Evaluation of sexual abuse in children takes special skills

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More than 88,000 children in the United States were confirmed victims of sexual abuse in 2002. Studies have suggested that each year approximately one percent of children experience some form of sexual abuse, resulting in the sexual victimization of 12 to 25 percent of girls and 8 to 10 percent of boys by 18 years of age.

Because many, if not most pediatricians will encounter sexually abused children in their practices, they must be informed about the best means for evaluating sexual abuse in children. A revised clinical report from the American Academy of Pediatrics, "The Evaluation of Sexual Abuse in Children," updates information that clinicians need in order to make that evaluation, including knowledge of normal and abnormal sexual behaviors, physical signs of sexual abuse, appropriate diagnostic tests for sexually transmitted infections, and medical conditions confused with sexual abuse.

The revised report focuses on new information for pediatricians regarding how to diagnose and treat sexual abuse, and indicates that approximately 90 percent of examinations of children and adolescents who are victims of sexual abuse or assault are normal, even when penetration has occurred. In most circumstances, sexual abuse either does not leave an injury, or results in an injury that heals quickly and completely, within days. Because of this, the history or statement from the child is usually the most important factor in the diagnosis and treatment of sexual abuse. Sexual abuse is rarely diagnosed on the basis of only physical examination or laboratory findings.

Because many pediatricians and primary care physicians may not have expertise in this area, an expanding clinical consultation network is available at many children's hospitals, advocacy centers and in other clinical settings to assist the primary care physician with the assessment of child abuse cases.

The report says that because pediatricians have trusted relationships with patients and families, they can provide essential support and guidance from the time that abuse is detected - and moving forward as the child and family recover. Because of this trust, the pediatrician may also gain information from the child or family that is valuable to the investigation, evaluation and treatment of the victim. The report cautions, however, that a close relationship between the pediatrician and the family may pose potential tension, prompting the pediatrician to refer the child to a specialist to avoid conflict in the family.

The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

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