Management and sequelae of sexual abuse in children and adolescents
- Kirsten Bechtel, MD
Kirsten Bechtel, MD
- Associate Professor of Pediatrics
- Section of Pediatric Emergency Medicine
- Yale University School of Medicine
- Berkeley L Bennett, MD, MS
Berkeley L Bennett, MD, MS
- Assistant Professor of Clinical Pediatrics Division of Emergency Medicine
- Cincinnati Children's Hospital Medical Center & Medical Director Northern Kentucky Children's Advocacy Center
- Section Editors
- Daniel M Lindberg, MD
Daniel M Lindberg, MD
- Section Editor — Pediatric Psychosocial Emergencies
- Associate Professor of Emergency Medicine and Pediatrics
- University of Colorado Kempe Center
- Amy B Middleman, MD, MPH, MS Ed
Amy B Middleman, MD, MPH, MS Ed
- Section Editor — Adolescent Medicine
- Professor of Pediatrics, Chief of Adolescent Medicine
- University of Oklahoma Health Sciences Center
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Sexual abuse occurs when a child engages in sexual activity for which he or she cannot give consent, is unprepared for developmentally, and cannot comprehend. This includes fondling and all forms of oral-genital, genital, or anal contact with the child (whether the victim is clothed or unclothed), as well as non-touching abuses, such as exhibitionism, voyeurism, or involving the child in pornography [1-3].
The management and sequelae of childhood sexual abuse will be reviewed here. The epidemiology, evaluation, and differential diagnosis of childhood sexual abuse and human sex trafficking are discussed separately. (See "Evaluation of sexual abuse in children and adolescents" and "Human trafficking: Identification, evaluation, and management in the health care setting".)
The management of sexual abuse involves prevention of sexually transmitted infections (STI) and pregnancy. Psychosocial support and anticipatory guidance should also be offered to the victims and their non-offending caregivers.
Although evaluation and management of sexual abuse should be performed by an experienced child abuse team, including a child abuse specialist or clinician with similar experience, whenever possible, urgent evaluation is necessary under the following circumstances and typically occurs in an emergent setting (see "Evaluation of sexual abuse in children and adolescents", section on 'Evaluation'):
●The alleged abuse occurred within the previous 72 to 96 hours, depending upon jurisdiction
- Kellogg N, American Academy of Pediatrics Committee on Child Abuse and Neglect. The evaluation of sexual abuse in children. Pediatrics 2005; 116:506.
- Kempe CH. Sexual abuse, another hidden pediatric problem: the 1977 C. Anderson Aldrich lecture. Pediatrics 1978; 62:382.
- Practice parameters for the forensic evaluation of children and adolescents who may have been physically or sexually abused. AACAP Official Action. American Academy of Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry 1997; 36:423.
- Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
- American Academy of Pediatrics. Sexually transmitted diseases in adolescents and children. In: Red Book 2006: The Report of the Committee on Infectious Diseases, 27th, Pickering LK. (Ed), American Academy of Pediatrics, Elk Grove 2006. p.166.
- Smith DK, Grohskopf LA, Black RJ, et al. Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the U.S. Department of Health and Human Services. MMWR Recomm Rep 2005; 54:1.
- Lindegren ML, Hanson IC, Hammett TA, et al. Sexual abuse of children: intersection with the HIV epidemic. Pediatrics 1998; 102:E46.
- Menick DM, Ngoh F. [Seroprevalence of HIV infection in sexually abused children in Cameroon]. Med Trop (Mars) 2003; 63:155.
- Havens PL, American Academy of Pediatrics Committee on Pediatric AIDS. Postexposure prophylaxis in children and adolescents for nonoccupational exposure to human immunodeficiency virus. Pediatrics 2003; 111:1475.
- Atabaki S, Paradise JE. The medical evaluation of the sexually abused child: lessons from a decade of research. Pediatrics 1999; 104:178.
- American Academy of Pediatrics. Human immunodeficiency virus infection. In: Red Book 2006: The Report of the Committee on Infectious Diseases, 27th, Pickering LK. (Ed), American Aademy of Pediatrics, Elk Grove Village 2006. p.394.
