NCJ Number
73465
Journal
New England Journal of Medicine Volume: 302 Issue: 6 Dated: (February 7, 1980) Pages: 319-323
Date Published
1980
Length
5 pages
Annotation
The issue of childhood sexual abuse is examined through the use of clinical records and a review of the literature. Recommendations, based on the Hennepin County Medical Center (HCMC) (Minnesota) practices, are made for the medical and therapeutic management of victims and families.
Abstract
The hospital records of 113 girls and 17 boys (mean age 2-16 years) who were the victims of sexual offenses were reviewed. A total of 30 incest cases were found. Thirty-four had additional medical or social problems, including seizure disorders, behavior disorders, suicide attempts, and prior rape and incest. Victims of incest tended to be accompanied more frequently by parents or relatives than other victims did. The accompanying parent was never the one actively engaged in sexual activity with the child. Children under 8-years old were more likely to know the assailant, to be victims of recurrent sexual or physical abuse, to report crimes without intercourse, and to have an abused sibling. Forty-three children had physical trauma; four were victims of concurrent physical and sexual abuse. No pregnancies occurred, although diethylstilbestrol was not routinely used. Three girls had gonorrhea; routine administering of antibiotics without serologic data and serial culture is not recommended. Although the psychiatric impact of these episodes are not documented, a trend toward persistent somatization, nightmares, and phobias was noted. The discovery of 18 medicolegally inadequate charts supports the finding that emergency-room records of victims of sexual abuse are more frequently inadequate than those of patients with other medical problems. The use of an outpatient clinic in which all new sexual abuse victims are referred for evaluation enables more complete documentation and treatment of these cases. The patient, family, and house staff are exposed to physicians, nurses, and social workers who are sensitive to the physical and emotional trauma of sexual abuse, who are aware of the pertinent local law, and who are experienced in dealing with police officers, attorneys, and child protection workers who become involved in these cases. Thus, exposure to these skilled providers ameliorates the stress felt by these children and families. The concurrent medical documentation often persuades these disturbed families to accept treatment and convinces most assailants to plead guilty without exposing their victims to the stress of a public trial. Tabular data and 20 references are provided. (Author abstract modified).