Child Sexual Abuse Triage : Suspected Sexual Abuse Overview

Local Child Abuse Resources

Local resources may include:

• Specialized providers and/or experts who will examine the patient and collect forensic evidence and are defined in Table 1 below
• Hospital emergency departments with resources and/or access to the specialized providers listed above, such as hospital-based Pediatric Emergency Departments
• Emergency medicine or primary care or other pediatric providers who can evaluate and stabilize the patient as needed prior to referral
• Child Advocacy Centers, also called Children’s Advocacy Centers, (CACs) offer many resources to support expert child and adolescent sexual abuse evaluations. See the National Children’s Alliance interactive map of U.S. centers. Resources vary among centers.

Child Abuse Medical Providers

The National Children’s Alliance (NCA) defines physicians, advanced practice nurses, physician assistants and SANE/SAFEs without advanced practice training as being eligible to engage in medical evaluations of child abuse. Health care providers of CACs must meet specific training and eligibility standards whether the exams are occurring on- or off-site.

Table 1

An advanced medical consultant is a Child Abuse Pediatrician, Physician or Advanced Practice Nurse who:

• Has met the minimum training outlined for a CAC provider (see below)
• Has performed at least 100 child sexual abuse examinations
• Is current in CQI requirements (continuing education and participation in expert review on their own cases)

NCA Med-Appendix 3, page 71 https://www.nationalchildrensalliance.org/wp-content/uploads/2021/10/2023-RedBook-v5B-t-Final-Web.pdf

Adapted from NCA Med-Appendix 2, page 70. https://www.nationalchildrensalliance.org/wp-content/uploads/2021/10/2023-RedBook-v5B-t-Final-Web.pdf

* Board-certified Child Abuse Pediatricians provide expertise in all forms of child abuse and neglect.

** For more information about Sexual Assault Nurse Examiners see https://www.forensicnurses.org/sane-certification-whats-the-scoop/

*** For more information about Sexual Assault Forensic Examiner Training see https://www.health.ny.gov/professionals/safe/

See information about making a referral to a child abuse expert [Internal Link]

Principles of Triage in Child/Adolescent Sexual Abuse Cases

• Every child deserves a skilled medical exam when child abuse is suspected.
• Steps for appropriate medical care will vary depending on the availability of local expert medical resources and costs to the patient and family.
• Avoid delays. There is a limited timeframe for forensic evidence collection. The timing of an expert exam can make a difference in findings used for legal purposes.
• Minimize further trauma. Use trauma informed care methods of communication.
• Document communication, including communication between the medical team and the patient and family, and observations of caregiver and patient interactions.
• Consider evaluation for other forms of child maltreatment and neglect (physical and emotional/psychological) as sexual abuse may occur concurrently.

Indications for a Medical Evaluation for Sexual Abuse

• There is any suspicion of child maltreatment or neglect
• There is a suspicion of sexual abuse, including concerns regarding less common sexual behaviors in children
• There is a concern regarding child/adolescent trafficking
• A child presents after an abduction or being missing for a period of time
• The child/adolescent is brought for a medical assessment by child protective authorities or law enforcement
• There is a history of a disclosure from a child/adolescent
• There is a history of pain, injury, genital bleeding, or other unwitnessed genital trauma
• There are physical signs and symptoms of genitourinary problems such as vaginal discharge or dysuria or evidence of severe physical abuse, leading to a suspicion of sexual abuse
• The child/adolescent and family or other caregivers need support and reassurance