Skip to main content

Acute Sexual Assault Evaluation of the Prepubertal Child

  • Living reference work entry
  • First Online:
  • 164 Accesses

Abstract

When a child makes a disclosure of acute sexual assault, the need for a timely evaluation becomes paramount. In this situation, the responsibility of the examiner becomes twofold: (1) ensuring appropriate medical care is provided for the child and (2) collection of forensic evidence to assist with investigation of the child’s disclosure. The primary focus of the examiner should be to perform a trauma-informed, victim-centered evaluation of the child, which is developmentally appropriate to individual child’s needs. The examiner should be able to obtain any necessary history, perform a thorough physical examination, determine what laboratory evaluation may be indicated, and address any medical or psychological needs which may be identified.

This chapter will focus on the medical and forensic components of the acute sexual assault evaluation of prepubertal children, including the collection of historical, physical, and forensic evidence; laboratory evaluation; interpretation of findings; and medical management considerations for this patient population.

This chapter was initially published with an incorrect copyright holder name. It has been corrected to © Springer Nature Switzerland AG.

This is a preview of subscription content, log in via an institution.

References

  • Adams, J. A., Kellogg, N. D., Farst, K. J., Harper, N. S., Palusci, V. J., Frasier, L. D., Levitt, C. J., Shapiro, R. A., Moles, R. L., & Starling, S. P. (2016). Updated guidelines for the medical assessment and care of children who may have been sexually abused. Journal of Pediatric and Adolescent Gynecology, 29(2), 81–87. https://doi.org/10.1016/j.jpag.2015.01.007.

    Article  Google Scholar 

  • Adams, J. A., Farst, K. J., & Kellogg, N. D. (2018). Interpretation of medical findings in suspected child sexual abuse: An update for 2018. Journal of Pediatric and Adolescent Gynecology, 31, 225–231. https://doi.org/10.1016/j.jpag.2017.12.011.

    Article  Google Scholar 

  • Alexander, R., & Harper, N. S. (2019). Medical response to child sexual abuse: A resource for professionals working with children and families (2nd ed.). Saint Louis: STM Learning, Inc.

    Google Scholar 

  • Allard, J. E. (1997). The collection of data from findings in cases of sexual assault and the significance of spermatozoa on vaginal, anal, and oral swabs. Science & Justice, 37, 99–108.

    Article  Google Scholar 

  • Anderson, L. J., Flynn, A., & Pilgrim, J. L. (2017). A global epidemiological perspective on the toxicology of drug-facilitated sexual assault: A systematic review. Journal of Forensic and Legal Medicine, 47, 46–54. https://doi.org/10.1016/j.jflm.2017.02.005.

    Article  Google Scholar 

  • Astrup, B. S., Thomsen, J. L., Lauritsen, J., & Ravn, P. (2012). Detection of spermatozoa following consensual sexual intercourse. Forensic Science International, 221, 137–141. https://doi.org/10.1016/j.forsciint.2012.04.024.

    Article  Google Scholar 

  • Brayley-Morris, H., Sorrell, A., Revoir, A. P., Meakin, G. E., Syndercomb Court, D., & Morgan, R. M. (2015). Persistence of DNA from laundered semen stains: Implications for child sex trafficking cases. Forensic Science International. Genetics, 19, 165–171.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention. (2016). Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV – United States, 2016. Washington, DC: U.S. Department of Health and Human Services.

    Google Scholar 

  • Christian, C. W., Lavelle, J. M., Jong, A. R. D., Loiselle, J., Brenner, L., & Joffe, M. (2000). Forensic evidence findings in prepubertal victims of sexual assault. Pediatrics, 106(1), 100–104. https://doi.org/10.1542/peds.106.1.100.

    Article  Google Scholar 

  • Committee on Identifying the Needs of the Forensic Sciences Community, National Research Council. (2009). Strengthening forensic science in the United States: A path forward. Washington, DC: National Academies Press.

