Child Sexual Abuse in Emergency Medicine Treatment & Management
- Author: Ann S Botash, MD; Chief Editor: Kirsten A Bechtel, MD more...
If a child presents within 96 hours of an acute assault or in the case of chronic incidents of abuse, the family should not bathe the child or allow the child to have anything to eat or drink.
Avoid questioning the child about the incident until appropriate interviewing can be arranged.
However, if the child spontaneously discloses, then who is in the room, what prompted the disclosure, and what time the disclosure occurred should be documented.
Emergency Department Care
The most important treatment is the staff's gentle reassurance that the child is now safe and that efforts and steps will be made to ensure further safety.
Reassurance that there is no permanent genital damage (as is true in most cases) is an important aspect of the child's emotional healing.
Care should be taken to avoid promises that cannot be kept.
Treatment for identified STDs should be initiated.
Prophylaxis is not usually indicated for STDs in prepubertal children but may be considered in adolescents. STD testing should be considered in accordance with local protocols and epidemiology of these diseases.
Possible pregnancy should be discussed with the pubertal child (see Sexual Assault).
Referral or consultation for mental health or other counseling should be made in almost every case of child sexual abuse.
Prophylaxis for HIV should be considered if the sexual contact was within 36 hours. Treatment depends on local protocols, and in most cases consultation with infectious disease experts is needed.
Consult a medical team on call for sexual abuse evaluations if available.
Child Protective Services or hotline
Law enforcement agencies
Rape crisis counselor, victim advocate, and/or other mental health professional
Infectious disease division regarding HIV prophylaxis protocols
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