Approach Considerations

It may be helpful to keep an outline of steps available for all child sexual abuse evaluations. One quick guide is Suspected Child Sexual Abuse.

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.

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.

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 sexually transmitted infections (STIs) should be initiated.

Prophylaxis is not usually indicated for STIs in prepubertal children but may be considered in adolescents. STI 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.

Consultations

Consult a medical team on call for sexual abuse evaluations if available.

Other consultations may include the following:

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

Long-Term Monitoring

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.

Guidelines

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. 1999 Jan. 103(1):186-91. [QxMD MEDLINE Link].
US Department of Health and Human Services, Administration for Children and Families. Child Maltreatment 2016. Children's Bureau. Available at https://www.acf.hhs.gov/sites/default/files/cb/cm2016.pdf. 2018; Accessed: August 1, 2018.
Cutajar MC, Mullen PE, Ogloff JR, Thomas SD, Wells DL, Spataro J. Schizophrenia and other psychotic disorders in a cohort of sexually abused children. Arch Gen Psychiatry. 2010 Nov. 67(11):1114-9. [QxMD MEDLINE Link].
Leetch AN, Woolridge D. Emergency department evaluation of child abuse. Emerg Med Clin North Am. 2013 Aug. 31(3):853-73. [QxMD MEDLINE Link].
Jenny C, Crawford-Jakubiak JE. The evaluation of children in the primary care setting when sexual abuse is suspected. Pediatrics. 2013 Aug. 132(2):e558-67. [QxMD MEDLINE Link].
Palusci VJ, Palusci JV. Screening tools for child sexual abuse. J Pediatr (Rio J). 2006 Nov-Dec. 82(6):409-10. [QxMD MEDLINE Link].
Floyed RL, Hirsh DA, Greenbaum VJ, Simon HK. Development of a screening tool for pediatric sexual assault may reduce emergency-department visits. Pediatrics. 2011 Aug. 128(2):221-6. [QxMD MEDLINE Link].
[Guideline] Adams JA, Kellogg ND, Farst KJ, Harper NS, Palusci VJ, Frasier LD, et al. Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused. J Pediatr Adolesc Gynecol. 2016 Apr. 29 (2):81-7. [QxMD MEDLINE Link].
Berson NL, Herman-Giddens ME, Frothingham TE. Children's perceptions of genital examinations during sexual abuse evaluations. Child Welfare. 1993 Jan-Feb. 72(1):41-9. [QxMD MEDLINE Link].
Palusci VJ, Cyrus TA. Reaction to videocolposcopy in the assessment of child sexual abuse. Child Abuse Negl. 2001 Nov. 25(11):1535-46. [QxMD MEDLINE Link].
Starling SP, Jenny C. Forensic examination of adolescent female genitalia: the Foley catheter technique. Arch Pediatr Adolesc Med. 1997 Jan. 151(1):102-3. [QxMD MEDLINE Link].
Adams JA, Farst KJ, Kellogg ND. Interpretation of Medical Findings in Suspected Child Sexual Abuse: An Update for 2018. J Pediatr Adolesc Gynecol. 2018 Jun. 31 (3):225-231. [QxMD MEDLINE Link].
Myhre AK, Adams JA, Kaufhold M, Davis JL, Suresh P, Kuelbs CL. Anal findings in children with and without probable anal penetration: a retrospective study of 1115 children referred for suspected sexual abuse. Child Abuse Negl. 2013 Jul. 37 (7):465-74. [QxMD MEDLINE Link].
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. 2007 Jun. 20(3):163-72. [QxMD MEDLINE Link].
Kellogg ND, Menard SW, Santos A. Genital anatomy in pregnant adolescents: "normal" does not mean "nothing happened". Pediatrics. 2004 Jan. 113(1 Pt 1):e67-9. [QxMD MEDLINE Link].
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. 2004 Mar. 158(3):280-5. [QxMD MEDLINE Link].
Botash AS. Examination for sexual abuse in prepubertal children: an update. Pediatr Ann. 1997 May. 26(5):312-20. [QxMD MEDLINE Link].
Berenson AB, Chacko MR, Wiemann CM, et al. A case-control study of anatomic changes resulting from sexual abuse. Am J Obstet Gynecol. 2000 Apr. 182(4):820-31; discussion 831-4. [QxMD MEDLINE Link].
Christian CW, Lavelle JM, De Jong AR, et al. Forensic evidence findings in prepubertal victims of sexual assault. Pediatrics. 2000 Jul. 106(1 Pt 1):100-4. [QxMD MEDLINE Link].
Emans SJ, Woods ER, Flagg NT, et al. Genital findings in sexually abused, symptomatic and asymptomatic, girls. Pediatrics. 1987 May. 79(5):778-85. [QxMD MEDLINE Link].
Sexual Assault and Abuse and STDs. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/std/tg2015/sexual-assault.htm. June 4, 2015; Accessed: November 13, 2015.
Botash AS and NYS CHAMP Program Mentors. CHAMP Program Child and Adolescent Sexual Offense. Champprogram.com. Available at http://champprogram.com/pdf/Post-Assault-Testing-and-Treatment-Guide-2016.pdf. October 2016; Accessed: October 31, 2018.
Black CM, Driebe EM, Howard LA, Fajman NN, Sawyer MK, Girardet RG, et al. Multicenter study of nucleic acid amplification tests for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in children being evaluated for sexual abuse. Pediatr Infect Dis J. 2009 Jul. 28 (7):608-13. [QxMD MEDLINE Link].
Leder MR, Leber AL, Marcon MJ, Scribano PV. Use of APTIMA Combo 2: the experience of a child advocacy center. J Child Sex Abus. 2013. 22 (3):297-311. [QxMD MEDLINE Link].
Girardet R, Bolton K, Lahoti S, Mowbray H, Giardino A, Isaac R, et al. Collection of forensic evidence from pediatric victims of sexual assault. Pediatrics. 2011 Aug. 128(2):233-8. [QxMD MEDLINE Link].
Thackeray JD, Hornor G, Benzinger EA, Scribano PV. Forensic evidence collection and DNA identification in acute child sexual assault. Pediatrics. 2011 Aug. 128(2):227-32. [QxMD MEDLINE Link].
Santucci KA, Nelson DG, McQuillen KK, Duffy SJ, Linakis JG. Wood's lamp utility in the identification of semen. Pediatrics. 1999 Dec. 104(6):1342-4. [QxMD MEDLINE Link].
Santucci KA, Hsiao AL. Advances in clinical forensic medicine. Curr Opin Pediatr. 2003 Jun. 15(3):304-8. [QxMD MEDLINE Link].
Muram D, Elias S. Child sexual abuse--genital tract findings in prepubertal girls. II. Comparison of colposcopic and unaided examinations. Am J Obstet Gynecol. 1989 Feb. 160(2):333-5. [QxMD MEDLINE Link].