Child Abuse and Neglect

Table of Contents

1. Child Abuse and Neglect
2. What is Child Abuse and Neglect?
3. Physical Abuse
4. Sexual Abuse
   1. Behavioral indicators of sexual abuse
   2. Evaluation of suspected sexual abuse
   3. Physical findings in sexual abuse examinations
   4. Evaluation of acute sexual assault
   5. Sequelae of sexual abuse
5. Child Neglect
6. When you suspect abuse or neglect
7. Domestic Violence and Children
8. Preventing Child Abuse
9. References

Physical findings in sexual abuse examinations

At least 90% of examinations of sexually abused prepubertal children show no acute findings of trauma. The reasons for this are several:

• Most children do not disclose the abuse until days, weeks, or sometimes even years have passed. Thus, superficial injuries have most likely healed by the time of the examination. One reason for this is that the perpetrator is often someone who lives in the home with them, and children may not feel safe or comfortable disclosing the abuse.
• Many types of sexual contact (e.g., fondling or oral-genital contact) do not ordinarily cause overt tissue injury.
• In many cases, perpetrators are interested in maintaining ongoing access to their child victims, and may try to avoid performing frankly painful sexual acts.

Thus, it is important to remember when speaking with child victims, families, and investigators that normal exam findings do not rule out sexual abuse. The key item of evidence in most child sexual abuse investigations remains the child's outcry, or description of what happened to her or him-not the physical findings.