Repro - 2-10 - Child Sexual Abuse

Front 1

ACE study

Back 1

Found the prevalence of many childhood exposures.

They are likely to occur together.

If a child has four or more, they have many medical problems late in life too (so early events impacts the rest of the child's life)

Front 2

3 legs of diagnosis

Back 2

Behavior concerns

Medical eval

Disclosure

Front 3

Is it common for an acute case to be seen with a child?

Back 3

No
So few exams are emergencies, but you don't get to see kids too often so the goal is one excellent exam.

Front 4

Exam techniques

Back 4

Frog-leg/butterfly - gives good view of ext genitalia and then you do labial separation and traction.

Knees-to-chest supine to see anus.

Then Prone knee-chest (kitty-cat) - So you can see the hymenal tissue (it comes down with gravity)

Front 5

Touch prepubertal hymen?

Back 5

No!!!!!!!!!!!!!

(I think it hurts?)

Front 6

Normal hymen variations

Back 6

Septate hymen, cribriform hymen

Front 7

Nonsexual infections/findings mistaken for abuse

Back 7

Group A strep
Pinworm
Urethral prolapse.
Lichen sclerosis
Failure of midline fusion
labial agglutination or adhesion (will normalize with estrogen effects of puberty)
diastasis ani
accidental injury
impalment of anus

Front 8

One time to use ultrasound

Back 8

with a messed up septum - to ensure nothing else is wrong.

Front 9

Will a child that was anally raped have lacerations?

Back 9

Often not.

Same goes for vaginal intercourse

Front 10

Difference with gonorrhea and chlamydia in prepubertal children

Back 10

less liekly to ascend and most of them are symptomatic and then clear spontaneously.

Front 11

Things to think abt with prepubertal children and STIs

Back 11

tissue damage makes children vuln to HIV

Some STIs may be perinatally acquired.

Front 12

Gold standard for court with STIs

Back 12

culture - but this is often difficult.

They don't like genomic tests because of (highly sensitive, not highly specific)

Front 13

PE in a child who was abused

Back 13

It is normal for it to be normal.

And never say "hymen intact" - because it implies that nothing happened.

Front 14

2 factors that are signif correlated with the presence of abnormal genital findings in girls:

Back 14

The time since the last incident

and a history of blood being reported at the time of the molestation.

Front 15

Child sexual abuse - red flags that your child is doing inapprop play with other children their age/developmental status

Back 15

Putting mouth on genitals
asking to engage in sexual acts
imitates intercourse
inserts objects into the vagina or anus
touches animal genitals.

Front 16

You disclose based on...

Back 16

SUSPICION!!!

Front 17

WHen interviewing

Back 17

Don't do forensics, don't repeat questions.

Mostly we need to know what touched where and associated sx at the time or afterward.

Front 18

CAC

Back 18

provides a safe place for children to interview with forensic interviewer. common in most states now.

Front 19

Take-home points

Back 19

Child sexual abuse is prevalent, and impacts heavily on public health and individual health through the lifespan

Kids are different. Medical evaluation alone is rarely diagnostic. Laws require reporting of suspicions!

The medical provider must be knowledgeable and work closely with other professionals

Children medical reassurance, and physical and mental health treatment