G515(P) Child sexual abuse: children at risk are being ignored

Abstract

Background Child sexual abuse (CSA) affects 11.3% UK children, more commonly those who have suffered other forms of abuse. There are many barriers which prevent children from disclosing CSA, therefore health care professionals must be proactive to detect it. Children suffering from physical abuse or neglect in the UK regularly undergo a Child Protection Medical Assessment (CMPA). It is vital that this is performed rigourously to detect co-existant CSA. Aims We aimed to determine whether the Royal College of Paediatrics and Child Health (RCPCH) standards for child protection medicals are being met, with a focus on whether indicators of CSA are recorded. Methods Data were collected prospectively across the region; any child (0–16 years) being referred for a child protection medical examination over a 4 week period were included. Children for whom CSA was the presenting concern were excluded. Data were analysed using multivariable logistic regression to establish which factors made it more likely that features specifically useful in the detection of CSA were present in the CMPA. Results In 91 examinations, anal or genital symptoms were specifically asked about in 25%, constipation was asked about in 41% and UTIs in 18%. A change in behaviour or mood was asked in 44% and specific abnormal behaviours in 26%. Persistent genital and anal symptoms were more likely to be enquired about if the medical was undertaken in a community setting (OR 6.59, 95% CI 2.05–21.1). A history of bowel and urinary problems were also more likely to be asked in community based medicals. Forty three percent of verbal children were spoken to alone. Conclusion Clinicians performing CPMAs are not consistently considering CSA in the children they are assessing. Given the frequent co-existance of different forms of abuse, we risk failing the children that we are aiming to protect using this approach. Anal, genital, bowel and urinary symptoms were more likely to be enquired about in the community; this may be due to differences in the training of the clinicians, differences in the children assessed or differing external factors.