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Will You Screen for Child Sexual Abuse in the Office? :

August 4, 2020

It doesn’t happen often, but if you ask, the child might just tell you.

It doesn’t happen often, but if you ask, the child might just tell you. My typical routine is to ask the child if anyone has touched his or her “private parts” while doing the exam. In this month’s Pediatrics, Ghastine et al (10.1542/peds.2019-3327) make the case for asking open-ended questions or using a pre-visit screener like the Pediatric ACEs and Related Life-events Screener (PEARLS) tool to screen for child sexual abuse (CSA). And it is a compelling case. Up to 1 in 5 women during their childhood are a victim of CSA and almost all see a primary care pediatrician, nurse practitioner, or family physician during their childhood. The opportunity is there. The rationale is there–the sooner a child discloses abuse, the sooner that child can be protected from future abuse. But can we actually do this?

As highlighted in the article, there are numerous barriers to CSA screening in primary care: lack of time, discomfort of the pediatrician, knowledge gaps about CSA, genital findings, and effective reporting process. And of course, the proverbial “opening the can of worms” and not having the systems in place to deal with what is disclosed. Not asking is clearly the easy approach. But given the impact of adverse childhood experiences on long-term health, the importance of detecting CSA and intervening as soon as possible is paramount. If you are not comfortable reporting child abuse or working with the system, reach out to your local child abuse pediatrician or Child Advocacy Center (CAC). Most states and locales have created systems to respond to child abuse in a child-centered approach following the CAC model.

The bottom line is every pediatrician needs to learn how to get comfortable dealing with the uncomfortable topic of CSA. We are in a unique position to intervene and protect children from a trauma that can lead to life-long health issues, and we must figure out how to fit CSA screening into our busy practice.

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