title: The value of paediatric assessment in historic child sexual abuse.
abstract: A perception exists that there are few benefits of a paediatric assessment in historic child sexual abuse (CSA), as the likelihood of finding forensic evidence is low.
  
  
  
  To determine the value of a comprehensive paediatric assessment in a dedicated clinic for children and young people who present following suspicion or allegation of historic CSA.
  
  
  
  All children with suspected or alleged historic CSA, defined as >7 days after the last episode of sexual assault in pubertal girls, or >3 days for prepubertal girls and all boys, were assessed in a specialised paediatric clinic. Clinic data were collected prospectively between October 2009 and November 2014 and through retrospective case note review.
  
  
  
  Among the 249 children who presented with possible historic CSA, ages ranged from 0 to 17 years (median 7, SD 4.3). Of these children, 141 (57%) had a medical concern(s) related to the referral reason, 78 (31%) had an unrelated medical concern(s) and 55 (22%) had emotional or behavioural concerns requiring onward referral, while 18 (7%) children had physical signs supportive of CSA. Findings referable to social care were identified in 26 cases (10%), the police in 6 cases and 15 (6%) parents required professional help for anxiety symptoms.
  
  
  
  This study highlights the value of a comprehensive paediatric assessment in a dedicated clinic for cases of suspected or alleged historic CSA, by identifying a broad variety of unmet health needs in this group. The findings have important implications for the child, their families and the multiagency team.
authors.affiliation: Department of Paediatrics, University College London Hospital, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Al-Jilaihawi
authors.affiliation: Department of Paediatrics, University College London Hospital, London, UK.
authors.forename: Kevin
authors.initials: K
authors.lastname: Borg
authors.affiliation: Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.
authors.forename: Sabine
authors.initials: S
authors.lastname: Maguire
authors.affiliation: Department of Paediatrics, University College London Hospital, London, UK.
authors.forename: Deborah
authors.initials: D
authors.lastname: Hodes
mesh_terms: D000293:Adolescent; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis*; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008131:London; D008297:Male; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D010808:Physical Examination / Q000379:methods; D011446:Prospective Studies; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors
keywords: historic child sexual abuse; multiagency; unmet health needs