Sigel RM, Schubert CJ, Myers PA, Shapiro RA. Wood's lamp utility in the identification of semen. Santucci KA, Nelson DG, McQuillen KK, Duffy SJ, Linakis JG. Evolution of a classification scale: medical evaluation of suspected child sexual abuse. Findings in sexual assault and consensual intercourse. Girardin BW, Faugno DK, Seneski PC, Slaughter L, Whelan M. Examination findings in legally confirmed child sexual abuse: it's normal to be normal. Comparison of genital examination techniques in prepubertal children. Medical diagnosis of the sexually abused child. Preparation for child abuse litigation: perspective of the prosecutor and the pediatrician. American Academy of Pediatrics Committee on Child Abuse and Neglect. Guidelines for the evaluation of sexual abuse of children: subject review. Adolescent sexual aggression: risk and protective factors. Washington, D.C.: National Center for Missing and Exploited Children, 1992:12–13.īorowsky IW, Hogan M, Ireland M. Child molesters: a behavioral analysis for law enforcement officers investigating cases of child sexual exploitation. Facing facts: child abuse and pediatric practice. Follow-up doses should be administered one to two and four to six months after the first dose. Postexposure hepatitis B vaccination (without hepatitis B immunoglobulin) should also be offered at the time of the initial examination if the child has never been immunized. 16 Because nausea is a common side effect, antiemetics may also be prescribed. Prophylactic treatment must be started within 72 hours of the assault with two tablets of emergency contraceptive pills (Ovral or Preven) given immediately and two tablets given 12 hours later. 15 (pp49–75) Following acute sexual assault, pregnancy prophylaxis should be offered to adolescent girls after an informed consent has been obtained and urine pregnancy test results are negative. Prophylactic antibiotics for the treatment of gonorrhea, Chlamydia, trichomonas and bacterial vaginosis should be given to sexually active adolescents following an acute sexual assault ( Table 3). Referral for psychologic services is important because victims of abuse are more likely to have depression, anxiety disorders, behavioral problems and post-traumatic stress disorder.Īntimicrobial therapy should be initiated in prepubertal children based on the results of laboratory testing. Forensic evidence collection is indicated in certain cases. Judicious use of laboratory tests, along with appropriate therapy, should be individually tailored. When examining the child's genitalia, it is important that the physician be familiar with normal variants, nonspecific changes and diagnostic signs of sexual abuse. A careful history should be obtained and a thorough physical examination should be performed with documentation of all findings. The child's history as obtained by the physician may be admitted as evidence in court trials therefore, complete documentation of questions and answers is critical. Because the examination findings of most child victims of sexual abuse are within normal limits or are nonspecific, the child's statements are extremely important. Behavioral changes may involve sexual acting out, aggression, depression, eating disturbances and regression. Child victims of sexual abuse may present with physical findings that can include anogenital problems, enuresis or encopresis.
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