Child Sexual Abuse.

Abstract

1. Antonia Chiesa, MD* 2. Edward Goldson, MD* 1. *Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO * Abbreviations: CDC: : Centers for Disease Control and Prevention HIV: : human immunodeficiency virus SANE: : Sexual Assault Nurse Examiner STI: : sexually transmitted infection 1. Clinicians should be aware that, in most cases, sexual abuse of a child is distinctly different from adult sexual assault. Usually there is no physical evidence of the abuse and delayed disclosure is common. 2. Developmental and behavioral histories are important components of a medical history for a sexual abuse diagnosis. Clinicians must be aware of normal sexual behaviors in children. The child’s developmental level also informs the approach to evaluation, including how much information can be obtained directly from the child. After completing this article, readers should be able to: 1. Review the epidemiology of child sexual abuse. 2. Recognize the history, signs, and symptoms of sexual abuse. 3. Recognize which patients require emergent evaluation and physical examination for sexual abuse or assault. 4. Describe the behavioral and emotional consequences of child sexual abuse. 5. Describe the normal process of disclosure. 6. Employ effective strategies for interviewing suspected victims of sexual abuse or assault. 7. Recognize that most children examined for sexual abuse have normal examination findings. 8. Discuss common abnormal anogenital findings associated with sexual abuse and differentiate them from those associated with accidental trauma and other medical conditions. 9. Plan appropriate collection of forensic evidence and laboratory evaluation during a sexual abuse concern. 10. Follow mandated reporting laws when there are suspicions of child sexual abuse. Child sexual abuse is one of the most challenging forms of child maltreatment encountered by pediatric clinicians. It is a highly emotional topic in our society, and although the legal and medical definitions appear to be relatively straightforward, it is very difficult to operationalize them in real-life circumstances. Social contexts affect awareness and cultural norms. High-profile cases with sports figures and clergy …