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Sexual Abuse in Children
Aka: Sexual Abuse in Children, Child Sexual Abuse
- See Also
- Child Abuse
- Sexual Assault of Male Victim
- Symptoms: Sexual Abuse Indicators
- Behavior change
- Unwilling to participate in activities
- Aggression
- School problems
- Sleep problems
- Eating disturbance
- Regression to Thumb Sucking or security blanket
- Bizarre, sophisticated behavior or knowledge
- Beyond age appropriate behavior
- Sexual acting out
- Child may report sexual abuse (believe them)
- May be most important piece of information
- Findings: Sexual Abuse Indicators
- Difficult walking or standing
- Torn, stained or bloody undergarments
- Genital pain or Pruritus
- Genital Bruising or bleeding
- Frequent Urinary Tract Infections
- Encopresis
- Enuresis
- Recurrent Abdominal Pain
- Chronic Headaches
- Pregnancy or Sexually Transmitted Disease
- History: Medical Interview Technique
- Perform alone with open ended questions
- Use neutral tone
- Avoid leading questions
- Record answers exactly as spoken
- Exam: Technique
- Forensic evidence with Rape Kit if within 72 hours
- Consider adjunctive examination equipment
- Colposcope
- Otoscope
- Examination points
- Examination of mouth for forced oral penetration
- Palatal Ecchymosis or Petechiae
- Trauma to frenulum of Tongue
- Genital exam in Girls
- Pubertal girls
- Speculum Exam in lithotomy position
- Prepubertal girls
- Examine in frog-leg position in caretakers lap
- Prone with knee-chest position exam
- Internal exam is typically performed in operating room under sedation
- Endoscope
- Speculum exam for unexplained bleeding
- Moistened cotton swab for hymenal exam
- Foley Catheter in vagina behind hymenal ring
- Genital exam in Boys
- Examine penis, Testicles, perineum, and anus
- Exam: Red Flags
- Findings suggestive of abuse
- Posterior hymenal ring deep notches or clefts
- Condyloma in children over age 2 years
- Significant anal dilatation or scarring
- Findings diagnostic of Penetrating Trauma
- Hymenal Laceration or Ecchymosis
- Posterior hymenal ring tissue defect or cleft
- Anal Laceration
- Management: Sexually Transmitted Disease
- See Rape Management
- References
- Claudius and Willner in Herbert (2019) EM:Rap 19(1): 2-4
- Adams (2004) J Pediatr Adolesc Gynecol 17:191-7 [PubMed]
- Bays (1993) Child Abuse Negl 17:91-110 [PubMed]
- Hymel (1996) Pediatr Rev 17:236-50 [PubMed]
- Lahoti (2001) Am Fam Physician 63(5):883-92 [PubMed]
- (1999) Pediatrics 103:186-91 [PubMed]