Child Sexual Abuse and Neglect

What is Child Sexual Abuse and Neglect?

Child sexual abuse involves forcing or tricking a child into participating in sexual activities that they don’t fully comprehend. These activities could involve things like exposing oneself, touching inappropriately, or even engaging in oral or penetrative sexual acts. It’s estimated that by the time they reach adulthood, 26% of girls and 5% of boys would have faced sexual abuse.

Healthcare providers often play a critical role, offering advice to parents and engaging other medical professionals or child protection services, unless the parents are the ones abusing the child. Signs of child sexual abuse can vary and might not always be physical. Symptoms might include pain, genital bleeding, discharge, difficulty in urinating, urinary infections, inappropriate use of sexual language or behavior, and suicidal thoughts.

However, it’s also possible for a child to show no physical signs at all. In such cases, bear in mind that the perpetrator is commonly someone known and close to the child, possibly even a family member. Any child suspected of being sexually abused should be seen by a healthcare professional as soon as possible especially if any worrying symptoms are present or if the suspected incident occurred less than 72 hours ago. Ideally, a sexual assault nurse or a specialized pediatrician should conduct the examination. When symptoms aren’t present and the alleged incident happened more than 72 hours before, the child should be scheduled for follow-up visits for further checking and needed treatment.

When dealing with cases of child sexual abuse, it’s vital that healthcare providers fully understand the laws in their state about treating minors and gaining their consent.

What Causes Child Sexual Abuse and Neglect?

Many things can increase the likelihood of child abuse, such as personal, family, environmental, and societal aspects. A child with a physical or mental disability or a behavioral disorder is also at a higher risk for abuse, especially if their family doesn’t have the means to give them the help they need.

Here are some specific things that may make child abuse more likely:

Having been abused as a child
Issues with forming close relationships
Recurring behavioral issues
Going through a divorce
Moving a lot
Living in a hostile environment
Being cut off from friends and family
Having low self-esteem
Dealing with medical problems
Having a mental or physical disability
Struggling with mental health issues
Being in a nonbiological relationship
Lacking a strong social network
Living in poverty
Being born prematurely
Being subject to harsh disciplinary styles
Dealing with substance abuse
Being unemployed
Having unrealistic expectations
Being young parents

There are also some situational triggers for child abuse:

Dealing with sudden environmental issues
Having arguments
Substance abuse
Feeling a need to discipline/punish the child

Risk Factors and Frequency for Child Sexual Abuse and Neglect

The fourth National Incidence Study on Child Abuse and Neglect indicates a shocking rise in incidents of emotional neglect among American kids. It found that the number of children affected has soared by a massive 101% from 1993 to 2006. This is a jump from 584,100 kids to a startling 1,173,800.

What’s particularly concerning is that girls aged 12 to 24 are the most susceptible population to falling victim to sexual assault and rape. Over half of these horrible events occur during their childhood. Even more distressing is that between 5% to 25% of adults recall being victims of child sexual abuse.

Shockingly, less than half of sexual abuse incidents are reported to law enforcement. This suggests that the real occurrences of child sexual abuse and neglect could be much higher than stated.

American children’s emotional neglect has increased by 101% from 584,100 in 1993 to 1,173,800 in 2006.
Females between the ages of 12 and 24 carry the highest risk of being subjected to sexual assault and rape.
Acknowledges that over 50% of rapes occur during these female victims’ childhood.
Between 5% to 25% of adults claim to have been victims of child sexual abuse.
Less than half of all sexual assaults are reported to the police, showing that child sexual abuse and neglect are greatly underestimated.

Signs and Symptoms of Child Sexual Abuse and Neglect

Child protection workers interview children who have experienced sexual abuse, providing crucial information for court cases. Medical professionals, on the other hand, need to focus on taking a relevant medical history from the child. They should look out for any signs of past injuries or infections to the genitals or urinary tract, unusual discharges, and issues with using the bathroom.

