Child sexual abuse: The emergency department response

A parent or carer’s observation of blood in a child’s nappy or underwear can be quite alarming for both parent and child and may indicate vaginal bleeding. At first glance, it may be difficult to ascertain whether the bleeding is from the skin, genital tract, urinary tract or anus. Confirmed vaginal bleeding in a pre-pubertal girl is rare but always abnormal and requires comprehensive assessment to determine the cause. Recognition of normal female pre-pubertal anatomy is essential to detect any abnormalities. Appropriate action should be taken according to findings on initial inspection of the ano-genital area. The possibility of child sexual abuse and the need for specialist paediatric sexual offences medicine examination by an FME (Forensic Medical Examiner) or specialist paediatrician should always be considered. This article offers a systematic approach to assessment in pre-pubertal girls with apparent vaginal bleeding which will benefit general paediatricians, emergency department practitioners and GPs.

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A review of child sexual abuse cases presenting to a paediatric emergency department

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.2021127 ◽

2021 ◽

Vol 50 (7) ◽

pp. 527-535

Author(s):

Magdalene HM Lee ◽

Sashikumar Ganapathy ◽

Soo Mei Low ◽

Christine LQ Chua ◽

Shu-Ling Chong ◽

...

Keyword(s):

Emergency Department ◽

Sexual Abuse ◽

Child Sexual Abuse ◽

Secondary Analysis ◽

Well Being ◽

Abuse Child ◽

Vulnerable Children ◽

Paediatric Emergency Department ◽

Paediatric Emergency ◽

Biological Parents

Introduction: Child sexual abuse (CSA) adversely affects a child’s growth and well-being. This study aimed to describe the profile of children presenting to a tertiary paediatric emergency department (ED) with CSA. Methods: Children 0–16 years old presenting to KK Women’s and Children’s Hospital ED from June 2016 to August 2020 with sexual abuse were retrospectively reviewed. We performed a secondary analysis on girls and stratified them by age <13 and ≥13 years o ld. Results: There were 790 patients who made 833 visits for CSA. Victims were predominantly girls (747, 94.8%) and perpetrators were predominantly men (763, 96.6%). The abuse first occurred before the age of 13 years in 315 victims (39.9%). For 468 (59.2%), more than one incident occurred before presentation. Compared to girls ≥13 years old, girls <13 years old were more frequently abused by a family member (47.7% versus 8.0%, P<0.001) and abused in their own home (55.7% vs 21.0%, P<0.001). Among all children, parental divorce and the absence of one or both biological parents in the household were prevalent, with 287/783 (36.7%) having divorced parents, and only 374/784 (47.8%) residing with both biological parents. Conclusion: The findings highlight common characteristics of CSA cases, and can aid the future identification and protection of vulnerable children. The fact that most children presented after more than one incident suggests the need to more closely monitor and protect potentially at-risk children. Keywords: Child abuse, child sexual abuse, child welfare, sexual abuse

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Emergency Department Admissions for Child Sexual Abuse in the United States From 2010 to 2016

JAMA Pediatrics ◽

10.1001/jamapediatrics.2019.3988 ◽

2020 ◽

Vol 174 (1) ◽

pp. 89

Author(s):

Jesse J. Helton ◽

Jason T. Carbone ◽

Michael G. Vaughn ◽

Theodore P. Cross

Keyword(s):

United States ◽

Emergency Department ◽

Sexual Abuse ◽

Child Sexual Abuse ◽

The United States

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Evaluating Child Sexual Abuse in the Emergency Department: Clinical and Behavioral Indicators

Academic Emergency Medicine ◽

10.1111/j.1553-2712.1996.tb03330.x ◽

1996 ◽

Vol 3 (10) ◽

pp. 966-976 ◽

Cited By ~ 2

Author(s):

Narendra Kini ◽

William J. Brady ◽

Stephen Lazoritz

Keyword(s):

Emergency Department ◽

Sexual Abuse ◽

Child Sexual Abuse ◽

Behavioral Indicators

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Malpractice & Negligence: State Supreme Courts Limit Therapists’ Duties to Third Parties

The Journal of Law Medicine & Ethics ◽

10.1017/s1073110500012985 ◽

1999 ◽

Vol 27 (2) ◽

pp. 204-205

Author(s):

Megan Cleary

Keyword(s):

Sexual Abuse ◽

Child Sexual Abuse ◽

Supreme Court ◽

New Hampshire ◽

Third Parties ◽

State Supreme Courts ◽

Recovered Memories ◽

Supreme Courts ◽

Repressed Memory ◽

University Of Colorado

In recent years, the law in the area of recovered memories in child sexual abuse cases has developed rapidly. See J.K. Murray, “Repression, Memory & Suggestibility: A Call for Limitations on the Admissibility of Repressed Memory Testimony in Abuse Trials,” University of Colorado Law Review, 66 (1995): 477-522, at 479. Three cases have defined the scope of liability to third parties. The cases, decided within six months of each other, all involved lawsuits by third parties against therapists, based on treatment in which the patients recovered memories of sexual abuse. The New Hampshire Supreme Court, in Hungerford v. Jones, 722 A.2d 478 (N.H. 1998), allowed such a claim to survive, while the supreme courts in Iowa, in J.A.H. v. Wadle & Associates, 589 N.W.2d 256 (Iowa 1999), and California, in Eear v. Sills, 82 Cal. Rptr. 281 (1991), rejected lawsuits brought by nonpatients for professional liability.

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