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)
- Clinical 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
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- 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