Child Sexual Abuse: Common, Under‐Reported and Concomitant with Other Maltreatment

Abstract

Child sexual abuse (CSA)as pointed out by Paediatric Research Across the Midlands (PRAM) (2021) in the first paper for this themed issue on sexual abuse and exploitationis common, under-reported and often co-exists with other forms of maltreatment. These features form a backdrop to several of the original papers included in the issue. Recognising Indicators of CSA The PRAM collaboration undertook an audit of child protection medical assessments in the West Midlands to establish whether CSA was being considered when children underwent medical assessments for other forms of maltreatment (PRAM, 2021). Their starting point was the understanding that some children who experience physical or emotional abuse or neglect will also be victims of CSA, but that much of this will go unrecognised, both because the children themselves find it difficult to report and professionals may not recognise, or look for indicators of, CSA. The authors analysed data from nine healthcare trusts over a four-week period 'to establish which factors made it more likely that features specifically useful in the detection of CSA' were looked for (PRAM, 2021, p. 12). Their audit included 91 medical assessments, mostly for physical abuse, in children aged from two weeks to 15 years. They found that persistent or recurrent anal or genital symptoms, bowel or urinary disorders and changes in behaviour were specifically asked about in less than half of the medical assessments, thus potentially missing important indicators of possible sexual abuse. They found that consultants were more likely than trainees to ask about abnormal sexualised behaviours, and that those doctors working in the community (who, they assert, will have had more specific training in CSA) were more likely to enquire about genito-urinary and bowel symptoms. The findings from this audit reinforce the challenge expressed by Finkel (2019, p. 99) that 'the medical community at large could play a more proactive role in providing primary prevention and in the recognition and