title: Reflex anal dilatation: An observational study on non-abused children.
abstract: OBJECTIVE
  Reflex anal dilatation (RAD) is considered as a possible sign of anal abuse,however studies evaluating its prevalence in non-abused children are limited. The aim of this study was to evaluate the prevalence of RAD in a convenience sample of children with no suspicion of abuse admitted to a Pediatric Emergency Department (PED).
  
  
  METHODS
  Prospective observational study including children admitted to the PED of Padova, Italy, between January and June 2011. Patients with no suspicion of abuse and for whom ano-genital examination was part of their medical evaluation were included. Children were excluded if in critical clinical conditions or if any suspicion of abuse arose during medical evaluation. Presence/absence of RAD and of factors favoring its appearance were recorded for each patient.
  
  
  RESULTS
  Two-hundred and thirty children (median age of 12 months, interquartile range 5-35 months) were finally included. A positive RAD was reported in 14 (6.1%, CI 95% 3.4-10). Only 3 patients (1.3%, CI 95% 0.3-3.7) showed a positive RAD in the absence of any predisposing factor.
  
  
  CONCLUSIONS
  RAD is an infrequent sign in non-abused children and it is particularly rare in the absence of any predisposing factor. Case-control studies are necessary to better clarify its diagnostic relevance.
authors.affiliation: Pediatric Emergency Department, University of Padova, via Giustiniani 3, Padova, 35128, Italy. Electronic address: fsfriso@yahoo.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Sfriso
authors.affiliation: Pediatric Emergency Department, University of Padova, via Giustiniani 3, Padova, 35128, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Masiero
authors.affiliation: Pediatric Emergency Department, University of Padova, via Giustiniani 3, Padova, 35128, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Mardegan
authors.affiliation: Pediatric Emergency Department, University of Padova, via Giustiniani 3, Padova, 35128, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bressan
authors.affiliation: Department of Environmental Medicine and Public Health - Legal Medicine, University of Padova, via Falloppio 50, Padova, 35121, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Aprile
mesh_terms: D001003:Anal Canal / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D004108:Dilatation, Pathologic; D005260:Female; D005554:Forensic Medicine; D006801:Humans; D007223:Infant; D008297:Male; D009126:Muscle Relaxation / Q000502:physiology*; D010808:Physical Examination; D011446:Prospective Studies; D012018:Reflex / Q000502:physiology*; D012494:Sampling Studies