Immediate Management of Pediatric Sexual Assault
Perform the physical examination immediately to assess for injuries and collect forensic evidence—medical needs take priority and should not be delayed waiting for police arrival, while simultaneously notifying appropriate authorities as required by mandatory reporting laws. 1
Immediate Priorities in Sequential Order
1. Stabilize and Assess for Life-Threatening Injuries
- Treat any life-threatening or serious physical injuries first, particularly non-genital trauma requiring urgent intervention. 1
- The presence of blood in underwear indicates potential significant genital or internal injury requiring immediate assessment. 1
- Medical care proceeds regardless of whether the family consents to forensic evaluation or legal action. 1
2. Provide Emotional Support While Preparing for Examination
- Ensure the child's immediate physical safety and provide emotional support in a calm, private environment. 1
- Obtain consent for examination from the parent/guardian while maintaining a trauma-informed approach. 1
- Do not allow the child to change clothes, bathe, eat, drink, or use the bathroom until forensic examination is complete, as this preserves critical evidence. 1
3. Conduct Physical Examination and Evidence Collection
- Perform a thorough physical examination immediately to document injuries and collect forensic evidence—do not delay waiting for police arrival. 1
- Assess for both genital and non-genital injuries with meticulous documentation using diagrams and photographs when possible. 1
- Utilize a Sexual Assault Nurse Examiner (SANE) or Sexual Assault Forensic Examiner (SAFE) if available, with video colposcopy or imaging systems to document findings. 1
- Collect specimens for DNA evidence (viable for at least 72 hours post-assault) and STI testing including gonorrhea, chlamydia, and trichomoniasis. 1
4. Notify Authorities Simultaneously
- Child sexual abuse cases require mandatory reporting in all jurisdictions—notify both child protective services and police as required by law. 1, 2
- This notification occurs concurrently with medical care, not as a prerequisite to examination. 1
Medical Treatment Protocol
STI Prophylaxis
- Administer ceftriaxone 125 mg intramuscularly for gonorrhea prophylaxis. 1
- Provide metronidazole 2 g orally once. 1
- Give either azithromycin 1 g orally once or doxycycline 100 mg twice daily for 1 week. 1
Vaccination Status
- Initiate hepatitis B vaccination if not previously immunized. 1
- Consider HPV vaccination if not previously completed. 1
- Assess need for HIV post-exposure prophylaxis based on risk assessment. 1
Psychological Assessment
- Screen immediately for suicidal ideation, self-harm behaviors, and homicidal ideation, as sexual assault survivors have significantly elevated rates of depression and self-harm. 3
- Provide age-appropriate reassurance that the assault was not the child's fault. 1
- Arrange for prompt mental health follow-up with professionals experienced in childhood trauma. 1
Critical Documentation Requirements
- Document the history using the child's own words when possible. 1
- Medical records will likely be subpoenaed for legal proceedings, so documentation must be thorough and precise. 1
Common Pitfalls to Avoid
- Most sexually assaulted children will have unremarkable anogenital examinations—absence of physical findings does not rule out assault. 1
- Never delay physical examination waiting for police arrival, as medical needs take priority. 1
- Do not omit STI prophylaxis due to young age. 1
- Avoid inadequate documentation of physical findings. 1
Follow-Up Care
- Schedule follow-up within 1-2 weeks to assess healing of injuries and medication adherence. 1
- Arrange STI retesting as appropriate. 1
- Ensure ongoing psychological support and counseling. 1
- Consider referral to specialized child advocacy centers if available. 1
The correct answer prioritizes B (Physical examination) as the immediate action, with A and C (notification of authorities) occurring simultaneously but not delaying medical care.