Emergency Department Management of Pediatric Sexual Abuse (Child Abuse CME, Sexual Assault CME, and Pharmacology CME)

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Delivery Method:	Online
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Publication Date: May 2025 (Volume 22, Number 5)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 05/01/2028.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Child Abuse CME credits, 4 Sexual Assault CME credits, and 1 Pharmacology CME credit, subject to your state and institutional approval.

Authors

Peer Reviewers

Abstract

Pediatric sexual abuse is a widespread problem impacting children and adolescents across all ages, races, ethnicities, and socioeconomic groups, and it is a topic that emergency clinicians caring for children need to be familiar with. A structured, multidisciplinary approach to the assessment, diagnosis, treatment, and follow-up of these patients is essential. This issue provides a comprehensive review of the current definitions, assessment techniques, diagnostic considerations, and management strategies for children who have experienced sexual abuse.

Case Presentations

A 7-year-old boy is brought to the emergency department after he disclosed sexual abuse by his mother’s boyfriend…

• The child told his grandmother today that the boyfriend has been touching him in the genital area and has been asking him to engage in oral sex. The grandmother states she is concerned about the child because he has been having difficulty at school and has been more withdrawn the past 6 months after his mother’s boyfriend moved in with the family. The boyfriend is often alone with the child several evenings a week when his mother is working, most recently yesterday.
• The boy’s vital signs are unremarkable, and the child is engaged and interactive. The physical examination, including genital and rectal examination, is normal.
• What is the next step in management? What testing or treatment is indicated in this case? Whom do you need to notify?

A 16-year-old girl is brought to the ED by her mother after she disclosed sexual assault by a peer at a party…

• The patient was at a party and was given a drink by a male classmate. She remembers having a few sips of the drink and thinks that she blacked out after that. The next thing that she remembers is being in a bedroom with her clothing removed and her classmate sexually assaulting her. This happened 12 hours before arrival. She reports vaginal pain and bruises to her arms. She called her mother and told her she was raped, and her mother immediately brought her to the ED. The girl is concerned she does not remember exactly what happened and reports she drank only a half a cup of soda that a peer handed to her. The patient is requesting a rape kit and wants to press charges.
• The girl is tearful on examination, but she is alert and oriented. The girl’s vital signs are unremarkable.
• What are the next steps in ED evaluation? What special factors should you consider with this assault? What medications or treatments should you offer this patient?

A mother brings in her 3-year-old daughter and wants her checked out for abuse…

• The child lives with her father, mother, and 5-year-old sister, and attends daycare 3 days a week. The mother is concerned because she noticed some redness “down there” and noticed that the child has been scratching her genital area more often this week.
• What are your next steps in evaluating this patient? What are some techniques you can utilize for physical examination of this patient? Does this patient require a SAFE examination?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.