Medical treatment is guided by any conditions uncovered. The incidence of STDs in child sexual abuse (CSA) is low. In prepubertal children, asymptomatic vaginal infections are thought to be increasingly uncommon. Therefore, the Centers for Disease Control and Prevention (CDC) does not recommend prophylaxis for STDs in asymptomatic prepubertal children who are evaluated for possible CSA. In contrast, the CDC recommends that teenaged patients and adults who are sexually abused or assaulted should receive antibiotic prophylaxis for STDs. For more information, see MMWR Recommendation and Report Sexually Transmitted Diseases Treatment Guidelines.
- Treat STDs with appropriate medications based on the infection and the child’s age and weight.
- In postmenarcheal children, consider the possibility of pregnancy.
- Recognize the overriding need for emotional support and attention to the psychosocial crisis in which the child and family now find themselves.
- Health care providers are mandated reporters in all 50 states; once sexual abuse seriously is suspected or diagnosed, a report to the appropriate child protective services (CPS) agency is necessary. Attention to the safety of the child is essential. The AAP recommends reporting in the following situations:
- When a child makes a clear disclosure of abusive sexual contact, with or without specific findings
- When individuals present with STDs (see Workup section)
- When physical examination findings are believed to be the result of abusive sexual contact
- When sexual abuse is being considered, the AAP suggests the possibility of reporting, depending on the perceived risk to the child. In such cases, discussion with members of an interdisciplinary team may be helpful.
- Cases of sexual abuse may result in law enforcement action against the alleged perpetrator and possible criminal court proceedings. Well-documented medical records are essential, since legal proceedings may occur over long periods of time. The health care provider cannot rely solely on recollection of the case.
- Mental health consultation is warranted to evaluate and treat acute stress reaction and, later, posttraumatic stress disorder (PTSD).
- Expert mental health management of stress disorders is warranted because of the burgeoning evidence that psychic trauma in young children has a significant effect.
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