    Google Scholar 

  • Cross, T. P., & Schmitt, T. (2019). Forensic medical results and law enforcement actions following sexual assault: A comparison of child, adolescent, and adult cases. Child Abuse & Neglect, 93, 103–110. https://doi.org/10.1016/j.chiabu.2019.04.014.

    Article  Google Scholar 

  • De Jong, A. R., & Rose, M. (1989). Frequency and significance of physical evidence in legally proven cases of child sexual abuse. Pediatrics, 84(6), 1022–1026.

    Google Scholar 

  • Donaruma-Kwoh, M., Giardino, E. R., & Giardino, A. P. (2016). Back to basics: The identification of genital anatomic structures and forensic evidence collection kits in cases of suspected child sexual abuse. Open Medicine Journal, 3(1), 212–221. https://doi.org/10.2174/1874220301603010212.

    Article  Google Scholar 

  • Fiorentin, T. R., & Logan, B. K. (2019). Toxicological findings in 1000 cases of suspected drug facilitated sexual assault in the United States. Journal of Forensic and Legal Medicine, 61, 56–64. https://doi.org/10.1016/j.jflm.2018.11.006.

    Article  Google Scholar 

  • Fonnelop, A. E., Johannessen, H., Heen, G., Molland, K., & Gill, P. (2019). A retrospective study on the transfer, persistence, and recovery of sperm and epithelial cells in samples collected in sexual assault casework. Forensic Science International. Genetics, 43, 1–6. https://www.fsigenetics.com/article/S1872-4973(19)30134-6/.

    Article  Google Scholar 

  • Fortin, K., & Jenny, C. (2012). Sexual abuse. Pediatrics in Review, 33(1). https://doi.org/10.1542/pir.33-1-19.

  • Gabby, T., Winkleby, M. A., Boyce, W. T., Fisher, D. L., Lancaster, A., & Sensabaugh, G. F. (1992). Sexual abuse of children: The detection of semen on skin. American Journal of Diseases of Children, 146(6), 700–703. https://doi.org/10.1001/archpedi.1992.02160180058017.

    Article  Google Scholar 

  • Gallion, H., Milam, L., & Littrell, L. (2016). Genital findings in cases of child sexual abuse: Genital vs vaginal penetration. Journal of Pediatric and Adolescent Gynecology, 29(6), 604–611. https://doi.org/10.1016/j.jpag.2016.05.001.

    Article  Google Scholar 

  • Gavril, A. R., Kellogg, N. D., & Nair, P. (2012). Value of follow-up examinations of children and adolescents evaluated for sexual abuse and assault. Pediatrics, 129(2), 282–289. https://doi.org/10.1542/peds.2011-0804.

    Article  Google Scholar 

  • Giardino, A. P., & Finkel, M. A. (2005). Evaluating child sexual abuse. Pediatric Annals, 34(5), 382–392. https://doi.org/10.3928/0090-4481-20050501-12.

    Article  Google Scholar 

  • Girardet, R., Giacobbe, L., Bolton, K., Lahoti, S., & Mcneese, M. (2006). Unmet health care needs among children evaluated for sexual assault. Archives of Pediatrics & Adolescent Medicine, 160(1), 70. https://doi.org/10.1001/archpedi.160.1.70.

    Article  Google Scholar 

  • Girardet, R. G., Lahoti, S., Howard, L. A., Fajman, N. N., Sawyer, M. K., Driebe, E. M., Lee, F., Sautter, R. L., Greenwald, E., Beck-Sagué, C. M., Hammerschlag, M. R., & Black, C. M. (2009). Epidemiology of sexually transmitted infections in suspected child victims of sexual assault. Pediatrics, 124, 79–86. https://doi.org/10.1542/peds.2008-2947.

    Article  Google Scholar 

  • Girardet, R., Bolton, K., Lahoti, S., Mowbray, H., Giardino, A., Isaac, R., Arnold, W., Mead, B., & Paes, N. (2011). Collection of forensic evidence from pediatric victims of sexual assault. Pediatrics, 128(2), 233–238. https://doi.org/10.1542/peds.2010-3037.

