Sexually abused children is a topic no one likes to think about, but according to the U.S. Department of Justice, it’s a significant problem in this country with nearly 70% of all reported sexual assaults affecting children ages 17 and under.
Diane Daiber, BSN, RN, SANE-A, SANE-P, a pediatric training specialist with the International Association of Forensic Nurses in Elkridge, Md., knows these statistics all too well. A forensic nurse with 33 years of experience, Daiber and her colleagues at IAFN recently partnered with the Department of Justice and the Office on Violence Against Women to develop A National Protocol for Sexual Abuse Medical Forensic Examinations: Pediatric.
“Sexual abuse cases concerning children are very different than those that we see with teens or adults,” Daiber said. “The perpetrator is usually a trusted adult or family member who manipulates the child into remaining silent.”
Daiber said nurses play a crucial role in helping to detect cases of child sexual abuse, and that it’s imperative for them to know the signs of sexual abuse, how to establish a rapport with victims, and how to report cases of suspected abuse.
Physical signs of sexual abuse
“If a child complains of pain in his or her genital or anal area or pain when they go to the bathroom, or if they exhibit bruising or sores in these areas, that should trigger additional questions,” Daiber said.
Other signs can include children with frequent urinary tract infections, sexually transmitted diseases,and vaginal or anal discharge. Some abuse victims also complain of physical ailments such as headaches or stomachaches.
Knowing how to respond
It’s important for nurses to tailor the conversation to the age of the child and to conduct an exam in a matter of fact way to normalize the experience for the child, according to Daiber.
“Ask questions to determine why the child has come in for medical treatment and if they are experiencing pain in any part of their body,” Daiber said.
“If they speak limited English, you may need the assistance of a qualified language interpreter.”
Daiber said that if the child’s guardian is suspected of being the perpetrator, the child should be questioned in an area separate from the adult where the child is able to verbalize freely.
For children who are nonverbal or disabled, begin by questioning the child’s guardian.
“Often family members may have a sense that something may be happening to the child, but they aren’t sure what to do or how to respond,” Daiber said.
Creating a rapport
Daiber said it’s important for nurses to establish trust with children and to talk to them directly at their eye level.
“Respect their boundaries,” she said. “If the child doesn’t want to answer a specific question that needs to be respected. Ask their permission before you touch them and explain what you’re doing as you conduct an exam,” Daiber said. “Encourage questions as you go along and treat them with empathy, not sympathy.”
Daiber also noted it’s important to reassure children of the following:
• You’re there to help them.
• You believe what they’re saying.
• They did nothing to deserve the abuse.
Even suspicion of sexual abuse is enough to trigger a mandatory report, according to Daiber.
“Child abuse reporting systems function to protect children and ensure their safety,” she said. “It’s not mandatory for nurses to verify that the sexual abuse has occurred.”
Daiber said nurses should receive mandated reporting training from their employer. For nurses who want to expand on this, IAFN offers an online 43-hour pediatric/adolescent didactic training for nurses and nurse practitioners who want to learn the specifics of recognizing and reporting child abuse.
Linda Childers is a freelance writer.