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At least 19 recordsLinked to original sources
PubMed1993

Child sexual abuse.

Child sexual abuse is being recognized as a common and serious problem which affects children regardless of their age, sex, socio-economic class, or geographic location. Children of all ages, from infancy to young adulthood, have been victims of abuse. It is well accepted that the number of reported incidents of child sexual abuse represents only a portion of the actual number of victims. The National Center on Child Abuse and Neglect estimates the number of child-victims to be more than 200,000 per year. Many of these children are brought to emergency facilities or to their private physician's office for evaluation. Many physicians have difficulties in correctly identifying and managing child-victims of sexual abuse. The purpose of this chapter is to review the most recent advances in the medical evaluation of children who are the victims of sexual abuse.

Adolescent↗
PubMed1991

Treatment issues in child sexual abuse.

Child sexual abuse is a commonly encountered and often emotionally damaging experience, maintained by secrecy and followed by denial after disclosure. Treatment in this field involves both the child and the family in a variety of treatment settings and modalities, often proceeding in parallel. Child developmental considerations dictate that treatment often proceeds in phases. It aims to protect the child from further abuse and the consequences of disclosure, and address the trauma and context of the abuse. Careful planning and co-operation is required by the many professionals working in this stressful area in order to avoid confusion, conflicts, and splits which may mirror relationships in the family. The heterogeneity of the problem is reflected in the fact that treatment cannot be offered in a uniform programme. Legal issues may influence the treatment process. Evaluation of treatment modalities, the identification of protective factors and achieving long-term adjustment in the least detrimental manner offer challenges in this newly developing field.

Adaptation, Psychological↗
PubMed1990

Methodological considerations in research on child sexual abuse.

Child sexual abuse research presents practical, methodological and statistical challenges. This paper examines some recent literature about the incidence and effects of child sexual abuse. Researchers who use epidemiological studies to attempt to ascertain the prevalence of different forms of abuse should be aware of the different populations studied, different methodologies used, diverse definitions of sexual abuse and practical limitations on participants' memories. Common problems in retrospective and prospective studies into the effects of child sexual abuse include the use of atypical populations, inappropriate statistical analyses, the use of unvalidated psychometric instruments and limited sources of information on child functioning. Attention must also be paid to potentially confounding demographic and family variables. A thorough understanding of, and attention to, these problem areas in child sexual abuse research will give a clearer picture of the prevalence and effects of abuse, thus indicating the most appropriate forms of prevention and treatment.

Child↗
PubMedDate not supplied

Child sexual abuse.

Child sexual abuse is a worldwide concern. It is an insidious, persistent, and serious problem that, depending on the population studied and definition used, affects 2-62% of women and 3-16% of men as victims. Pain and tissue injury from child sexual abuse can completely heal in time, but psychological and medical consequences can persist through adulthood. Associated sexually transmitted diseases (such as HIV) and suicide attempts can be fatal. All physicians who treat children should be aware of the manifestations and consequences of child sexual abuse, and should be familiar with normal and abnormal genital and anal anatomy of children. This aim is best accomplished through training and routine examination of the anus and genitalia of children. Because as many as 96% of children assessed for suspected sexual abuse will have normal genital and anal examinations, a forensic interview by a trained professional must be relied on to document suspicion of abuse.

Child↗
PubMed1989

Prevention of child sexual abuse.

Child sexual abuse prevention programs are a growing phenomenon addressing an expanding number of topics raised by a variety of violent and perverse acts. Currently programs tend to focus on a fairly narrow age group and use an educational model for children. There is a need for broad-based programs with a strong focus on the adults around children. Perinatal prevention programs require an adult focus and must take advantage of a special time in child and family development to address lesson of health and intimacy in a way that may decrease the incidence of future child sexual abuse.

Child↗
PubMed1996

The obligation of health care professionals and supervisors to report child sexual abuse.

Child sexual abuse is a problem that often can be stopped or prevented if reported. This article summarizes child sexual abuse: its incidence, signs and symptoms. and legal and ethical issues. Through a case study, a five-step approach to the reporting of child sexual abuse is presented to help health care professionals and supervisors in fulfilling their ethical and legal obligations.

Child↗
PubMed1993

Sexually transmitted diseases and the sexually abused child.

