Experience and Reason: A US Clinician's Perspective of An Approach to Meeting the Diagnostic and Therapeutic Needs of Children Suspected of Being Sexually Abused
Abstract:This paper reflects an approach to the medical evaluation of children alleged to have been sexually abused to meet their diagnostic and therapeutic needs. The approach emphasises the importance of the role of the doctor in conducting thorough medical histories to understand a child's suspected experience and integrating that information into the formulation of a balanced and objective opinion.
Key Practitioner Messages
Understand the clinical presentation of child sexual victimisation.
Appreciate the importa… Show more
“…'s () case study was the medical examination. Our first two papers in this issue discuss the medical evaluation of children suspected of having been sexually abused (Finkel, ; Gifford, ). The first by Martin Finkel, professor of pediatrics in New Jersey, USA, provides a US paediatrician's perspective and considers how CSA may present clinically (including caregiver concerns and children's narratives) and discusses when a medical examination for concerns of sexual abuse might be conducted.…”
supporting
confidence: 86%
“…Our continuing professional development (CPD) paper (to be found at the end of this issue) is from Rosaleen McElvaney () and provides an overview of recent research on children's experiences of disclosing sexual abuse. This complements the papers by Finkel () and Gifford () by highlighting factors that influence children's decisions to disclose CSA and which are reported in a systematic review by Morrison et al . (): ‘…fear of what will happen; others' reactions, such as fear or disbelief; emotions and impact of the abuse; opportunity to tell; concern for self and others; and conflicted feeling about the abuser’ (McElvaney, , p. 167)This CPD paper very helpfully summarises key learning points for practice and importantly talks about creating the opportunities for children to tell, as McElvaney (, p. 168) notes children ‘for the most part do not spontaneously disclose sexual abuse’.…”
Section: Continuing Professional Developmentmentioning
confidence: 97%
“…The first by Martin Finkel, professor of pediatrics in New Jersey, USA, provides a US paediatrician's perspective and considers how CSA may present clinically (including caregiver concerns and children's narratives) and discusses when a medical examination for concerns of sexual abuse might be conducted. The article emphasises the physician's role in ‘conducting thorough medical histories to understand a child's suspected experience and integrating that information into the formulation of a balanced and objective opinion’ (Finkel, , p. 98).…”
mentioning
confidence: 99%
“…We invited Jo Gifford, consultant paediatrician in Coventry, UK, to provide a commentary on Finkel's () paper from her perspective as a UK practitioner. Gifford () helpfully reviews the key points from Finkel's paper from a UK perspective, drawing on the Royal College of Paediatrics and Child Health () guidelines on medical evaluation of children and young people who may have been sexually abused.…”
mentioning
confidence: 99%
“…Her informative commentary includes a useful case illustration highlighting ‘the potential benefit of the medical assessment in terms of evidence, even outside the forensic window for DNA trace evidence, and the difficulties of recognising indicators of CSA in the absence of disclosure’ (Gifford, , p. 108). Both papers (Finkel, ; Gifford, ) highlight the importance of the exercise of professional curiosity in child protection work and having skilled conversations with children and young people about difficult topics. In particular, both stress the importance of listening to children's voices, and, as Gifford (, p. 112) concludes, there is a need ‘to ‘think the unthinkable’ and take timely action.…”
“…'s () case study was the medical examination. Our first two papers in this issue discuss the medical evaluation of children suspected of having been sexually abused (Finkel, ; Gifford, ). The first by Martin Finkel, professor of pediatrics in New Jersey, USA, provides a US paediatrician's perspective and considers how CSA may present clinically (including caregiver concerns and children's narratives) and discusses when a medical examination for concerns of sexual abuse might be conducted.…”
supporting
confidence: 86%
“…Our continuing professional development (CPD) paper (to be found at the end of this issue) is from Rosaleen McElvaney () and provides an overview of recent research on children's experiences of disclosing sexual abuse. This complements the papers by Finkel () and Gifford () by highlighting factors that influence children's decisions to disclose CSA and which are reported in a systematic review by Morrison et al . (): ‘…fear of what will happen; others' reactions, such as fear or disbelief; emotions and impact of the abuse; opportunity to tell; concern for self and others; and conflicted feeling about the abuser’ (McElvaney, , p. 167)This CPD paper very helpfully summarises key learning points for practice and importantly talks about creating the opportunities for children to tell, as McElvaney (, p. 168) notes children ‘for the most part do not spontaneously disclose sexual abuse’.…”
Section: Continuing Professional Developmentmentioning
confidence: 97%
“…The first by Martin Finkel, professor of pediatrics in New Jersey, USA, provides a US paediatrician's perspective and considers how CSA may present clinically (including caregiver concerns and children's narratives) and discusses when a medical examination for concerns of sexual abuse might be conducted. The article emphasises the physician's role in ‘conducting thorough medical histories to understand a child's suspected experience and integrating that information into the formulation of a balanced and objective opinion’ (Finkel, , p. 98).…”
mentioning
confidence: 99%
“…We invited Jo Gifford, consultant paediatrician in Coventry, UK, to provide a commentary on Finkel's () paper from her perspective as a UK practitioner. Gifford () helpfully reviews the key points from Finkel's paper from a UK perspective, drawing on the Royal College of Paediatrics and Child Health () guidelines on medical evaluation of children and young people who may have been sexually abused.…”
mentioning
confidence: 99%
“…Her informative commentary includes a useful case illustration highlighting ‘the potential benefit of the medical assessment in terms of evidence, even outside the forensic window for DNA trace evidence, and the difficulties of recognising indicators of CSA in the absence of disclosure’ (Gifford, , p. 108). Both papers (Finkel, ; Gifford, ) highlight the importance of the exercise of professional curiosity in child protection work and having skilled conversations with children and young people about difficult topics. In particular, both stress the importance of listening to children's voices, and, as Gifford (, p. 112) concludes, there is a need ‘to ‘think the unthinkable’ and take timely action.…”
Child sexual abuse (CSA)as pointed out by Paediatric Research Across the Midlands (PRAM) (2021) in the first paper for this themed issue on sexual abuse and exploitationis common, under-reported and often co-exists with other forms of maltreatment. These features form a backdrop to several of the original papers included in the issue. Recognising Indicators of CSA The PRAM collaboration undertook an audit of child protection medical assessments in the West Midlands to establish whether CSA was being considered when children underwent medical assessments for other forms of maltreatment (PRAM, 2021). Their starting point was the understanding that some children who experience physical or emotional abuse or neglect will also be victims of CSA, but that much of this will go unrecognised, both because the children themselves find it difficult to report and professionals may not recognise, or look for indicators of, CSA. The authors analysed data from nine healthcare trusts over a four-week period 'to establish which factors made it more likely that features specifically useful in the detection of CSA' were looked for (PRAM, 2021, p. 12). Their audit included 91 medical assessments, mostly for physical abuse, in children aged from two weeks to 15 years. They found that persistent or recurrent anal or genital symptoms, bowel or urinary disorders and changes in behaviour were specifically asked about in less than half of the medical assessments, thus potentially missing important indicators of possible sexual abuse. They found that consultants were more likely than trainees to ask about abnormal sexualised behaviours, and that those doctors working in the community (who, they assert, will have had more specific training in CSA) were more likely to enquire about genito-urinary and bowel symptoms. The findings from this audit reinforce the challenge expressed by Finkel (2019, p. 99) that 'the medical community at large could play a more proactive role in providing primary prevention and in the recognition and
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