Problematic Sexualized Behavior in Children: Essentials for the Pediatric Forensic Nurse.

ABSTRACT: Problematic sexual behavior (PSB) in children and adolescents is a significant public health problem. PSB is defined as harmful or developmentally inappropriate behaviors involving sexual organs or regions of the body exhibited by children or adolescents. PSB may be harmful to self or others or be abusive toward another child, adolescent, or adult. Adolescents, typically defined as children 12 years old or older, engaging in PSB can be vulnerable to formal court adjudication as their behaviors may be considered a sexual offense. PSB can result in significant negative consequences for all children and adolescents involved as well as their families. This article will describe sexual behavior in children, normative and problematic, and explore implications for forensic nursing practice.

Healthcare Use and Case Characteristics of Commercial Sexual Exploitation of Children: Teen Victims Versus High-Risk Teens.

INTRODUCTION: The overall goal of this study was to provide further information about the characteristics of commercial sexual exploitation of children (CSEC) victims by comparing the characteristics of a known victim pool to high-risk patients identified. The specific objectives of this study were to describe patient demographic characteristics, pediatric healthcare use, familial psychosocial characteristics, and child sexual abuse case characteristics present in youth identified as high risk for CSEC victimization compared with a sample of known victims. METHODS: A retrospective chart review was conducted on patients presenting to the emergency department or Child Advocacy Center for a concern of sexual abuse/assault at a midwestern U.S. academic pediatric medical center. Adolescents aged 12-21 years were included in the study. RESULTS: In the current study, multiple CSEC risk factors were noted to increase odds for CSEC victimization: homelessness or life on the streets, runaway behavior, living with mother only, placement in a juvenile detention center, placement in a residential treatment center or group home, and number of living arrangements (four or greater). Multiple elements of high-risk sexual behavior increased odds of CSEC victimization: legally age-inappropriate sex, gonorrhea diagnosis, trichomonas diagnosis, other sexually transmitted infection (STI) diagnoses, number of STIs, and chlamydia diagnosis. DISCUSSION: These findings suggest that age of sexual partners and number and types of STIs are associated with CSEC and should be validated in other groups. In addition, these data suggest that use of cocaine and opiates could serve as an important, yet underrecognized, risk factor.

Nonoffending Caregiver Support After Child Sexual Abuse: Essentials for the Forensic Nurse.

ABSTRACT: Child sexual abuse (CSA) is a pediatric health problem of epidemic proportions. CSA can result in significant lifelong physical and mental health consequences. A disclosure of CSA affects not only the child but also everyone close to the child. Nonoffending caregiver support after a disclosure of CSA is key to optimal victim functioning. Forensic nurses play an integral role in the care of CSA victims and are uniquely positioned to ensure best outcomes for both child victims and their nonoffending caregivers. In this article the concept of nonoffending caregiver support is explored, and = implications for forensic nursing practice delineated.

Intimate Partner Violence and Children: Essentials for the Pediatric Nurse Practitioner.

Intimate partner violence (IPV) is a public health problem of epidemic proportions. IPV often starts early in adolescence and continues throughout an individual's lifespan. IPV is defined as abuse or aggression occurring in the context of a romantic relationship that is perpetrated by a current or former partner. IPV victims often experience severe psychological trauma, physical injury, and even death. The direct recipient of the violence is often not the only individual impacted. Children are often peripheral victims of IPV. It is vital that pediatric health care providers, including pediatric nurse practitioners, recognize that IPV is indeed a pediatric health care crisis requiring strategies for both identification and intervention. This continuing education article will discuss IPV and its impact on children from conception to adolescence while exploring implications for practice.

Online Sexual Solicitation of Children and Adolescents in a High-Risk Population.

INTRODUCTION: The Internet provides a powerful potential tool for sexual predators. Experiencing trauma, including sexual abuse, can increase child and adolescent risk of experiencing online sexual solicitation. METHOD: A retrospective chart review was conducted for the detailed information of all children and adolescents aged 8-18 years presenting to the Child Advocacy Center of large, tertiary care, Midwestern U.S. pediatric hospital with concerns of sexual abuse. RESULTS: Three-hundred twenty-five children and adolescents were seen in the Child Advocacy Center during the 9 months; 139 (42.8%) denied talking to anyone online that they had not met offline (face to face in real life), 88 (27.1%) reported talking to individuals online that they had not met offline but never talking about sex; 65 (20%) reported online sexual solicitation with individuals they had not met offline; and 33 (10.2%) reported highest-risk behaviors online involving meeting someone offline or having sex with someone offline whom they had met online. DISCUSSION: The number of youth involved in online sexual solicitation illustrates that children who have been sexually abused are at increased risk for sexual solicitation. This study also suggests that young children are vulnerable to online sexual solicitation. Youth engaged in these concerning online behaviors with individuals of all ages.