Sexually transmitted diseases pose a significant problem for children who have been sexually abused. The pattern of sexually transmitted diseases in this group reflects their changing pattern in the community at large. The prevalence of sexually transmitted diseases in sexual abuse victims is significant although it depends on a number of factors, including sexually transmitted disease prevalence in the community, the organism, and the type of abuse. The transmission route of most common sexually transmitted diseases beyond the neonatal period is accepted as sexual abuse, although the possibility of nonsexual transmission of some organisms, particularly those that can be transmitted at birth and have a long incubation and latency periods, is recognized. Mounting evidence for nonsexual transmission of human papillomavirus is generating continuing controversy. The significance of other organisms as indicators of abuse remains unclear. It is recommended that children suspected of being abused be screened for sexually transmitted diseases. There has been considerable discussion about the extent of screening. Screening should adhere to clear guidelines that address local epidemiologic issues. Screening for human immunodeficiency virus should be based on the extent of the virus in the community in which the child lives and on the nature of the abuse. Child sexual abuse must be recognized as an exposure category for human immunodeficiency virus. Test selection for evaluating sexually transmitted diseases in sexual abuse victims is a critical issue. Rapid screening methodologies should not be relied on, and if positive results are obtained, they should be confirmed using another method or even another laboratory.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1991

[Sexual child abuse: definition, prevalence and sequelae].

This review focuses on two aspects of research on sexual child abuse during the last ten years, namely prevalence and long-term effects. Differing results for prevalence (6-62% for female subjects) have been found depending on the concept of sexual child abuse (incest vs. extra-familial child sexual abuse, child sexual abuse with or without physical contact, child sexual abuse with or without violence and sexual actions between adults and children) and depending on the method, and features of the subject. Long-term effects are complex (affective, somatic, eating and sleeping disorders, dissociations, disorders in interpersonal relationships, problems in sexuality and social functioning). The main syndrome seems to be a pattern of affective disorders.

Adaptation, Psychological↗
PubMed1982

Incest and child sexual abuse.

Child sexual abuse was examined nationally and in the Washington, DC and Howard University Hospital area. In an attempt to describe this widespread problem, two case histories are presented which reflect some of the typical characteristics of child sexual abuse cases seen at Howard University Hospital. Pertinent literature is reviewed citing the prevalence rates and the personality and environmental factors which may contribute to the sexual abuse of children in this country. Finally, the role of the physician in identifying and treating the physical and emotional effects of child abuse are discussed.

Child↗
PubMed2000

The challenge of defining child sexual abuse.

Although child sexual abuse has been a concern for many researchers, therapists, and advocates for the past 3 decades, several fundamental issues regarding child sexual abuse remain unresolved. In particular, the term child sexual abuse has never been unequivocally defined. The lack of a commonly accepted definition of child sexual abuse continues to inhibit research, treatment, and advocacy efforts. Early researchers used broad and inclusive definitions of child sexual abuse--definitions that often continue to be used today. The consequences of these definitions are discussed, and strategies for developing other definitions of child sexual abuse are suggested.

Adolescent↗
PubMed1991

Human immunodeficiency virus transmission by child sexual abuse.

During 1987-1989, 14 (14.6%) of the 96 children who tested positive for the human immunodeficiency virus (HIV) and were followed up by the Duke University (Durham, NC) pediatric acquired immunodeficiency syndrome team were confirmed to have been sexually abused. Every sexually abused child was evaluated for each of five modes of HIV transmission, and in nine children the pathway was identified. Four of the study children acquired HIV from child sexual abuse and in six, abuse was a possible source. Transmission by child sexual abuse was the most frequent of the proven modes of acquisition of HIV in this population. The other proven modes of acquisition were vertical transmission (n = 3) and HIV-contaminated blood transfusion (n = 2). Twelve males were identified (n = 8) or suspected (n = 4) of being perpetrators. Three knew themselves to have HIV at the time of an assault and eight were aware that the child had HIV at the time of an assault. There was no indication from any child that "safe sex" precautions had been observed. Children with HIV infection had multiple risk factors for abuse or neglect. The sociological descriptors of the lives of the 14 abused children showed multiple known risk factors for sexual abuse that also overlapped with known risk factors for or sequelae of the acquisition of HIV infection. These included drug abuse and alcoholism in the home, prostitution of a parent, lack of parenting, poverty, and chronic illness of the child. Prevention efforts should recognize that children as well as adults are at risk for sexually transmitted HIV infection.

