The Role of Physicians in Reporting and Evaluating Child Sexual Abuse Cases

Abstract

Physicians become involved in child sexual abuse when they must report suspected abuse or when they are asked to medically evaluate a child who is an alleged victim of abuse. This article reviews recent progress in the medical profession's attention to child sexual abuse and discusses current issues surrounding reporting and medical evaluation. The reporting requirement raises several concerns for pediatricians. Their legal responsibilities as reporters may conflict with their traditional relationship with the family as a unit and with the confidentiality of the doctor-patient relationship. Knowledge about pediatric anogential anatomy is in a relatively early stage of development, and few pediatricians receive training adequate to enable them to determine whether medical observations are consistent with sexual abuse. Even fewer pediatricians receive training in the unique considerations and needs present when taking the medical history of a possible abuse victim or when preserving evidence for possible later use in court. The medical evidentiary evaluation of suspected sexual abuse also raises a number of concerns. There is great variability in referral patterns, which determine whether a medical examination will be requested and whether a general practice physician or a specialist will be asked to conduct the exam. Although professional medical associations have laid out broad outlines of recommended procedures for medical exams when sexual abuse is suspected, more detailed protocols are needed for addressing the many cases where findings are ambiguous or subtle. Often physicians need training in forensics and assistance in coordinating services with multiple agencies and professions. Finally, attention must be given to ensuring adequate cost reimbursement for medical evaluations.

Adolescent Pregnancy and Sexual Abuse

“…22,23 The medical examination can also provide an opportunity to reassure the adolescent that her body is not damaged by the abuse. 24 It is critical that the clinician be sensitive and communicate with the teen throughout the examination so that the patient does not experience the examination as a continuation of the trauma. To facilitate teens' access to further medical treatment, immediate appointments must be made available on an emergency basis.…”

Child Abuse Training, Comfort, and Knowledge Among Emergency Medicine, Family Medicine, and Pediatric Residents

“…Presently, the amount of residency training in the area of child maltreatment considered optimal for each specialty has not been established, and there is no national accrediting or licensing body that regulates residency programs' curricula on this topic. 21 In addition, the lack of nationally representative data on residency training characteristics precludes the identification of an optimal or even baseline level of child abuse training for which programs across the United States should strive. This is a relevant educational and training issue for all specialties.…”

The Relationship between Knowledge and Child and Caregiver Distress during the Medical Examination for Child Sexual Abuse

“…The purpose of the CSAME is to ensure the child's health and well-being, treat any potential sexually transmitted diseases or abuse-related injuries, and collect potential evidence (Britton 1998;Kerns, Terman, & Larson, 1994). Per recommendations of the American Academy of Pediatrics Committee on Child Abuse and Neglect (2005), CSAME should entail the examination of the child's genital and anal regions with the use of a colposcope (McCann, 1990;Steward, Schmitz, Steward, Joye, & Reinhart, 1995).…”