What is the immediate management for a 10-year-old female reporting abuse?

Immediate Management for a 10-Year-Old Female Reporting Abuse

When a 10-year-old female reports abuse, the healthcare provider must immediately create a supportive, non-judgmental environment, perform a thorough medical evaluation, document all findings meticulously, report to child protective services, and ensure the child's safety before discharge. 1, 2

Initial Approach

• Provide a safe, private environment for disclosure
• Use age-appropriate, non-leading questions
• Reassure the child that she is not at fault
• Explain that your role is to help keep her safe
• Document the child's statements using direct quotes when possible

Medical Assessment

• Perform medical assessment only after ensuring the child feels comfortable
• Assess for immediate medical needs and treat accordingly
• Document all physical findings thoroughly, including:
  • Location and appearance of bruises/abrasions
  • Any genital or anal trauma
  • Any discrepancies between presenting complaints and physical findings

Evidence Collection

• If sexual abuse is reported or suspected within the past 72-96 hours:
  • Advise against bathing, showering, or changing clothes until examination
  • Store clothes in paper (not plastic) bags
  • Collect forensic evidence according to local protocols
  • Consider colposcopic examination by trained personnel 1
  • Collect specimens from all sites of potential contact 2

Laboratory Testing

• For suspected sexual abuse:
  • Baseline STI testing (gonorrhea, chlamydia, trichomoniasis)
  • Baseline HIV, hepatitis B, and syphilis serology
  • Pregnancy test if post-pubertal

Prophylactic Treatment

• Consider STI prophylaxis:
  • Ceftriaxone 125 mg IM once
  • Azithromycin 1g orally once or doxycycline 100 mg twice daily for 7 days
  • Metronidazole 2g orally once 1, 2
• Consider emergency contraception if post-pubertal
• Consider HIV post-exposure prophylaxis if high-risk exposure within 72 hours
• Consider hepatitis B vaccination if not previously immunized

Mandatory Reporting

• Report to child protective services and/or law enforcement immediately
• Understand that all states have mandatory reporting laws for suspected child abuse
• Reporting is required even if the child does not want it reported 1
• Provide factual information without speculation

Safety Assessment

• Directly ask about safety concerns:
  • Is the perpetrator in the home?
  • Does the perpetrator have access to the child?
  • Is there a history of threats or violence?
  • Does the perpetrator have access to weapons? 1, 2
• Determine if it's safe for the child to return home
• Consider hospital admission if safety cannot be ensured

Psychological Support

• Provide immediate emotional support
• Avoid questioning that might feel like an interrogation
• Reassure the child that they did the right thing by telling someone
• Explain next steps in age-appropriate language
• Consider child life specialist involvement if available

Follow-up Planning

• Schedule follow-up within 1-2 weeks to:
  • Assess injury healing
  • Ensure counseling has been arranged
  • Assess medication adherence
  • Provide ongoing support 1, 2
• Arrange for trauma-focused cognitive behavioral therapy
• Plan for repeat STI testing at appropriate intervals (6 weeks, 3 months, 6 months)

Common Pitfalls to Avoid

• Failing to document thoroughly
• Confronting potential perpetrators before ensuring child safety 3
• Asking leading questions that could compromise legal proceedings
• Missing the window for forensic evidence collection or prophylaxis
• Neglecting the psychological impact of abuse
• Failing to coordinate with child protective services

Remember that children may initially deny abuse due to fear or intimidation but may disclose later when they feel safe. Creating a supportive environment is crucial for both immediate care and long-term healing 3.