Guidelines for the Evaluation of Sexual Abuse of Children

Abstract

There are few areas of pediatrics that have so rapidly expanded in clinical importance in recent years as sexual abuse of children. What Kempe referred to in 1977 as a "hidden pediatric problem"1 is certainly less hidden. Recent incidence studies, while imperfect, suggest approximately 1% of children will experience some form of sexual abuse each year.2 Children may be sexually abused either in intrafamilial or extrafamilial settings and are more frequently abused by males. Boys may be victimized nearly as often as girls. Adolescents are perpetrators in at least 20% of reported cases,2 and women may be perpetrators, especially in day-care settings.3 Pediatricians will encounter these cases in their practices and will be asked by parents and other professionals for their opinions. These guidelines are prepared for use by the primary care pediatrician. Pediatricians who "specialize" in the area of child abuse or child sexual abuse have generally developed their own protocols for their referral practices. In addition, specific American Academy of Pediatrics guidelines for the evaluation of rape of the adolescent are published and should be used for this age-group.4 Because a pediatrician has unique skills and a trusted relationship with patients and families, he or she will often be in a position to provide essential support and gain information not readily available to others involved in the investigative, evaluative, or treatment processes. By the same token, the pediatrician may feel inadequately prepared to perform a medical examination of a sexually abused child. The pediatrician should think about these issues when determining how best to utilize his or her skills while avoiding actions that may obstruct the collection of essential evidence.