Ep 73 – Sexual abuse in children

In this episode, Dr Kate Chesterman talks to Dr Briony Arrowsmith, who is a Consultant Paediatrician at the Haven, a sexual assault referral centre in London. They discuss the many and varied ways that sexual abuse can present, as well as the considerations surrounding who the abuse should be disclosed to. They talk through the physical health concerns that need to be addressed and the role of the sexual assault referral centre in the care of abused children and their families. Finally, they discuss agencies that can offer ongoing psychological support to children, families and healthcare practitioners who have been affected by cases of abuse.

Key take-home points:

• Sexual abuse can present in many ways, from a forthright disclosure to vague and unexplained symptoms.
• It is important to listen and document carefully what you are being told. If there are presentations that are less clear-cut, open and non-leading questions such as “Tell me more about that” and “Is there anything that’s worrying you?” can be helpful in encouraging a disclosure.
• Following a disclosure of sexual abuse, a referral needs to be made to children’s social care (Multi-Agency Safeguarding Hub [MASH] team or equivalent). The MASH team can advise how and when they’re going to contact the child and help to decide initial questions of the child’s immediate safety.
• If the child is under 13, you must also call the police. When a child is 13 or over the child has more choice about police involvement, depending on their capacity and the identity of the perpetrator. More information regarding the public interest breach of confidentiality can be found in the resources section below.
• If a child is post-pubertal then emergency hormonal contraception is an important consideration and should not be delayed if there is a risk of pregnancy. Hepatitis B immunisation should always be offered, as if it is given soon enough it could cover an assault that has already happened. Post-exposure prophylaxis for HIV is an important consideration and one you may want advice on as it is dependent on the type of assault and what is known about the alleged assailant.
• The treatment of injuries or infections should not be delayed and is the priority over forensic evidence.
• Ongoing psychological support can be found from local and national organisations. See the links below for some suggestions.

Resources:

1. Mosac – helping all non-abusing parents and carers whose children have been sexually abused. (Or telephone 0800 980 1958.)
2. NAPAC – supporting recovery from childhood abuse. (Or telephone 0808 801 0331.)
3. Barnardo’s. Child sexual abuse and exploitation.
4. NSPCC.
5. GMC guidance on public interest breach of confidentiality.