    Article  Google Scholar 

  • Graves, H. C. B., Sensabaugh, G. F., & Black, E. T. (1985). Postcoital detection of a male-specific semen protein – Application to the investigation of rape. The New England Journal of Medicine, 312, 338–343.

    Article  Google Scholar 

  • Green, W. (2013). Forensic photography: An overview of basic principles for healthcare providers. In American College of Emergency Physicians (ACEP) (Ed.), Evaluation and management of the sexually assaulted or sexually abused patient (2nd ed.). Dallas: Author.

    Google Scholar 

  • Hartley, D. J., Mullings, J. L., & Marquart, J. W. (2013). Factors impacting prosecution of child sexual abuse, physical abuse, and neglect cases processed through a children’s advocacy center. Journal of Child & Adolescent Trauma, 6(4), 260–273. https://doi.org/10.1080/19361521.2013.836586.

    Article  Google Scholar 

  • Herrmann, B., & Navratil, F. (2004). Sexual abuse in prepubertal children and adolescents. Endocrine Development, 7, 77–105. https://doi.org/10.1159/000077079.

    Article  Google Scholar 

  • Hornor, G., Thackeray, J., Scribano, P., Curran, S., & Benzinger, E. (2012). Pediatric sexual assault nurse examiner care: Trace forensic evidence, ano-genital injury, and judicial outcomes. Journal of Forensic Nursing, 8(3), 105–111. https://doi.org/10.1111/j.1939-3938.2011.01131.x.

    Article  Google Scholar 

  • Jenny, C. E., Crawford-Jakubiak, J. E., & the Committee on Child Abuse and Neglect. (2013). The evaluation of children in the primary care setting when sexual abuse is suspected. Pediatrics, 132(2), 558–567. https://doi.org/10.1542/peds.2013-1741.

    Article  Google Scholar 

  • Joki-Erkkilä, M., Niemi, J., & Ellonen, N. (2014). Child sexual abuse – Medical statement conclusions in criminal legal process. Forensic Science International, 239, 31–36. https://doi.org/10.1016/j.forsciint.2014.03.006.

    Article  Google Scholar 

  • Keil, W., Bachus, J., & Tröger, H. D. (1996). Evaluation of MHS-5 in detecting seminal fluid in vaginal swabs. International Journal of Legal Medicine, 108, 186–190.

    Article  Google Scholar 

  • Kellogg, N., & the Committee on Child Abuse and Neglect. (2005a). Oral and dental aspects of child abuse and neglect. Pediatrics, 116(6), 1565–1568. https://doi.org/10.1542/peds.2005-2315.

    Article  Google Scholar 

  • Kellogg, N., & the Committee on Child Abuse and Neglect. (2005b). The evaluation of sexual abuse in children. Pediatrics, 116(2), 506–512.

    Article  Google Scholar 

  • Kellogg, N., Melville, J., Lukefahr, J., Nienow, S., & Russell, E. (2018). Genital and extragenital gonorrhea and chlamydia in children and adolescents evaluated for sexual abuse. Pediatric Emergency Care, 34(11), 761–766.

    Article  Google Scholar 

  • Kimberlin, D. W., Brady, M. T., Jackson, M. A., & Long, S. S. (Eds.). (2018). Red book: 2018 report of the Committee on Infectious Diseases (31st ed.). Itasca: American Academy of Pediatrics.

    Google Scholar 

  • National Commission on the Future of DNA Evidence. (2000). The future of forensic DNA testing: Predictions of the Research and Development Working Group (publication no. NCJ 183697). Retrieved from the National Criminal Justice Reference Service. https://www.ncjrs.gov/pdffiles1/nij/183697.pdf

  • National Institute of Justice (2012a). DNA evidence: Basics of analyzing. Retrieved from the National Institute of Justice. https://nij.ojp.gov/topics/articles/dna-evidence-basics-analyzing

  • National Institute of Justice. (2012b). DNA evidence basics: Possible results from testing. Retrieved from the National Institute of Justice. https://nij.ojp.gov/topics/articles/dna-evidence-basics-possible-results-testing

  • National Institute of Justice. (2017). National best practices for sexual assault kits: A multidisciplinary approach (publication no. NCJ 250384). Retrieved from the National Institute of Justice. https://nij.ojp.gov/topics/articles/national-best-practices-sexual-assault-kits-multidisciplinary-approach

  • Ricci, L. R., & Hoffman, S. A. (1982). Prostatic acid phosphatase and sperm in the post-coital vagina. Annals of Emergency Medicine, 11(10), 530–534. https://doi.org/10.1016/S0196-0644(82)80424-1.

