title: Update on childhood sexual abuse.
abstract: OBJECTIVE
  Childhood sexual abuse (CSA) is a problem of epidemic proportion affecting children and communities worldwide. This review will examine the most recent published CSA literature emphasizing not only new findings in diagnosis, management, and prevention, but also practice implications for the medical and community-based provider. Sexual assault and rape, though forms of sexual abuse, are broader than the scope of this article and not discussed in detail at this time.
  
  
  RESULTS
  Prevalence rates for CSA are difficult to obtain. To identify populations at greatest risk and tailor treatment and prevention initiatives, consistent methods for defining and reporting cases of CSA are needed. Appreciating the quality and quantity of adverse health outcomes associated with CSA has helped clinicians and community providers expand and develop treatment programs. The physical and psychological late effects of abuse can be permanent and life threatening and the primary care provider should assess for mental health problems as well as physical maladies in all routine examinations. Children do not often disclose experiences of abuse for months to years and caregivers must be cognizant of the medical and behavioral indicators that signal early abuse. Child advocacy centers are community-based programs that incorporate medical, psychological, and legal support services for children and their families. This therapeutic model is based on a multidisciplinary team assessment aimed at decreasing stress, providing adequate protection and services for the child, and optimizing chances for a successful legal outcome.
  
  
  CONCLUSIONS
  While prevention remains the ultimate goal, improved awareness and education for communities and professionals alike is required to ensure appropriate and quality care for all children who are sexually abused.
authors.affiliation: Department of Pediatrics, Harvard Medical School, and the Child Protection Program, Children's Hospital Boston, Boston, Massachusetts 02115, USA. mark.sapp@childrens.harvard.edu
authors.forename: Mark V
authors.initials: MV
authors.lastname: Sapp
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Vandeven
mesh_terms: D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis* / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D010353:Patient Education as Topic; D012307:Risk Factors; D012725:Sexual Behavior / Q000523:psychology; D012749:Sexually Transmitted Diseases / Q000209:etiology; D019966:Substance-Related Disorders / Q000209:etiology