title: Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused.
abstract: The medical evaluation is an important part of the clinical and legal process when child sexual abuse is suspected. Practitioners who examine children need to be up to date on current recommendations regarding when, how, and by whom these evaluations should be conducted, as well as how the medical findings should be interpreted. A previously published article on guidelines for medical care for sexually abused children has been widely used by physicians, nurses, and nurse practitioners to inform practice guidelines in this field. Since 2007, when the article was published, new research has suggested changes in some of the guidelines and in the table that lists medical and laboratory findings in children evaluated for suspected sexual abuse and suggests how these findings should be interpreted with respect to sexual abuse. A group of specialists in child abuse pediatrics met in person and via online communication from 2011 through 2014 to review published research as well as recommendations from the Centers for Disease Control and Prevention and the American Academy of Pediatrics and to reach consensus on if and how the guidelines and approach to interpretation table should be updated. The revisions are based, when possible, on data from well-designed, unbiased studies published in high-ranking, peer-reviewed, scientific journals that were reviewed and vetted by the authors. When such studies were not available, recommendations were based on expert consensus.
authors.affiliation: Department of Pediatrics, University of California, Davis Medical Center, Sacramento, California. Electronic address: jadams@ucsd.edu.
authors.forename: Joyce A
authors.initials: JA
authors.lastname: Adams
authors.affiliation: Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Kellogg
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Farst
authors.affiliation: Department of Pediatrics, University of Minnesota; University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Harper
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, New York.
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Palusci
authors.affiliation: Department of Pediatrics, Penn State Milton S. Hershey Children's Hospital, Hershey, Pennsylvania.
authors.forename: Lori D
authors.initials: LD
authors.lastname: Frasier
authors.affiliation: Department of Pediatrics, University of Minnesota; Children's Hospitals and Clinics of Minnesota, St. Paul, Minnesota.
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Levitt
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Shapiro
authors.affiliation: Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Moles
authors.affiliation: Department of Pediatrics, Eastern Virginia Medical School; Children's Hospital of The King's Daughters, Norfolk, Virginia.
authors.forename: Suzanne P
authors.initials: SP
authors.lastname: Starling
mesh_terms: D000293:Adolescent; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis* / Q000331:legislation & jurisprudence; D002669:Child Welfare / Q000331:legislation & jurisprudence; D002675:Child, Preschool; D003245:Consensus Statements as Topic; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods / Q000592:standards*; D010372:Pediatrics / Q000592:standards*; D010808:Physical Examination / Q000379:methods / Q000592:standards*; D017410:Practice Guidelines as Topic; D012749:Sexually Transmitted Diseases / Q000175:diagnosis; D019966:Substance-Related Disorders / Q000175:diagnosis; D014481:United States
keywords: Child sexual abuse; Differential diagnosis; Expert opinion; Expert testimony; Medical history taking; Peer review; Sexually transmitted infections