Prevention Book

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Pediatrics

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Sexual Abuse in Children

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  1. See Also
    1. Child Abuse
  2. Symptoms: Sexual Abuse Indicators
    1. Behavior change
      1. Unwilling to participate in activities
      2. Aggression
      3. School problems
      4. Sleep problems
      5. Eating disturbance
      6. Regression to thumb sucking or security blanket
    2. Bizarre, sophisticated behavior or knowledge
      1. Beyond age appropriate behavior
      2. Sexual acting out
    3. Child may report sexual abuse (believe them)
      1. May be most important piece of information
  3. Sexual Abuse Indicators
    1. Difficult walking or standing
    2. Torn, stained or bloody undergarments
    3. Genital pain or Pruritus
    4. Genital bruising or bleeding
    5. Frequent Urinary Tract Infections
    6. Encopresis
    7. Enuresis
    8. Recurrent Abdominal Pain
    9. Chronic Headaches
    10. Pregnancy or Sexually Transmitted Disease
  4. Medical Interview Technique
    1. Perform alone with open ended questions
    2. Use neutral tone
    3. Avoid leading questions
    4. Record answers exactly as spoken
  5. Physical Examination Technique
    1. Forensic evidence with rape kit if within 72 hours
    2. Consider adjunctive examination equipment
      1. Colposcope
      2. Otoscope
    3. Examination points
      1. Examination of mouth for forced oral penetration
        1. Palatal Ecchymosis or Petechiae
        2. Trauma to frenulum of Tongue
      2. Genital exam in Girls
        1. Pubertal girls
          1. Speculum Exam in lithotomy position
        2. Prepubertal girls
          1. Examine in frog-leg position in caretakers lap
          2. Adjuncts (consider Sedation)
            1. Speculum exam for unexplained bleeding
            2. Moistened cotton swab for hymenal exam
            3. Foley Catheter in vagina behind hymenal ring
      3. Genital exam in Boys
        1. Examine penis, Testicles, perineum, and anus
  6. Physical Examination Red Flags
    1. Findings suggestive of abuse
      1. Posterior hymenal ring deep notches or clefts
      2. Condyloma in children over age 2 years
      3. Significant anal dilatation or scarring
    2. Findings diagnostic of penetrating trauma
      1. Hymenal Laceration or Ecchymosis
      2. Posterior hymenal ring tissue defect or cleft
      3. Anal Laceration
  7. Management: Sexually Transmitted Disease
    1. See Rape Management
  8. References
    1. Adams (2004) J Pediatr Adolesc Gynecol 17:191
    2. Bays (1993) {a 18589} Negl 17:91
    3. Hymel (1996) Pediatr Rev 17:236
    4. Lahoti (2001) Am Fam Physician 63(5):883
    5. (1999) Pediatrics 103:186

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