Abstract
This chapter provides an overview of an increasingly specialised and complex area where the understanding of physical signs is advancing and opinions changing. Detailed guidance on the assessment of children and young people for CSA is described in the RCPCH document ‘The Physical Signs of Child Sexual Abuse – an evidence based review and guidance for best practice’ [1].
A child is sexually abused when he or she is forced or persuaded to observe or take part in sexual acts including online activities. The Sexual Offences Act makes it an offence, where a child is under the age of 13 years, for a person to rape (the penetration by the penis of a child’s vagina, anus or mouth), sexually assault by penetration (penetrate sexually the vagina or anus of a child with a part of the body or object), sexually assault by touch or cause or incite a child to engage in sexual activity whether or not the child consented to the act [2].
Sexual abuse presents in many ways and children who suffer in this manner are often coerced into secrecy for many years. Presenting symptoms may be general (e.g. abdominal pain, enuresis, behavioural problems) or more specific (e.g. vaginal bleeding or a sexually transmitted infection).
A child may make a disclosure or be unwilling or unable to do so. Grooming and threats from a perpetrator may maintain secrecy. Disclosures are rarely fabricated and must always be taken as significant. When a child resides with an adult known to pose a risk to children, vigilance is required.
A meticulous assessment by a paediatrician with specialist and appropriate training is essential.
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Further Reading
Royal College of Paediatrics and Child Health. The physical signs of child sexual abuse. An evidence-based review and guidance for best practice. May 2015.
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Robinson, D.L. (2017). Child Sexual Abuse. In: Pediatric Forensic Evidence. Springer, Cham. https://doi.org/10.1007/978-3-319-45337-8_9
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