Evaluation of the Sexually Abused Child

Heger, Astrid; Emans, S. Jean

doi:10.1097/00004703-199312010-00013

Cited by 23 publications

(13 citation statements)

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“…8,14,15 In this study, none of these presenting symptoms were associated with an increased likelihood of a sexual abuse diagnosis. Overall, slightly more than half (54%) of the patients with these symptoms and signs had findings reflective of the presenting complaint.…”

Section: Commentmentioning

confidence: 50%

“…Many, if not most, examinations of sexually abused children elicit no abnormalities. 8 Depending on the type of sexual contact, there may be no visible tissue damage. When tissue damage does occur, injuries may heal quickly and completely.…”

Section: Commentmentioning

confidence: 99%

“…The children may present with anogenital symptoms or signs, including bleeding, pain, inflammation, and vaginal discharge. 8 Alternatively, they may be asymptomatic, and a clinician may uncover suspicious findings during the anogenital examination. Clinicians are challenged to differentiate symptoms or findings attributable to sexual abuse from physiologic, skin, or other conditions.…”

mentioning

confidence: 99%

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Children With Anogenital Symptoms and Signs Referred for Sexual Abuse Evaluations

Kellogg

Parra

Menard

1998

Arch Pediatr Adolesc Med

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Section: Commentmentioning

confidence: 50%

Section: Commentmentioning

confidence: 99%

mentioning

confidence: 99%

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Children With Anogenital Symptoms and Signs Referred for Sexual Abuse Evaluations

Kellogg

Parra

Menard

1998

Arch Pediatr Adolesc Med

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“…Taking sexual abuse into the diagnostic process is an important step in correlating a pattern of behavioural and medical indicators with the possibility of sexual abuse [2]. Behavioural indicators include a history of a newly manifested clinging behaviour and irritability, thumb sucking and loss of bowel control, sleepwalking or bed-wetting, anorexia, loss of concentration and sexualised behaviour inappropriate for developmental age [3,4]. Medical indicators are bruising, scratching, bites, sexually transmitted diseases, bloodstained underwear, bruising of the anogenital region, bruises without consistent history, enuresis, constipation and anal fissures.…”

Section: Discussionmentioning

confidence: 99%

δ-Storage pool disease: a pitfall in the forensic investigation of sudden anal blood loss in children: a case report

et al. 2005

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We present the case of a 3.5-year-old boy with sudden anal blood loss at school. Sexual abuse was suspected, and, apart from anal fissures seen on sigmoidoscopy, no other clinical signs of any sort of disorder were present. As no medical explanation for the blood loss could be given, penetrating anal trauma was suggested. During follow-up consultations, there were complaints of occasional blood loss. Platelet aggregation tests and electron microscopy finally helped diagnose a delta-storage pool disease which is a rare haemostatic disorder involving the dense granules of the platelets. Although exclusion of well-known blood diseases through routine laboratory testing is a common practice in children with sudden blood loss, this case illustrates the value of more specialised investigation both from a diagnostic and forensic point of view.

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“…Increasingly, it appears that doctors are being asked in court to justify their expertise by referring to the numbers of CSA examinations they conduct. Previous studies have shown that the clinical findings are influenced by the experience of the examiner and examination technique, as well as the position of the child during examination (McCann et al, 1990;Adams, 1997;Heger et al, 2000). A survey in the United States (Adams and Wells, 1993) showed that more experienced examiners were likely to perform between five and 25 sexual abuse examinations per week.…”

mentioning

confidence: 99%

Medical examinations for child sexual abuse in Scotland: good enough practice?

Mok

Busuttil

2004

Child Abuse Review

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This questionnaire survey of a representative sample of practitioners in Scotland sought to establish specifically how widely guidance on child protection issued by the Scottish Executive Health Department was being followed by practitioners, NHS Trusts and health boards. It aimed to identify the medical practitioners involved and the range of current practice in child sexual abuse examinations throughout Scotland. The results suggest that the medical assessment of children who disclose sexual abuse is a low-volume, highly specialized activity, practised by about one in five paediatricians and forensic medical examiners in Scotland. Most (79%) are aged between 41 and 60 years; 59.8% have less than 10 years' experience in the field; and the majority (86.3%) perform fewer than two examinations per week. Available guidance is comprehensive and uniform, highlighting the importance of joint specialist working, use of the colposcope for photodocumentation, training and continuing professional development in this specialized area of work. Despite this, the results of our survey of practitioners show that throughout Scotland, the care offered to children and the service provided to the courts are suboptimal.

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Evaluation of the Sexually Abused Child

Cited by 23 publications

References 0 publications

Children With Anogenital Symptoms and Signs Referred for Sexual Abuse Evaluations

Children With Anogenital Symptoms and Signs Referred for Sexual Abuse Evaluations

δ-Storage pool disease: a pitfall in the forensic investigation of sudden anal blood loss in children: a case report

Medical examinations for child sexual abuse in Scotland: good enough practice?

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