Abuse
Sexual Abuse in Children
search
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 Infection
s
Encopresis
Enuresis
Recurrent
Abdominal Pain
Chronic
Headache
s
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,
Testicle
s, 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]
Type your search phrase here