Even though a physical exam may not always show obvious sign of abuse, it’s still really important for checking the child’s current health. Doctors should take note of the child’s overall appearance and emotional state. Looking closely at the skin, hair, and inside of the mouth for any injury signs is also crucial. Before feeling for any painful areas, the child should be asked if they are experiencing pain anywhere. It’s not needed to use a speculum for an internal exam in children who haven’t hit puberty. A careful check of the genitals must be performed with the child in a comfortable position on their back with their legs apart.

For girls, the exam should cover the larger and smaller folds of skin around the vagina (labia majora and minora), the sensitive area at the front (clitoris), the opening of the urinary tract (urethra), the innermost fold of skin (hymen), inside of the vagina (vaginal vault), and the space at the bottom of the vagina (fossa navicularis).
Any injury signs should be written down carefully. For example, injuries that occurred by accident might cause bruises or scrapes on the labia or back part of the vagina. However, it’s rare for the hymen to get injured in non-abuse situations due to its position, so the state and form of the hymen should be detailed very meticulously.
In boys who have been abused, the exam should include their circumcision status and any visible injury signs.

Finally, both boys and girls will need an anal exam. This will show if the anal passage is wider than it should be (more than 2 cm), which could suggest abuse.

Testing for Child Sexual Abuse and Neglect

Studies show that between 2% and 12% of children who have been sexually abused carry gonorrhea, and almost 10% may have chlamydia when first examined. Because of this, testing for sexually transmitted infections is critical in situations where there is higher risk. This includes situations where the child may already have a sexually transmitted infection, if their sibling has one, or if the child or parents ask for testing.

Doctors usually test for gonorrhea and chlamydia by examining a urine sample using a method known as nucleic acid amplification. If the test comes back positive, it should be confirmed with a culture test. Although kids typically don’t have sores or blisters, these should be checked for viruses if they are present.

Currently, the guidelines recommend taking legal evidence within 24 hours of sexual contact for children who have not yet hit puberty, and within 72 hours in older teenagers. However, some places have extended this to between 5 and 7 days. The kits used to gather this evidence can vary greatly, so it’s important to carefully package and label everything to keep the evidence intact.

A Woods light, a special kind of lamp, might be helpful when collecting specimens. Lastly, any clothes, such as underwear, that were worn during the incident should be put into a sealed paper bag for examination.

Treatment Options for Child Sexual Abuse and Neglect

It’s crucial to have a thorough early evaluation to ensure the best results for children who have been sexually abused and their families. This process should involve a variety of specialists, including doctors, nurses, social workers, and mental health professionals to provide the best possible care and therapy. In particular, doctors should consider the risk of sexual transmission infections and potential pregnancy in older girls and teenagers. However, the specific care given should be based on the individual situation and relevant medical findings. In emergency situations, it’s important that all victims of child sexual abuse have arranged medical and psychological check-ups in the future.

Tears in the lining of the anus (anal fissures)
Long-term constipation
Birth defects
Crohn’s disease (a type of inflammatory bowel disease)
Skin inflammation
Infections acquired during instances of child abuse
Injuries to the lower parts of the urinary and reproductive systems
Infections around the anus caused by strep bacteria
Situations of sexual assault
Inflammation of the vagina (vaginitis)

What to expect with Child Sexual Abuse and Neglect

Child sexual abuse can lead to long-term damages on a person’s physical and mental health. Young people who have experienced such abuse often face increased risks of various conditions as they transition into adulthood. These can include anxiety, depression, low self-esteem, hospitalizations due to mental health issues, social fears, and post-traumatic stress disorder.

Additionally, those who have been sexually abused during their childhood are more likely to become victims of domestic abuse or sexual assault later in life. They are also more susceptible to chronic health issues like irritable bowel syndrome, fibromyalgia, obesity, and sexually transmitted infections. Research has also shown that survivors of child sexual abuse are more likely to struggle with addiction to tobacco, alcohol, and illicit drugs.