Child Sexual Abuse and Suicide: Essentials for the Forensic Nurse.

ABSTRACT: Sexual abuse can result in significant negative sequelae for victims. One particularly harmful consequence is suicidal ideation, which can lead to suicide attempts and even death. It is essential to screen children and adolescents for suicidal ideation when providing medical forensic care after disclosure of acute or nonacute sexual abuse/assault. Forensic nurses must feel confident in their abilities to assess suicide risk and provide appropriate intervention and referrals. A thorough understanding of the relationship between sexual abuse and suicidal ideation and behaviors can assist the forensic nurse in the development of practice behaviors to better identify, intervene, and prevent suicidal ideation and behaviors among youth experiencing sexual abuse.

Pediatric Forensic Analysis: The Benefits of DNA Collection Beyond 24 Hours.

BACKGROUND: Although the presence of forensic evidence aids in successful prosecution of sexual abuse, controversy remains regarding the timing and indications for collection of forensic evidence in child sexual abuse/assault. OBJECTIVE: The purpose of this study was to describe forensic evidence findings in acute child sexual abuse after implementing more inclusive indications for collection of evidence in a pediatric emergency department and to identify factors associated with yield of DNA. RESULTS: Of the 306 evidence kits collected and analyzed, 110 (35.9%) kits were positive for an interpretable DNA profile foreign to the patient, which may or may not have contributed to the investigation of the sexual abuse concern. Several factors were associated with increased forensic yield of identifiable foreign DNA: increased age of child victim, 48 hours or less between the latest incident of sexual abuse and the collection of forensic evidence, child disclosure of high-severity sexual abuse acts (anal-genital or genital-genital contact) in the pediatric emergency department forensic interview, and sexual abuse by a nonrelative perpetrator. CONCLUSIONS: Finally, although certain factors were associated with increased yield of identifiable foreign DNA within each factor, there were multiple outliers where failure to collect forensic evidence would have resulted in a loss of recoverable foreign DNA.

Multidisciplinary Approach to Emergent Sexual Abuse in a Pediatric Emergency Department: A Simulated Child Advocacy Center Model of Care.

INTRODUCTION: The purpose of this study was to compare child sexual abuse interview disclosures and judicial outcomes for cases of child and adolescent sexual abuse/assault seen in a pediatric emergency department (PED) before and after the implementation of a simulated child advocacy center (CAC) multidisciplinary model of care. METHOD: A retrospective chart and legal records review was conducted from both the PED model of care group and the simulated CAC multidisciplinary model of care for judicial outcomes, child sexual abuse interview disclosures, and sexual abuse case characteristics. RESULTS: The simulated CAC multidisciplinary model of care did not result in increased indictments, pleas, trials, or disclosure of sexual abuse in the sexual abuse interview when compared with the PED model of care. The simulated CAC multidisciplinary model of care did result in a significantly higher rate of sexual abuse interview completion. DISCUSSION: Demographic risk factors for sexual abuse victimization as well as perpetration have been identified in the literature and were supported by this study. Law enforcement and child protective services were more frequently present in the PED under the simulated CAC multidisciplinary model allowing for improved protection of children.

Medical Child Abuse: Essentials for Pediatric Health Care Providers.

Medical child abuse (MCA) is a rare but potentially deadly variant of child maltreatment. MCA results in unnecessary health care for a child because of a caregiver's exaggeration, fabrication, or induction of physical and/or psychological symptoms of illness. These unnecessary health care interventions result in a morbidity rate of 100% in the form of complications and disabilities and a mortality rate as high as 9%. Although MCA is relatively rare, it is estimated that pediatric health care professionals, including pediatric nurse practitioners, will most likely encounter at least one MCA victim in the course of their career. This continuing education article will discuss MCA in terms of definition and features, epidemiology, perpetrators, variants in presentation, consequences, and implications for practice.

Online Sexual Solicitation of Children and Adolescents.

Technological advances have exploded in the new millennium. The Internet provides many opportunities to enrich the lives of youth by providing greater access to learning opportunities, valuable resources, and positive social interactions with peers. However, the Internet is a relatively new and unregulated entity that can also place children and adolescents at risk for a variety of negative and potentially dangerous exposures. One such risk is online sexual solicitations and interactions with older adolescents, peers, and adults. This continuing education article will explore online sexual solicitation of child and adolescents in terms of definition, epidemiology, predictors, consequences, and implications for practice.

Child Labor Trafficking Essentials for Forensic Nurses.

Human trafficking is a form of modern-day slavery and is a significant pediatric healthcare problem in the United States. The term "human trafficking" encompasses both sex and labor trafficking. Sex trafficking, especially child sex trafficking, has received significant lay and professional attention. However, few efforts have focused on learning more about youth experiencing labor trafficking in the United States. Pediatric healthcare providers, including forensic nurses, are likely to encounter victims of child labor trafficking in their practice. A basic understanding of child labor trafficking will assist forensic nurses in timely identification of and appropriate intervention for victims. In this article child labor trafficking is discussed in terms of definition, epidemiology, history, risk factors, consequences, identification, and implications for practice.

