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Child Sexual Abuse Medical Evaluation

Child Sexual Abuse Medical Evaluation. Cara Christanell RN, CPNP Child Protection Division. Sexual Abuse. The involvement of children and adolescents in sexual activities that they do not understand, cannot give consent to, or that violate social taboos. Sexual Abuse. Exhibitionism

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Child Sexual Abuse Medical Evaluation

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  1. Child Sexual AbuseMedical Evaluation Cara Christanell RN, CPNP Child Protection Division

  2. Sexual Abuse • The involvement of children and adolescents in sexual activities that they do not understand, cannot give consent to, or that violate social taboos.

  3. Sexual Abuse • Exhibitionism • Fondling • Genital viewing • Pornography

  4. Sexual Abuse • Oral-genital contact • Insertion of objects • Vaginal penetration • Anal penetration

  5. Missouri Statutes • Mandated Reporters- any physician, coroner, dentist, chiropractor, optometrist, podiatrist, resident, intern, nurse, hospital or clinic personnel(engaged in examination, care, treatment, or research of persons), and other health practitioner, psychologist, mental health professional, social worker, day care center worker or other child care worker, juvenile officer, probation or parole officer, jail or detention personnel, teacher, principal or other school official, minister, peace officer or law enforcement official, or other person with the responsibility for the care of children, has reasonable cause to suspect that a child has been or may be subjected to abuse or neglect or observes a child being subjected to conditions or circumstances which would reasonably result in abuse or neglect, he shall immediately report or cause a report to be made to the division

  6. Sexual Abuse WHY KIDS? • Respect and obey adults • Naturally trusting • Curious • Seek attention

  7. Who should have an evaluation?

  8. Who • Anyone reasonably believed to have been abused

  9. Disclosure • Accidental 74% • Purposeful

  10. Why should a child have an evaluation?

  11. Why • Injury assessment • STI treatment / testing • Pregnancy issues • Evidence • Reassurance • Guidance

  12. When should an examination be conducted?

  13. When • Emergent • if assault* within 72 hrs *good history of significant contact

  14. When • Emergent • if assaultmay have placed child at risk for pregnancy and occurred in the previous 5 days

  15. When • Emergent • pain in the genital area or anal area • anogenital bleeding or injury

  16. When • Emergent • Child is not safe • Child is experiencing significant behavioral or emotional problems

  17. When • Urgent • if assault >72 hrs, but < 2 wks

  18. When • Urgent • if recent assault with symptoms • bleeding, heavy discharge

  19. When • Non-urgent • if assault > 2 weeks

  20. When • Emergent – immediately • Urgent – 1 - 3 days • Non-urgent - anytime

  21. Where should an examination be conducted?

  22. Where • Emergent = ER • Urgent = ER

  23. Where • Emergent = ER • Urgent ≠ ER • Non-urgent ≠ ER

  24. Who should perform an examination?

  25. SAFE-CARE Provider • Sexual Assault Forensic Examination-Child Abuse Resource and Education

  26. Who • Providers • MD, DO • PNP(Pediatric Nurse Practitioner) • PA(Physician’s Assistant) • SANE-P(Sexual Assault Nurse Examiner-Pediatric)

  27. SAFE-CARE Provider Responsibilities • Identify treatable injuries or infections • Collect forensics specimans, if abuse was recent • Screen for sexually transmitted conditions • REASSURE the child that he/she is still “OK”

  28. SAFE-CARE Provider Responsibilities • Asses the patient and parent’s mental and emotional state and make appropriate referrals • Provide accurate documentation, at least drawings • Be available for court testimony • Know what is normal and when to refer

  29. SAFE-CARE Provider • TEL-LINK 1-800-835-5465 • Missouri Department of Health and Senior Services toll-free information and referral line for maternal and child healthcare

  30. Examination vsEvaluation

  31. Who • Provide “big picture” assessment of child • Medical history, exam, diagnosis

  32. How to explain the evaluation?

  33. Are exams painful?

  34. Are exams traumatic?

  35. Are exams stressful?

  36. How do kids respond to exams?

  37. How is an evaluation conducted?

  38. Evaluation • Introductions • Parent in room with child • Obtain information • Explain examination • Answer questions

  39. Evaluation • Complete forensic interview typically not conducted • Medical history is not a forensic interview

  40. How is an examination conducted?

  41. A Typical Exam • General physical • Rarely “invasive” • Rarely sedation

  42. Anogenital Exam • Frog Leg • Knee Chest • Supine

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