Child maltreatment, Part 2: Sexual exploitation and abuse

Sexual abuse—the term generates a myriad of responses, and few of us can hear it without having some type of emotional reaction. For physicians, the response may include feelings of confusion and trepidation; for families, the reaction often goes much deeper. This is in large part because the vast majority of perpetrators of sexual abuse against children are family members or friends. The emotional devastation and turmoil that ensue can be catastrophic.

The investigative field of child sexual abuse is relatively new, with most of the published research appearing in just the past 10 to 15 years. From the 1983 Badgley Report to the 2001 Canadian Incidence Study of Reported Child Abuse and Neglect, numerous studies have documented the prevalence of sexual abuse in the pediatric population. Many authors and leading health care authorities have proposed a variety of guidelines and protocols to assist the physician in the management of these children. With the current trend toward evidence-based medicine, the task of keeping up with recent developments can be overwhelming.

In this second issue dedicated to child maltreatment, we focus on a few of the more serious problems related to pediatric sexual abuse. The first article highlights many of the factors contributing to the commercial sexual exploitation of our youth and points out the relatively hidden nature of this burgeoning social problem. The second and third articles provide a framework for the management of pre-pubescent and adolescent children who have been subjected to a sexual assault. The sensitive issues of patient confidentiality and consent are discussed with particular emphasis on the adolescent age group. Finally, the fourth article—a concise summary of sexually transmitted diseases in the pediatric population—addresses many of the questions commonly posed to the provincial SCAN team members by referring general physicians and pediatricians.

Health care providers must recognize that they have unique skill sets that render them invaluable members of the multidisciplinary team. Although the main focus of any assessment must always remain the health and well-being of our patients, it is vital that we continue to strive for answers and improve our collaboration with other investigative personnel. Despite the complexities we may encounter as professionals, we have an obligation to act on behalf of our young patients and their families. We must make it clear that both the sexual exploitation and sexual abuse of our children are intolerable, that all children have the right to personal safety, and that we are going to be active participants in both the intervention and prevention processes.

—Margaret Colbourne, MD
Pediatric Emergency Physician, Child Protection Service Unit, BC’s Children’s Hospital