Approach to evaluation of sexual assault in children. Experience of a secondary-level regional pediatric sexual assault clinic.

OBJECTIVE To determine whether a 3-year-old girl, brought to an after-hours clinic because her mother was concerned, had been assaulted by her father during a weekend visit. SOURCES OF INFORMATION MEDLINE: was searched using the key words child, sexual assault/abuse, and expectations. Recent textbooks on childhood sexual assault and abuse were consulted. The secondary-level regional pediatric sexual assault clinic's experience over 1 year was reviewed. Articles in the literature generally provide level II evidence.

MAIN MESSAGE The literature review and the clinic's experience both indicated that specialty centres for child sexual assault and abuse rarely produce positive physical findings that conclusively confirm or rule out sexual assault, especially when children are asymptomatic and not in an acute state. Primary care practitioners can use a brief history and physical examination to decide on the next level of care and determine the urgency of referral. Urgent assessment of children thought to have been abused or assaulted is required when children disclose assault (especially with genital-genital contact or ejaculation); when children have acute pain, bleeding, or discharge; when results of a physician's examination are abnormal; or when parents are extremely distressed.

CONCLUSION Family physicians have a pivotal role in evaluation of childhood sexual assault or abuse. Knowledge of the outcomes of evaluation is crucial to understanding when and how to refer.