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TAS Child Protection > Sexual Abuse > Flashcards

Sexual Abuse Flashcards

1
Q

What is sexual abuse?

A

Forcing or enticing a child or young person to take part in sexual activities, whether or not the child is aware of what is happening

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2
Q

Doer sexual abuse always include physical contact?

A

No

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3
Q

What forms of sexual abuse don’t include physical contact?

A
  • Involving children in looking at, or in the production of, sexual images
  • Watching sexual activities
  • Encouraging children to behave in sexually inappropriate ways
  • Grooming a child in preparation for abuse (including via the internet)
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4
Q

Can children commit sexual abuse?

A

Yes

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5
Q

What’s % of UK children are subject to sexual abuse at some the?

A

4%

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6
Q

Who usually perpetrates sexual abuse?

A

Someone close to the child

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7
Q

What is the limitation of statistics about child sexual abuse?

A

It is often unrecognised, and therefore frequently missed

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8
Q

What % of 18-24 year olds consider they have been sexually abused (as per NSPCC survey)?

A

11%

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9
Q

Why does sexual abuse often go unrecognised?

A

Sexually abused children may not manifest any signs or symptoms, and they may not allege it is happening for fear of not being believed

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10
Q

What are sexually abused children at higher risk of when they grow up?

A
  • Further sexual abuse
  • Promiscuity
  • Teenage pregnancy
  • Mental health problems
  • Drug misuse
  • Difficulties with relationships
  • Difficulty protecting their own children
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11
Q

How might child sexual abuse present?

A
  • Allegation
  • Physical symptoms
  • Emotional/behavioural changes
  • Psychosomatic
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12
Q

When might an allegation of child sexual abuse occur?

A
  • In the acute period

- Weeks or years after the event

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13
Q

What is important when an allegation of sexual abuse is made in the acute period?

A

Forensic evidence must be gathered as a matter of urgency

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14
Q

Are allegations of child sexual abuse more commonly made in the acute phase or weeks/years later?

A

Weeks/years later

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15
Q

When is it more common for allegations of child sexual abuse to be made weeks/years later?

A

In cases of intra-familial abuse

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16
Q

How might symptoms linked to sexual abuse be discovered?

A
  • Incidentally by a carer
  • Reported by the child
  • Found on examination
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17
Q

What physical symptoms may be linked to sexual abuse?

A
  • Constipation
  • Dysuria
  • Enuresis
  • Recurrent urinary tract infections
  • Vaginal discharge or vulvovaginitis
  • Recurrent itching or soreness
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18
Q

What needs to be excluded when children present with physical symptoms suspicious of sexual abuse?

A

Medical causes

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19
Q

Give 2 examples of medical causes that can cause physical symptoms similar to those linked to sexual abuse?

A
  • Lichen sclerosus et atrophicus

- Rectal fissures

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20
Q

When are sudden changes in behaviour particularly suspicious for sexual abuse?

A

If associated with other changes, e.g. new people in the household

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21
Q

What can be helpful when determining if a sudden behavioural change is related to sexual abuse?

A

Asking the child alone if there is anything worrying them or if they have a bad secret

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22
Q

What emotional/behavioural changes may be associated with sexual abuse?

A
  • Sleep disturbance or nightmares
  • Anxiety, depression, withdrawal
  • Aggression, attention seeking and/or poor concentration
  • Sexualised behaviour
  • Encopresis
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23
Q

What emotional/behavioural changes may be associated with sexual abuse in older children/adolescents?

A
  • Self harm
  • Suicidal ideation
  • Running away
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24
Q

Give 3 examples of psychosomatic symptoms that can be related to sexual abuse?

A
  • Headaches
  • Changing in eating behaviour
  • Abdominal pains
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25
Q

What should be done in children presenting as victims of sexual abuse acutely?

A
  • Intimate body swabs taken for forensic evidence (semen, saliva, hair, and other substances)
  • Clothing examined for semen and DNA
26
Q

Where should forensic investigations undertaken in acute cases of sexual abuse be carried out?

A

In a sexual abuse referral centre

27
Q

What investigations may be carried out when sexual abuse is taken, irrespective of time frame?

