Child Sexual Abuse in Emergency Medicine Treatment & Management

  • Author: Ann S Botash, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Oct 14, 2011
 

Prehospital Care

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.

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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.

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Consultations

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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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, Helfer Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Kirsten A Bechtel, MD  Associate Professor, Department of Pediatrics, Yale University School of Medicine; Attending Physician, 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.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

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.

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  Associate 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: Nothing to disclose.

References

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