eMedicine Specialties > Emergency Medicine > Pediatric

Pediatrics, Child Sexual Abuse: Follow-up

Author: Ann S Botash, MD, Director, Child Abuse Referral and Evaluation Program, Professor and Vice Chair for Educational Affairs, Department of Pediatrics, State University of New York Upstate Medical University
Contributor Information and Disclosures

Updated: Jul 2, 2008

Follow-up

Further Inpatient Care

  • Inpatient care is recommended if the child's safety is in jeopardy or if the child has an acute traumatic injury requiring inpatient treatment.
  • Occasionally, treatment for a STD requires hospital admission and inpatient treatment.
  • Severe mental or emotional trauma may necessitate inpatient admission and care.

Further Outpatient Care

  • Most sexually abused children should be referred for mental health counseling.
  • Follow up for medical problems (eg, genitourinary complaints) should be arranged with the child's primary care physician.
  • If the community has a child abuse referral center, the children should be referred there for follow-up care according to local protocol.

Inpatient & Outpatient Medications

  • Prophylactic antibiotics in prepubertal sexually abused children are indicated in rare cases.
  • Prophylactic antibiotics may be given to pubertal sexually abused children after an acute assault.
  • Use of postassault pregnancy prevention options should be discussed with the pubertal sexual assault victim.

Complications

  • Infection
  • Psychological/social problems

Prognosis

  • Sexually abused children have significantly higher occurrences of the following:
    • Eating disorders
    • Suicidal behaviors
    • Self-injury
  • Children who are sexually abused may be at increased risk of reabuse.
  • Ongoing emotional/psychological problems may be indicative of abused children's false beliefs about themselves and the sexual abuse experience.

Patient Education

  • Families are usually concerned about injury in the child. Reassurance may involve an explanation that children can be sexually abused and have no physical findings to support their allegations.
  • For excellent patient education resources, visit eMedicine's Children's Health Center and Public Health Center. Also, see eMedicine's patient education articles Child Abuse and Sexual Assault.

Miscellaneous

Medicolegal Pitfalls

  • Proper history and physical documentation using a sexual abuse protocol decrease the need for future testifying.
  • The following are tips for testifying:
    • Prepare the case. Review the entire medical record, review literature pertinent to the case, and plan your explanation of medical findings and case development to the jury. Call the court and arrange to be "on call" for testimony.
    • Meet with the prosecutor and review the case. Practice sample questions; discuss significant findings; assist the attorney with a logical approach to your testimony; and discuss possible cross-examination issues, potential weaknesses in the case, and visual aids.
    • Do not discuss the case casually or publicly.
    • In the courtroom, listen carefully to the entire question before responding, do not answer a question that you do not understand (ask for clarification or restatement), give simple answers, and do not volunteer information.
    • Do not offer additional explanation beyond the direct question. That is, keep your answers as simple as possible.
    • Concentrate on the truth (do not worry about whether your answer is going to hurt or help the case).
    • If a question is beyond your area of expertise, say so.
    • Do not speak after an attorney objects until the judge rules.
    • Ignore inflection and innuendo.

Special Concerns

  • Children may present to the emergency department with a vague history of genital complaints and a parental concern of child abuse but no other findings or specific disclosure. Evaluation for other genital problems, including urethral prolapse, urinary tract infection, accidental straddle injury, vaginitis due to poor hygiene or pinworms, and masturbation should be considered.
  • Children repeatedly presenting to the emergency department for evaluation of sexual abuse should raise suspicion of parental misuse of the examination for secondary gain (eg, false allegations in custody situations, maternal mental illness).
 


More on Pediatrics, Child Sexual Abuse

Overview: Pediatrics, Child Sexual Abuse
Differential Diagnoses & Workup: Pediatrics, Child Sexual Abuse
Treatment & Medication: Pediatrics, Child Sexual Abuse
Follow-up: Pediatrics, Child Sexual Abuse
References
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References

  1. American Academy of Pediatrics. Guidelines for the evaluation of sexual abuse of children: subject review. American Academy of Pediatrics Committee on Child Abuse and Neglect. Pediatrics. Jan 1999;103(1):186-91. [Medline].

  2. US Department of Health and Human Services, Administration for Children and Families. Child Maltreatment 2005 [Web site]. US Department of Health and Human Services. Available at http://www.acf.dhhs.gov/programs/cb/pubs/cm05/cm05.pdf. Accessed March 20, 2008.

  3. Palusci VJ, Palusci JV. Screening tools for child sexual abuse. J Pediatr (Rio J). Nov-Dec 2006;82(6):409-10. [Medline].

  4. Berson NL, Herman-Giddens ME, Frothingham TE. Children's perceptions of genital examinations during sexual abuse evaluations. Child Welfare. Jan-Feb 1993;72(1):41-9. [Medline].

