Jun 26

Be Human Stop Child Abuse : Vol 21, 26th June, 2013

  Facts about sexual abuse

Situation: A 9-year-old child came with injury in the genital area.

Dr. Bad: This is a classical case of child abuse.

Dr. Good: This can be an accident.
Lesson: Injuries in the genital region of boys are mostly caused by accidents. In a study, three cases of child abuse and one case suspicious for child abuse but explainable by a congenital undiscovered malformation was presented. Injuries or findings in the genital region are especially suspicious for child abuse, including sexual abuse. Because of the possible misinterpretation and the consequences of a false confirmation of a child abuse, an interdisciplinary cooperation between pediatrics, forensic experts, and pediatric urologist should be carried out in doubtful cases. (Int J Legal Med. 2013 Jun 7)

Situation: A 19-year-old male came with a history of substance abuse.

Dr. Bad: He is a drug addict.

Dr. Good: I need to take history of childhood and maltreatment.

Lesson: Childhood maltreatment has an impact in juvenile and adulthood periods in the form of offending, mental health concerns such as suicide and homicide, substance abuse, school failure, employment difficulties, teenage pregnancy, adult attachment difficulties, family violence, intergenerational violence. (Iran J Pediatr 2013 Apr;23(2):159-64)

Situation: A sexually abused child was brought for examination.

Dr. Bad: Lie down for physical examination.

Dr. Good: I need to check him physically and also examine stool guaiac test.
Lesson: Examination of the anus in both males and females may be accomplished with the patient lying in the lateral recumbent position and grasping his or her knees. The examiner separates the buttocks for
approximately 30 seconds, allowing sphincter relaxation and visualization of the anal canal. If penetration is suspected, a stool guaiac test should be performed. (J Pediatr Health Care 1999;13:112)

Situation: A child with suspected child abuse was found to have a lax anus.

Dr. Bad: This can be normal.

Dr. Good: This is suspicious of sexual abuse.
Lesson: Laxity of the anus may represent abuse. It also can be seen with chronic constipation, neurologic disorders, or sedation. Dilation greater than 20 mm is suggestive of abuse if there is no stool in the

(J Pediatr Adolesc Gynecol 2004;17:191)

Situation: A child with sexual abuse was found to have discoloration of the anus at 48 hours.

Dr. Bad: It cannot be sexual abuse.

Dr. Good: It can be sexual abuse.

Lesson: Evidence of acute anal trauma may be seen if the child is evaluated soon after the abuse; however, anorectal changes are rarely definitive indicators of abuse. Swelling of the anus with blue
discoloration is suggestive of trauma (Child Abuse Negl 1989;13:195) and may be present up to 48 hours
after the event. It is important not to confuse this finding with hemorrhoids.

Situation: A child with anal sexual abuse came after two years.

Dr. Bad: It was not a sexual abuse as there is no scaring.

Dr. Good: Sexual abuse cannot be ruled out.

Lesson: Penetrating injuries causing lacerations of the rectum may heal with scarring, but over time are difficult to detect. Midline anal tags are not indicative of abuse, whereas deformities outside of
the midline may indicate chronic trauma. (J Pediatr Health Care 1999; 13:112)





Dr Vinay Aggarwal, President, Elect CMAAO

Dr K Vijayakumar (National President) IMA

Dr N Saini (Secretary General) IMA

Dr M Pillai (Chairman Organising Committee)

Dr D R Rai (Organising Secretary)

Dr S Arulrhaj (Chairman Scientific Committee)

Dr KK Aggarwal (Co-Chairman & Editor)

  1. Dear Sir, Nice updates. Regards:Dr Shantanu

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