Frequently asked questions

Child sexual abuse involves forcing or tricking a child into participating in sexual activities that they don't fully comprehend. These activities could involve things like exposing oneself, touching inappropriately, or even engaging in oral or penetrative sexual acts.

Between 5% to 25% of adults claim to have been victims of child sexual abuse.

Signs and symptoms of child sexual abuse and neglect can vary, but there are several indicators that professionals should look out for. These signs and symptoms include: - Physical signs: Professionals should look for signs of past injuries or infections to the genitals or urinary tract, unusual discharges, and issues with using the bathroom. It's important to note that a physical exam may not always show obvious signs of abuse, but it is still crucial for checking the child's current health. Doctors should take note of the child's overall appearance and emotional state, as well as closely examine the skin, hair, and inside of the mouth for any injury signs. - Girls: For girls, the exam should cover the larger and smaller folds of skin around the vagina (labia majora and minora), the clitoris, the urethra, the hymen, the vaginal vault, and the fossa navicularis. Any injury signs should be carefully documented, including bruises or scrapes on the labia or back part of the vagina. The state and form of the hymen should be detailed meticulously, as it is rare for the hymen to get injured in non-abuse situations due to its position. - Boys: In boys who have been abused, the exam should include their circumcision status and any visible injury signs. - Anal exam: Both boys and girls will need an anal exam. This will help determine if the anal passage is wider than it should be (more than 2 cm), which could suggest abuse. It's important for child protection workers and medical professionals to be thorough in their examinations and documentation, as the information gathered can provide crucial evidence for court cases involving child sexual abuse.

Child Sexual Abuse and Neglect can occur due to various factors such as personal, family, environmental, and societal aspects. Some specific factors that may increase the likelihood of child abuse include having a physical or mental disability, behavioral disorders, being in a nonbiological relationship, living in poverty, dealing with substance abuse, and being subject to harsh disciplinary styles. Situational triggers for child abuse can include sudden environmental issues, arguments, substance abuse, and feeling a need to discipline or punish the child.

The conditions that a doctor needs to rule out when diagnosing Child Sexual Abuse and Neglect are: - Tears in the lining of the anus (anal fissures) - Long-term constipation - Birth defects - Crohn’s disease (a type of inflammatory bowel disease) - Skin inflammation - Infections acquired during instances of child abuse - Injuries to the lower parts of the urinary and reproductive systems - Infections around the anus caused by strep bacteria - Situations of sexual assault - Inflammation of the vagina (vaginitis)

The types of tests needed for Child Sexual Abuse and Neglect include: - Testing for sexually transmitted infections, such as gonorrhea and chlamydia, using nucleic acid amplification method on a urine sample. - Confirming positive results with a culture test. - Checking for viruses if sores or blisters are present. - Using a Woods light, a special lamp, to collect specimens. - Collecting and preserving any clothes worn during the incident in a sealed paper bag for examination.

Child Sexual Abuse and Neglect is treated through a thorough early evaluation involving a variety of specialists, including doctors, nurses, social workers, and mental health professionals. The specific care given should be based on the individual situation and relevant medical findings. In emergency situations, it is important for all victims of child sexual abuse to have arranged medical and psychological check-ups in the future. Doctors should also consider the risk of sexual transmission infections and potential pregnancy in older girls and teenagers.

The text does not mention any specific side effects when treating child sexual abuse and neglect.

Child sexual abuse and neglect can have long-term negative effects on a person's physical and mental health. Some potential consequences include increased risks of anxiety, depression, low self-esteem, hospitalizations due to mental health issues, social fears, and post-traumatic stress disorder. Survivors of child sexual abuse are also more likely to become victims of domestic abuse or sexual assault later in life and may experience chronic health issues such as irritable bowel syndrome, fibromyalgia, obesity, and sexually transmitted infections. Additionally, they may struggle with addiction to tobacco, alcohol, and illicit drugs.

A sexual assault nurse or a specialized pediatrician should conduct the examination.

Abuse Abuse or Neglect Child Health STD / STI