A
  • Serum and urine samples for STDs

- Pregnancy testing if appropriate

28
Q

What is offered after the acute presentation of sexual abuse?

A

Psychological assessment and treatment

29
Q

Who interviews a child following an allegation of sexual abuse?

A

A trained police officer and social worker

30
Q

Where is a child interviewed after an allegation of sexual abuse?

A

A purpose-built suit with video-recording

31
Q

What is the interview that occurs with the child after an allegation of sexual abuse termed?

A

The ‘achieving best evidence’ (ABE) interview

32
Q

What interview style is adopted in the ABE interview?

A

The police and social worker will hear details of what happened without asking direct questions

33
Q

Does the ABE occur before or after medical examination?

A

If the medical examination is urgent (aka within the forensic time frame), the ABE interview will occur after

34
Q

What care needs to be taken during medical examination if it is being performed before the ABE interview?

A

Health professionals should only ask questions pertinent to the examination so they do not contaminate the verbal evidence

35
Q

Who’s permission should you seek prior to performing an examination in cases of sexual abuse?

A

The child and care giver’s

36
Q

What should the child be reminded of prior to performing an examination for sexual abuse?

A

How to keep safe

37
Q

Who should carry out the examination of the anogenital area following sexual abuse?

A

A senior doctor

38
Q

What is done with intimate body swabs taken during examination in cases of acute sexual assault?

A

They are labelled and given to the police officer in the case

39
Q

What should be used to enable detailed examination of the genitalia and anus?

A

A colposcope

40
Q

Should photo documentation be obtained when performing an examination in cases of sexual abuse?

A

Yes

41
Q

What form of consent is required when performing an anogenital examination in cases of sexual abuse?

A

Written consent from the parent/carer with parental responsibility, and the child if old enough

42
Q

What needs to be considered when looking for changes in the hymen in sexual abuse examinations?

A

There is much variation in normal anatomy, and the size and appearance of the hymen changes from birth to puberty

43
Q

In what position are the genitalia examined during a sexual abuse examinations in girls?

A

Frog legged position and, if tolerated, knee-chest position

44
Q

What might be found on examination in cases of acute genital injury?

A
  • Erythema
  • Bruising
  • Lacerations
45
Q

What injury might vaginal penetration lead to?

A

Laceration to the hymen

46
Q

In what position does laceration to the hymen caused by vaginal penetration most commonly occur?

A

Between 3 and 9 o’clock

47
Q

What may be found on examination of the hymen in non-acute allegations of penetration?

A

Notches and transections in the hymen

48
Q

How can notches and transections in the hymen be demonstrated?

A

With a swab or Foley catheter

49
Q

Are notches and transections of the hymen commonly found in cases of non-acute penetration?

A

No, they are only found in a small perfect of victims

50
Q

In what position is the anus examined in sexual abuse examinations?

A

Left lateral

51
Q

What may be found on examination following the actual or attempted application of a blunt penetrating force to the anus in the acute setting?

A
  • Erythema
  • Bruising
  • Laceration
52
Q

What might be found on examination following non-acute actual or attempted application of a blunt penetrating force to the anus?

A
  • Lacerations

- Reflex anal dilatation

53
Q

What is reflex anal dilatation?

A

When the anus dilates to reveal the rectum after separating the buttocks for up to 30 seconds

54
Q

In what proportion of children with a history of anal abuse is reflex anal dilatation seen?

A

1/3

55
Q

Is reflex anal dilatation ever seen in children without a history of anal abuse?

A

It is seen in small numbers of children

56
Q

What needs to be excluded when reflex anal dilatation is found on examination?

A

Constipation

57
Q

What might be found on general examination in acute allegations of sexual abuse?

A

Other injuries to the body, such as bruising, scratches, or bite marks

58
Q

What documentation is required at the conclusion of a sexual abuse examination?

A

A body map

59
Q

What happens to the DVD of evidence produced by a sexual abuse examination?

A

It is taken for peer review and court proceedings

60
Q

What % of children alleging historic abuse have normal physical findings?

A

90%

TAS Child Protection (4 decks)

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