New Guidelines for Evaluating Suspected Child Sexual Abuse

Jenni Laidman

July 31, 2013

Child sexual abuse is common, and pediatricians must know how to respond to it, according to new guidelines from the American Academy of Pediatrics.

The guidelines, published online July 29 in Pediatrics, reiterate the physician's legal obligation to report abuse to the proper law enforcement or child protection agency.

They also provide recommendations on how to talk to parents, how to interview children, what to include in the medical record, and what to cover during a physical examination of the child, as well as when tests should be ordered and, what tests to order, and how to protect the child's mental and emotional well-being. In addition, the guidelines emphasize the need for physicians to know what expert help is available in the community.

Pediatricians should approach every concern about possible child sexual abuse "objectively, thoughtfully, and with an open mind," write authors Carole Jenny, MD, MBA, professor of pediatrics at Brown University, Providence, Rhode Island, and colleagues on the American Academy of Pediatrics Committee on Child Abuse and Neglect.

When the issue of possible child sexual abuse arises during an office visit, physicians need to resolve 5 important issues, the authors write:

  • 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 needs to determine if there is evidence of suspected abuse that would require him or her to contact law enforcement or child protection. "The threshold for reporting is low," the authors write. "The pediatrician should report when there is a reasonable suspicion the child was abused." It is up to the child protective agencies to conduct a thorough investigation to make a final determination of abuse.

  • The pediatrician should also assess the child for possible mental health problems and seek emergency mental healthcare for the child, who may suffer posttraumatic stress disorder and depression or who may be the focus of family anger because of the disclosure.

  • Pediatricians need to perform a thorough physical examination to determine whether the child has been injured, although an exam 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 such evidence be collected if the suspected abuse occurred in the last 72 hours, although the rise of DNA testing may extend the value of forensic evidence even beyond 72 hours.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online July 29, 2013. Full text

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