine genital examinations should be performed. Assessment of other specific medical concerns may also be an indication for conducting a genital examination.

  6. Pediatricians must explain to parents and to children who can speak and understand why each part of the examination is being performed. Pediatricians must drape the patient appropriately and allow privacy while changing to ensure that the child's need for modesty is respected. Chaperones should be offered and provided whenever requested by the child and/or parent, when required by standard practice and local regulations, and whenever a chaperone is needed according to the provider's judgment.

  7. Medical facilities for children should implement policies and procedures to train employees of medical facilities for children regarding staff–patient boundaries, use of chaperones, and their duty to immediately report concerns of patient abuse by other staff members.

  8. Parents should be informed of their right to request a chaperone during examination of their child and to report any concerns they may have regarding sexually inappropriate examinations or provider actions. These concerns should be reported to the clinic's or medical facility's administration, or to their state's protective service for investigation, if warranted by their concerns.

  9. All healthcare providers and institutions are legally mandated to report reasonable suspicions of child abuse by another healthcare provider to protective services and/or the police.

    1. Institutions should have implemented policies and procedures to document and assess reported concerns for patient abuse.

    2. Complaints about employees should be handled confidentially, sensitively, and expeditiously. During the investigation, the accused should be provided with independent, confidential support and counseling services.

    3. Individuals and institutions are required to follow legal guidelines for reporting suspected child abuse to the responsible institutional, local, and state authorities.

    4. Individuals and institutions need to cooperate with protective, legal, and licensing agencies responsible for investigating reports of suspected sexual abuse by medical providers.

    5. Because protection of patients from future abuse remains the responsibility of institutions, they should not facilitate transfer of problem providers without notifying other institutions or communities that could potentially be at risk.

  10. Institutions should help victims of sexual abuse by staff to receive appropriate evaluation and counseling as needed.

Sexual abuse in childhood is linked to increased risk for emotional, behavioral, cognitive, social, and general health impairments, including internalizing and externalizing psychiatric disorders, depression, anxiety, substance abuse, conduct/antisocial personality disorder, suicidal ideation and attempts, poor self-esteem, posttraumatic stress disorder, sexually inappropriate behaviors, eating disorders, delinquency, and general behavioral disorders. Adults who were victims of childhood sexual abuse continue to be at increased risk for these psychological disorders.

"When children are abused by those who are entrusted with their medical care, the profession has the responsibility to take the necessary actions to protect future patients from harm by those providers," the authors conclude. "These actions include helping families affected by abuse by ensuring proper emotional support. Pediatricians should also work with government agencies and licensing bodies to ensure that in the future children are protected from pediatricians and other health care providers who sexually abuse patients."

Pediatrics. Published online June 27, 2011. Full text

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