Sexual abuse in the pediatric patient
Keywords:
Pediatric sexual abuse, pediatric victim, medical-legal evaluationAbstract
Child sexual abuse is the most common specific cause of intrafamilial violence in children under 18 years old in Costa Rica. Among the risk factors are belonging to a dysfunctional family, the use of violence as a method of education, lack of sexual education, and children with cognitive disabilities or developmental disorders. Minors tend to be chronically abused victims and that their report is delayed, so the assessment should start from the moment of the slightest suspicion. The approach must be comprehensive, performing a detailed clinical history and physical examination, as well as a legal assessment and evidence collection. Countless consequences suffer the victims of child sexual abuse, among them are personality disorders, gender disorder, sexually transmitted diseases, and depression. Although Costa Rica is at the forefront of international human rights issues, the incidence of reported cases of child sexual abuse has increased in recent years, which is why it is an issue that involves all actors in society to address it.
References
2. Elmi MH, Daignault IV, Hébert M. Child sexual abuse victims as witnesses: The influence of testifying on their recovery. Child Abuse Negl. 2018;86:22-32.
3. Adams J, Mrug S, Knight DC. Characteristics of child physical and sexual abuse as predictors of psychopathology. Child Abuse Negl. 2018;86:167-177.
4. Franco A, Ramírez L. Abuso sexual infantil: perspectiva clínica y dilemas ético-legales. Rev Colomb Psiquiat. 2016;45(1):51-58.
5. Organización Mundial de la Salud. Child maltreatment. En: https://www.who.int/es/news-room/factsheets/detail/child-maltreatment. Revisada el 8 de enero, 2019.
6. UNICEF. Convención sobre los derechos del niño. En: http://www.unicef.org/spanish/crc/. Revisada el 8 de enero, 2019.
7. Flaherty EG, Sege R. Barriers to Physical Identification and Reporting of Child Abuse. Pediatr Ann. 2005;34(5):349-356.
8. Giardino AP, Finkel MA. Evaluating child sexual abuse. Pediatr Ann. 2005;34:382-394.
9. Shulman ST. Child Abuse. Pediatr Ann. 2005;34(5):338.
10. Murray LK, Nguyen A, Cohen JA. Child Sexual Abuse. Child Adolesc Psychiatr Clin N Am. 2014;23(2):321-337.
11. Heger A, Ticson L, Velasquez O, Bernier R. Children referred for possible sexual abuse: medical findings in 2384 children. Child Abuse Negl. 2002 Jun;26(6-7):645-659.
12. Indest GF. Medico-Legal Issues in Detecting and Proving the Sexual Abuse of Children. Med Sci Law. 1989;29(1):33-46.
13. Niveau G, Lacasa M, Berclaz M, Germond M. Inter-rater Reliability of Criteria-Based Content Analysis of Children’s Statements of Abuse. J Forensic Sci. 2015;60(5):1247-1252.
14. Jewkes R, Christofides N, Vetten L, JIna R, Sigsworth R, Loots L. Medico-Legal Findings, Legal Case Progression, and Outcomes in South African Rape Cases: Retrospective Review. PLoS Med. 2009;6(10):e1000164.
15. Hansen LA, Mikkelsen SJ, Sabroe S, Charles AV. Medical Findings and Legal Outcomes in Sexually Abused Children. J Forensic Sci. 2010;55(1):104-109.
16. Seth R, Srivastava RN. Child Sexual Abuse: Management and Prevention, and Protection of Children from Sexual Offences (POCSO) Act. Indian Pediatr. 2017;54:949-953.
17. Christian CW, Giardino AP. Forensic evidence collection. In: Finkel MA, Giardino, AP, eds. Medical Evaluation of Child Sexual Abuse: A Practical Guide. Thousand Oaks, CA: Sage Publications; 2002:131-158.
18. Drummond R, Gall JAM. Evaluation of forensic medical history taking from the child in cases of child physical and sexual abuse and neglect. J. Forensic Leg. Med. 2017;46:37-45.
19. Hardner K, Wolf M, Rinfrette ES. Examining the relationship between higher educational attainment, trauma symptoms, and internalizing behaviors in child sexual abuse survivors. Child Abuse Negl. 2018;86:375-383.
20. Joki-Erkkila M, Niemi J, Ellonen N. Child sexual abuse – Initial suspicion and legal outcome. Forensic Sci Int. 2018;291:39-43.
21. Sekhar DL, Kraschnewski JL, Stuckey HL, Witt PD, Francis EB, Moore GA, Morgan PL, Noll JG. Opportunities and challenges in screening for childhood sexual abuse. Child Abuse Negl. 2918;85:156-163.
22. Finkel MA. Obtaining the medical history in suspected child sexual abuse: suggested rationale and questions. En: Finkel MA, ed. Medical Evaluation of Child Sexual Abuse: A Practical Guide. third ed. American Academy of Paediatrics; 2009
23. Segue-Castillo M. Legal outcome of sexually abused children evaluated at the Philippine General Hospital Child Protection Unit. Child Abuse Negl. 2009;33:193-202.
24. Joki-Erkkila M, Niemi J, Ellonen N. Child sexual abuse – Medical statement conclusion in criminal legal process. Forensic Sci Int. 2014;239:31-36.
25. Periódico La nación. Mal imparable denuncias por delitos sexuales. 2018. En: https://www.nacion.com/sucesos/malimparable-denuncias-por-delitossexuales/KV35P5UG5RAOBIWGGVA3V5HGRI/story/. Revisada el 10 de enero,2019.
26. UNICEF. Una revision sistemática de los determinantes de la violencia que afectan a niños, niñas y adolescentes: Costa Rica. 2017. San José, Costa Rica. En: https://www.unicef.org/costarica/Innocenti-Violencia-2017.pdf. Revisada el 14 de enero, 2019.
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