Teen Knowledge of Commercial Sexual Exploitation of Children.

INTRODUCTION: The commercial sexual exploitation of children (CSEC) is a pediatric health care problem with significant physical and mental health consequences for victims, even death. Although there exists community-wide collaborations in the United States to address professional response to CSEC, these efforts often have a limited capacity to reach adolescents and involve them in CSEC prevention. As part of a prevention strategy, the National Institute of Justice recommends educating youth about CSEC and exploiters' recruitment tactics. Despite this recommendation, little is known regarding American youth knowledge of CSEC. METHODS: A descriptive research design was used for this study. All adolescents, male and female, presenting to a high-volume urban pediatric hospital-based Midwestern Child Advocacy Center (CAC) due to concerns for alleged sexual abuse were invited to participate in the study by answering a self- administered electronic questionnaire. This questionnaire explores the participants' knowledge, awareness, and attitudes about CSEC, in addition to collecting demographic data, such as participant age, gender identity, grade, school district, and school. RESULTS: During the six-month study period, 286 CAC patients were eligible to participate in the study. Nearly all participants (n = 217; 97%) agreed that pimping is wrong. While the majority of participants indicated an awareness of human trafficking (n = 198; 94%) and sex trafficking (n = 193; 87%); just (n = 91; 41%) had heard of labor trafficking. Fewer participants (n = 55; 25%) identified that a doctor, nurse, or other health care provider had ever spoken with them about sex trafficking. DISCUSSION: Study participants overwhelmingly conveyed negative attitudes toward CSEC. Participating adolescents indicated a significantly higher awareness of sex trafficking (87%) versus labor trafficking (10%). Sex trafficking receives more attention in the media than labor trafficking. Given that study participants indicated hearing about trafficking primarily from the media (74%) and family/friends, this may explain the deficit in labor trafficking awareness. Although study participants demonstrated mostly accurate baseline knowledge of CSEC, that knowledge was not universal.

Building a Safe and Healthy America: Eliminating Corporal Punishment via Positive Parenting.

corporal punishment (CP) is associated with negative short-term and long-term children outcomes. However, many caregivers continue to administer spankings and other forms of CP. Pediatric nurse practitioners are in a unique position to affect change in parental behavior related to CP use and other parenting practices. This article will summarize the research on the dangers of CP and the corresponding benefits of positive parenting. It defines positive parenting and offers resources pediatric health care providers, including pediatric nurse practitioners, can use to educate both themselves and caregivers about specific discipline techniques appropriate to each developmental stage. Finally, it suggests practice strategies pediatric nurse practitioners can use to help caregivers replace CP and other harsh parenting practices with positive parenting to build a safe and healthy America.

Attachment Disorders.

The ability to form attachments with other human beings is an essential skill that typically begins early in life. The parent/caregiver-child relationship is the first crucial relationship that an infant forms, and the health of this relationship has a profound effect on the child's social and emotional development. Children who form secure relationships with their parent or other primary caregiver have fewer internalizing and externalizing behaviors, are more socially competent, and have better-quality friendships. Conversely, children with attachment disorders exhibit a varying capacity to form and sustain relationships and demonstrate emotional depth, they and experience a higher level of peer conflict. Children with insecure attachments have a greater likelihood for physical health morbidities and impaired social, psychological, and neurobiological functioning extending into adulthood. It is crucial that pediatric nurse practitioners implement practice behaviors to better identify children at risk for attachment disorders and link them with appropriate interventions. This continuing education article will explore attachment; and attachment theory; and attachment disorders in terms of types, risk factors, consequences, and treatment and will also provide implications for practice.

Commercial Sexual Exploitation of Children: An Update for the Forensic Nurse.

Commercial sexual exploitation of children (CSEC) is the sexual abuse of children through buying, selling, or trading their sexual services. This may involve engaging a child under the age of 18 years in prostitution, pornography, stripping, exotic dancing, escort services, or other sexual services. CSEC is a problem of epidemic proportions throughout the world including the United States; however, the actual number of CSEC victims in the United States is unknown. Studies indicate that most child victims are seen by a healthcare provider while being trafficked and that many victims receive care at a pediatric hospital within 1 year of their identification as a victim. CSEC is a significant pediatric healthcare problem. It is vital that forensic nurses possess a thorough understanding of the problem and be poised to better identify, intervene, and prevent CSEC. In this article, we focus on risk factors commonly experienced by victims, recruitment strategies used by traffickers, indicators to identify child victims, and intervention and educational strategies of relevance to forensic nurses.