Emergency Department Assessment of Children and Teen Victims
Transcript Of Emergency Department Assessment of Children and Teen Victims
Emergency Department Assessment of Children and Teen Victims of Sexual Abuse
Jacqueline Sugarman, MD Associate Professor of Pediatrics
University of Kentucky Medical Director, Children’s Advocacy Center of the Bluegrass
Objectives
• Recognize common presentations of sexually abused children • Dispel myths related to sexual abuse • Recognize the indications for evidence collection • Know how to report suspected abuse • Know how to obtain additional consultation
Child Sexual Abuse
• “Occurs when a child is engaged in sexual activities he/she cannot comprehend, for which he/she is developmentally unprepared and cannot give informed consent and which violate social and legal taboos.” (Kempe, 1978)
Child/Teen Sexual Abuse Statistics
• 9.3% of cases of maltreatment of children in 2012 were classified as sexual abuse.
• 62,939 cases of child sexual abuse were reported in 2012
• Research conducted by the Centers for Disease Control (CDC) estimates that approximately 1 in 6 boys and 1 in 4 girls are sexually abused before the age of 18
• Teens 16 to 19 years of age were 3 ½ times more likely than the general population to be victims of rape, attempted rape, or sexual assault
Common Presentations for Child and Adolescent Sexual Abuse
• Disclosure • Injury • Sexually Transmitted Disease • Concerning Signs and Symptoms
Child Sexual Abuse Disclosure
• Not all sexually abused children exhibit symptoms (physical or emotional)
• Often delayed • “Is often a process rather than a single event” • Adult response to the disclosure matters • The relationship to the perpetrator, age at first incident of abuse, use
of physical force, severity of abuse, and demographic variables, impact a child’s willingness disclose
Reporting Child Abuse and Neglect
• Healthcare providers are mandated reporters of suspected child abuse and neglect.
• To make a report, call the Child Protection Hot Line or the Protection and Permanency office in your county.
• Child Protection Hot Line: 1-877-KY-SAFE1 (597-2331)
Examination Logistics
• Nature of abuse, timing and chronicity is important in determining where and when the examination should be performed, whether forensic evidence collection is necessary, and what tests should be sent.
Indications for acute exam
• Assault within 96 hours and/or forensic evidence may need to be collected
• Acute pain, bleeding • Suicidal ideation • Needs emergency contraception (up to 120 hours) • Needs HIV post exposure prophylaxis (up to 72 hours)
Indications for an Urgent Exam
• Suspected or reported sexual contact that occurred within the last two weeks, without emergency medical, psychological and safety needs identified
Jacqueline Sugarman, MD Associate Professor of Pediatrics
University of Kentucky Medical Director, Children’s Advocacy Center of the Bluegrass
Objectives
• Recognize common presentations of sexually abused children • Dispel myths related to sexual abuse • Recognize the indications for evidence collection • Know how to report suspected abuse • Know how to obtain additional consultation
Child Sexual Abuse
• “Occurs when a child is engaged in sexual activities he/she cannot comprehend, for which he/she is developmentally unprepared and cannot give informed consent and which violate social and legal taboos.” (Kempe, 1978)
Child/Teen Sexual Abuse Statistics
• 9.3% of cases of maltreatment of children in 2012 were classified as sexual abuse.
• 62,939 cases of child sexual abuse were reported in 2012
• Research conducted by the Centers for Disease Control (CDC) estimates that approximately 1 in 6 boys and 1 in 4 girls are sexually abused before the age of 18
• Teens 16 to 19 years of age were 3 ½ times more likely than the general population to be victims of rape, attempted rape, or sexual assault
Common Presentations for Child and Adolescent Sexual Abuse
• Disclosure • Injury • Sexually Transmitted Disease • Concerning Signs and Symptoms
Child Sexual Abuse Disclosure
• Not all sexually abused children exhibit symptoms (physical or emotional)
• Often delayed • “Is often a process rather than a single event” • Adult response to the disclosure matters • The relationship to the perpetrator, age at first incident of abuse, use
of physical force, severity of abuse, and demographic variables, impact a child’s willingness disclose
Reporting Child Abuse and Neglect
• Healthcare providers are mandated reporters of suspected child abuse and neglect.
• To make a report, call the Child Protection Hot Line or the Protection and Permanency office in your county.
• Child Protection Hot Line: 1-877-KY-SAFE1 (597-2331)
Examination Logistics
• Nature of abuse, timing and chronicity is important in determining where and when the examination should be performed, whether forensic evidence collection is necessary, and what tests should be sent.
Indications for acute exam
• Assault within 96 hours and/or forensic evidence may need to be collected
• Acute pain, bleeding • Suicidal ideation • Needs emergency contraception (up to 120 hours) • Needs HIV post exposure prophylaxis (up to 72 hours)
Indications for an Urgent Exam
• Suspected or reported sexual contact that occurred within the last two weeks, without emergency medical, psychological and safety needs identified