Managing child sexual abuse

By Dr Alice Johnson, Consultant Paediatrician and Head of Department, Child Protection Unit, Perth Children’s Hospital.

Child sexual abuse (CSA) is common. Approximately one in three girls and one in seven boys will experience sexual abuse in their childhood. (1)

GPs see these children in their daily practice and play a key role in the detection and reporting of CSA. GPs will also see adult survivors of CSA suffering the devastating and lifelong psychological sequelae of their childhood abuse. This issue was highlighted in the recent Royal Commission into Institutional Responses to Child Sexual Abuse. (2)

“As a victim, I can tell you the memories, sense of guilt, shame and anger live with you every day. It destroys your faith in people, your will to achieve, to love, and one’s ability to cope with normal everyday living” (Royal Commission private session).

Western Australia’s mandatory reporting laws require doctors (and certain other professional groups), to make a mandatory report if they form a reasonable belief that a child or adolescent aged under 18 years has been sexually abused. (3)

Six key facts about CSA:

  1. Perpetrators of CSA are almost always known the child, and are often family members (including siblings) or family friends.
  2. Types of CSA range from genito-anal touching or penetration, to child pornography or child prostitution. All cases involve a lack of consent from the child and a power differential between the offender and the victim.
  3. The most common presentation of CSA is a child’s disclosure (i.e. the child will tell someone, in their own words, what has happened to them [e.g. “he put his finger in my wee wee”]). If a child makes a disclosure, believe them and refer on (the child will be interviewed by experts to determine what, if anything, has happened).
  4. Genito-anal examination is normal in 85-95 percent of cases. This is either because no injury has occurred or because injuries have healed by the time of examination. Therefore, a normal examination result does not exclude CSA.
  5. Acute sexual assault refers to an incident occurring within the previous 72 hours and is a medical emergency. These children should be seen as soon as possible for post-coital contraception, post-exposure antibiotics (and HIV prophylaxis) and the collection of forensic evidence.
  6. Long term psychological sequelae are common and include depression, anxiety and post-traumatic stress disorder. All children and adolescents with a history of CSA should be referred for therapy.

Managing CSA in your practice may leave you with questions:

  • Should I talk to this child?
  • Should I examine this child?
  • Where should I refer this child for a medical assessment?
  • Have I formed a reasonable belief of CSA?
  • Should I make a Mandatory Report?

The updated Child Sexual Abuse HealthPathways are now available and include readily accessible information on management and referral processes for CSA. If you require further advice on any child protection matter, you can contact the Child Protection Unit at Perth Children’s Hospital where specialised doctors and social workers can help with any queries. Phone  08 6456 4300 or email PCHcpuduty@health.wa.gov.au.

References:

  1. The prevalence of child abuse and neglect. CFCA resource sheet April 2017
  2.  Royal Commission into Institutional Responses to Child Sexual Abuse. (2017). Final Report: Volume Commonwealth of Australia.
  3. About mandatory reporting legislation 

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