  5. Palusci VJ, Cyrus TA. Reaction to videocolposcopy in the assessment of child sexual abuse. Child Abuse Negl. Nov 2001;25(11):1535-46. [Medline].

  6. Starling SP, Jenny C. Forensic examination of adolescent female genitalia: the Foley catheter technique. Arch Pediatr Adolesc Med. Jan 1997;151(1):102-3. [Medline].

  7. Adams JA, Kaplan RA, Starling SP, Mehta NH, Finkel MA, Botash AS, et al. Guidelines for medical care of children who may have been sexually abused. J Pediatr Adolesc Gynecol. Jun 2007;20(3):163-72. [Medline].

  8. Kellogg ND, Menard SW, Santos A. Genital anatomy in pregnant adolescents: "normal" does not mean "nothing happened". Pediatrics. Jan 2004;113(1 Pt 1):e67-9. [Medline].

  9. Adams JA, Botash AS, Kellogg N. Differences in hymenal morphology between adolescent girls with and without a history of consensual sexual intercourse. Arch Pediatr Adolesc Med. Mar 2004;158(3):280-5. [Medline].

  10. Hammerschlag MR. Appropriate use of nonculture tests for the detection of sexually transmitted diseases in children and adolescents. Semin Pediatr Infect Dis. Jan 2003;14(1):54-9. [Medline].

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  12. Adams JA. Medical evaluation of suspected child sexual abuse. J Pediatr Adolesc Gynecol. Jun 2004;17(3):191-7. [Medline].

  13. Adams JA, Harper K, Knudson S, et al. Examination findings in legally confirmed child sexual abuse: it's normal to be normal. Pediatrics. Sep 1994;94(3):310-7. [Medline]. [Full Text].

  14. Berenson AB, Chacko MR, Wiemann CM, et al. A case-control study of anatomic changes resulting from sexual abuse. Am J Obstet Gynecol. Apr 2000;182(4):820-31; discussion 831-4. [Medline].

  15. Botash AS. Child Abuse Evaluation and Treatment for Medical Providers. 2008. ChildAbuseMD. Available at http://www.ChildAbuseMD.com.

  16. Botash AS. Examination for sexual abuse in prepubertal children: an update. Pediatr Ann. May 1997;26(5):312-20. [Medline].

  17. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2006. MMWR. 2006;Vol. 55:1-84. [Full Text].

  18. Christian CW, Lavelle JM, De Jong AR, et al. Forensic evidence findings in prepubertal victims of sexual assault. Pediatrics. Jul 2000;106(1 Pt 1):100-4. [Medline].

  19. Emans SJ, Woods ER, Flagg NT, et al. Genital findings in sexually abused, symptomatic and asymptomatic, girls. Pediatrics. May 1987;79(5):778-85. [Medline].

  20. Evans H. Vaginal discharge in the prepubertal child. Pediatr Case Rev. Oct 2003;3(4):194-202. [Medline].

  21. Finkel MA. Anogenital trauma in sexually abused children. Pediatrics. Aug 1989;84(2):317-22. [Medline].

  22. Finkelhor D. Current information on the scope and nature of child sexual abuse. In: Sexual Abuse of Children: The David and Luc Center for the Future of Children. Vol 4. 1994:31-53.

  23. Kellogg N. The evaluation of sexual abuse in children. Pediatrics. Aug 2005;116(2):506-12. [Medline]. [Full Text].

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  25. Siegel RM, Schubert CJ, Myers PA, Shapiro RL. The prevalence of sexually transmitted diseases in children and adolescents evaluated for sexual abuse in Cincinnati: rationale for limited STD testing in prepubertal girls. Pediatrics. Dec 1995;96(6):1090-4. [Medline].

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Further Reading

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Keywords

child abuse, sexual abuse, contact sexual abuse, penetrating injury, nonpenetrating injury, noncontact sexual abuse, incest, rape, child rape, sexually transmitted disease, STD, child sexual abuse

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Contributor Information and Disclosures

Author

Ann S Botash, MD, Director, Child Abuse Referral and Evaluation Program, Professor and Vice Chair for Educational Affairs, Department of Pediatrics, State University of New York Upstate Medical University
Ann S Botash, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, American Pediatric Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Medical Editor

Kirsten A Bechtel, MD, Associate Professor of Pediatrics, Department of Pediatrics, Yale University School of Medicine; Consulting Staff, Department of Pediatric Emergency Medicine, Yale-New Haven Children's Hospital
Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Wayne Wolfram, MD, MPH, Clinical Associate Professor, Departments of Pediatrics, Children's Hospital and University of Cincinnati
Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD, Assistant Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston
Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research
Disclosure: none None None

 
 
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