Child Sexual Abuse in Emergency Medicine Guidelines

Updated: Sep 24, 2019
  • Author: Ann S Botash, MD; Chief Editor: Kirsten A Bechtel, MD  more...
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Guidelines

Guidelines Summary

Medical history

Accurate and complete history is essential to making a medical diagnosis of sexual abuse. The history should include physical symptoms; emotional and behavioral symptoms; and past medical, family, and social histories. Information about the abuse needs to be collected to ensure appropriate management.

Examination

Evaluation can be prioritized as emergent (done without delay), urgent (done within 1-7 days), or nonurgent. Forensic evidence collection is recommended within 24 hours (prepubertal children) or 72 hours (adolescents) in cases of sexual contact. [8] Please refer to Physical Examination for details.

Workup

Laboratory testing for chlamydia, gonorrhea, hepatitis B, syphilis, and HIV should be considered. Please refer to Workup for guidance regarding obtaining samples. A rape kit should be done if the child presents for an examination within 96 hours of the sexual abuse.

Treatment

It is most important to reassure the child that he or she is safe and that steps will be taken to further ensure their safety going forward. Confirmed STIs should be treated. Prophylaxis for STIs should be given to adolescents. HIV prophylaxis should be considered in all children suspected of being sexually abused if exposure was within 36 hours (72 hours if using the CDC guidelines). Further workup/treatment should be initiated for any physical trauma.

Documentation

Documentation should always be thorough and include history, physical examination, laboratory testing results, imaging results, and interpretation of results. Use language that can be understood by nonmedical professionals. Including photo documentation, especially in cases with positive findings, is the recommended standard of care.

Consultations

Consult a medical team on call for sexual abuse evaluations if available. Infectious disease consultation is required for children who receive HIV prophylaxis. Always call Child Protective Services and/or law enforcement. Mental health referral for counseling is imperative.