Child Sexual Abuse in Emergency Medicine Treatment & Management

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

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.

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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 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.

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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
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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.

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