    Article  Google Scholar 

  • Santucci, K. A., Nelson, D. G., Mcquillen, K. K., Duffy, S. J., & Linakis, K. G. (1999). Woods lamp utility in the identification of semen. Pediatrics, 104(6), 1342–1344. https://doi.org/10.1542/peds.104.6.1342.

    Article  Google Scholar 

  • Sep, D., & Thies, K.-C. (2007). Strangulation injuries in children. Resuscitation, 74, 386–391. https://doi.org/10.1016/j.resuscitation.2006.09.019.

    Article  Google Scholar 

  • Smith, T. D., Raman, S. R., Madigan, S., Waldman, J., & Shouldice, M. (2018). Anogenital findings in 3569 pediatric examinations for sexual abuse/assault. Journal of Pediatric and Adolescent Gynecology, 31(2), 79–83. https://doi.org/10.1016/j.jpag.2017.10.006.

    Article  Google Scholar 

  • Thackeray, J. D., Hornor, G., Benzinger, E. A., & Scribano, P. V. (2011). Forensic evidence collection and DNA identification in acute child sexual assault. Pediatrics, 128(2), 227–232. https://doi.org/10.1542/peds.2010-3498.

    Article  Google Scholar 

  • U.S. Department of Justice, Office on Violence Against Women. (2016). A national protocol for sexual abuse medical forensic examinations – Pediatric. https://www.justice.gov/ovw/file/846856/download

  • Uprety, P., & Cardenas, A. M. (2019). Extragenital screening is essential for comprehensive detection of Chlamydia trachomatis and Neisseria gonorrhoeae in the pediatric population. Journal of Clinical Microbiology, 57(6), e00335–e00319. https://doi.org/10.1128/JCM.00335-19.

    Article  Google Scholar 

  • Wawryk, J., & Odell, M. (2005). Fluorescent identification of biological and other stains on skin by the use of alternative light sources. Journal of Clinical Forensic Medicine, 12(6), 296–301. https://doi.org/10.1016/j.jcfm.2005.03.005.

    Article  Google Scholar 

  • Wickenheiser, R. A. (2002). Trace DNA: A review, discussion of theory, and application on the transfer of trace quantities of DNA through skin contact. Journal of Forensic Science, 47(3), 442–450.

    Article  Google Scholar 

  • Workowski, K. A., Bolan, G. A., & Centers for Disease Control and Prevention. (2015). Sexually transmitted diseases treatment guidelines, 2015. Morbidity and Mortality Weekly Report, 64(3), 1–137.

    Google Scholar 

  • Young, K. L., Jones, J. G., Worthington, T., Simpson, P., & Casey, P. H. (2006). Forensic laboratory evidence in sexually abused children and adolescents. Archives of Pediatrics and Adolescent Medicine, 160, 585–588.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michelle Clayton .

Editor information

Editors and Affiliations

Section Editor information

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Shipman, A., Scaff, D., Elverum, C., Clayton, M. (2020). Acute Sexual Assault Evaluation of the Prepubertal Child. In: Geffner, R., White, J.W., Hamberger, L.K., Rosenbaum, A., Vaughan-Eden, V., Vieth, V.I. (eds) Handbook of Interpersonal Violence and Abuse Across the Lifespan. Springer, Cham. https://doi.org/10.1007/978-3-319-62122-7_121-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-62122-7_121-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-62122-7

  • Online ISBN: 978-3-319-62122-7

  • eBook Packages: Springer Reference Behavioral Science and PsychologyReference Module Humanities and Social SciencesReference Module Business, Economics and Social Sciences

Publish with us

Policies and ethics