Adolescent↗
PubMed1986

Allegations of child sexual abuse in child custody disputes: a therapeutic assessment model.

Guidelines are set forth for judges and others who must make decisions in custody disputes that include allegations of child sexual abuse. The focus is on the protection of the child and the model highlights the role of mental health professionals, prescribing separate therapists for child and parent where possible. Allegations of sexual abuse are seen as an indicator of emotional risk for the child, even in cases where the allegations are untrue.

Child↗
PubMed1993

Medical evaluation of the sexually abused child.

Clearly, there are numerous troubling variations in the medical diagnosis of child sexual abuse. These variations include delays in disclosure; rapid healing; maturational changes; variations in normal congenital findings; the technique of the examiner; patient position, relaxation, and cooperation; and additional medical conditions that mimic abuse. For these reasons, physical evidence is often inconclusive and can be an unreliable source of information in child sexual abuse cases. The reader is logically cautioned against attempts to diagnose child sexual abuse based on a single finding, particularly that of the diameter of the hymenal orifice. Emphasis on the child's history in documenting the abuse is increasing. As physicians, we must develop interviewing techniques that will assist in child protection, and we must listen and believe the comments made by our patients.

Child↗
PubMed1993

Initial evaluation and interview techniques for child sexual abuse.

Because physicians are often the first professionals to have contact with a sexually abused child, they must be alert to the symptoms and prepared to respond knowledgeably. Early and effective intervention affects the overall prognosis for the child and family positively. As physicians become aware of child sexual abuse, protocols can be used routinely as part of a child's medical care. Regular checks on potentially abusive situations can prevent the tragic and traumatic occurrence of child sexual abuse.

Adolescent↗
PubMed1999

Sudden infant death syndrome, child sexual abuse, and child development.

Since the introduction of the Back to Sleep Campaigns, there has been a dramatic reduction in sudden infant death syndrome in this country. Steven Blatt and Victoria Meguid review the literature surrounding sleep position. Investigators have continued efforts to find other modifiable risk factors of sudden infant death syndrome. A prospective study of more than 33,000 neonates found a link between a prolonged QT electrocardiogram interval and sudden infant death syndrome. Also discussed are investigations seeking to explain the relationship between smoking and sudden infant death syndrome. Ann Botash, Florence Jean-Louis and Mongkae Ploy Siripornsawan review the latest thinking on genital warts and their relation to specific viral etiologies and child sexual abuse. Other symptoms and signs of sexual abuse are the focus of a number of articles that can help the practitioner care for these unfortunate children. Catherine Church reviews medication options for children diagnosed with pervasive developmental disorders or autism spectrum disorders. Finally, in this article, risperidone, fluoxetine and naltrexone are reviewed.

Autistic Disorder↗
PubMedDate not supplied

Medical diagnosis of the sexually abused child.

This article reviews what has been learned in the last two decades about the medical diagnosis of child sexual abuse. Studies indicate that a normal physical exam is common in sexual abuse victims, that healing of injuries due to abuse is rapid and sometimes complete, that a minority of victims seen for abuse are boys, that nonsexual transmission of sexually transmitted diseases is rare, and that congenital and acquired conditions may mimic physical findings caused by sexual abuse. The article summarizes clinical research on physical findings in nonabused children, abused children, and abused children with independent confirmation of abuse. A classification of physical findings is proposed along a continuum of certainty that sexual abuse has occurred. The child's history is essential in the accurate diagnosis of most cases of sexual abuse.

Adolescent↗
PubMed1990

Child sexual abuse: who goes home?

The purpose of this study was to ascertain the factors which influence custody change in cases of children who have been sexually abused. Of 180 children admitted to La Rabida Children's Hospital and Research center with a suspicion of having been sexually abused, 138 met the state's criteria for proven sexual abuse, and 30% of those children had a sexually transmitted disease. One-third of the children with proven abuse were under 4 years of age. Of the children with proven abuse, ultimately 40% had a custody change. Only an initial outcry of abuse was associated with an increased probability of a change in custody. A change in custody was not found to be related to the patient's age, sex, the perpetrator's relation to the child or access to the home, the presence of sexually transmitted disease, whether the child was also physically abused, or whether the child had had developmental delay. These data suggest an absence of any discernible guidelines in the juvenile court's decision concerning custody change of a sexually abused child.

Adolescent↗