- Olshen E, Hsu K, Woods ER, et al. Use of human immunodeficiency virus postexposure prophylaxis in adolescent sexual assault victims. Arch Pediatr Adolesc Med 2006; 160:674.
- Linden JA, Oldeg P, Mehta SD, et al. HIV postexposure prophylaxis in sexual assault: current practice and patient adherence to treatment recommendations in a large urban teaching hospital. Acad Emerg Med 2005; 12:640.
- Schremmer RD, Swanson D, Kraly K. Human immunodeficiency virus postexposure prophylaxis in child and adolescent victims of sexual assault. Pediatr Emerg Care 2005; 21:502.
- Poirier MP. Care of the female adolescent rape victim. Pediatr Emerg Care 2002; 18:53.
- Kaufman M, American Academy of Pediatrics Committee on Adolescence. Care of the adolescent sexual assault victim. Pediatrics 2008; 122:462.
- American Academy of Pediatrics. Human Papillomaviruses. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th edition, Kimberlin DW, Brady MT, Jackson MA, Long SS. (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.576.
- Jenny C, Crawford-Jakubiak JE, Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of children in the primary care setting when sexual abuse is suspected. Pediatrics 2013; 132:e558.
- Macdonald G, Higgins JP, Ramchandani P, et al. Cognitive-behavioural interventions for children who have been sexually abused. Cochrane Database Syst Rev 2012; :CD001930.
- Adams JA, Kellogg ND, Farst KJ, et al. Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused. J Pediatr Adolesc Gynecol 2016; 29:81.
- van Toledo A, Seymour F. Interventions for caregivers of children who disclose sexual abuse: a review. Clin Psychol Rev 2013; 33:772.
- Ludwig S. Child abuse. In: Textbook of Pediatri Emergency Medicine, 5th, Fleisher GR, Ludwig S, Henretig FM. (Eds), Lippincott Willims & Wilkins, Philadelphia 2006. p.1761.
- Beitchman JH, Zucker KJ, Hood JE, et al. A review of the short-term effects of child sexual abuse. Child Abuse Negl 1991; 15:537.
- Kendall-Tackett KA, Williams LM, Finkelhor D. Impact of sexual abuse on children: a review and synthesis of recent empirical studies. Psychol Bull 1993; 113:164.
- Johnson CF. Child sexual abuse. Lancet 2004; 364:462.
- Ompad DC, Ikeda RM, Shah N, et al. Childhood sexual abuse and age at initiation of injection drug use. Am J Public Health 2005; 95:703.
- Noll JG, Trickett PK, Susman EJ, Putnam FW. Sleep disturbances and childhood sexual abuse. J Pediatr Psychol 2006; 31:469.
- Noll JG, Zeller MH, Trickett PK, Putnam FW. Obesity risk for female victims of childhood sexual abuse: a prospective study. Pediatrics 2007; 120:e61.
- Eisenberg ME, Ackard DM, Resnick MD. Protective factors and suicide risk in adolescents with a history of sexual abuse. J Pediatr 2007; 151:482.
- Cutajar MC, Mullen PE, Ogloff JR, et al. Schizophrenia and other psychotic disorders in a cohort of sexually abused children. Arch Gen Psychiatry 2010; 67:1114.
- Adverse Childhood Experience (ACE) Study: Major findings. Available at http://www.cdc.gov/ace/findings.htm. (Accessed March 27, 2014).
- Maniglio R. The impact of child sexual abuse on health: a systematic review of reviews. Clin Psychol Rev 2009; 29:647.
- Nwogu NN, Agrawal L, Chambers S, et al. Effectiveness of Child Advocacy Centers and the multidisciplinary team approach on prosecution rates of alleged sex offenders and satisfaction of non-offending caregivers with allegations of child sexual abuse: a systematic review. JBI Database System Rev Implement Rep 2016; 13:93.
- Sexually transmitted infection prophylaxis
- HIV prophylaxis
- Pregnancy prophylaxis
- Human papillomavirus vaccination
- Psychosocial support
- Anticipatory guidance
- Mandated reporting
- Abuse victim
- Impact on non-offending caregivers
- SUMMARY AND RECOMMENDATIONS