Papel do cirurgião dentista frente aos casos de abuso sexual infantil: uma revisão da literatura / Role of the dental surgeon in cases of child sexual abuse: a literature review

Objetivo:Revisar a literatura a respeito do papel do cirurgião-dentista frente aos casos de abuso sexual infantil, abordando sua importância na identificação e no encaminhamento adequado das vítimas, além de discutir a necessidade de conscientização eimplementação de políticas públicasque abordem o tema.Revisão deliteratura:O ambiente odontológico é um ambiente propício para a identificação de sinais de abusosexual infantil, uma vez que o profissional tem contato direto com a saúde bucal e facial das crianças. Desempenha um papel fundamental ao observar e reportar esses sinais, contribuindo para a identificação precoce e o encaminhamento adequado das vítimas.Discussão:A literatura préviasugere a necessidade de fornecersubsídios teóricos, aprofundados no tema,para contribuir na ampliação do conhecimento nessa área. Sendo importantea conscientização e capacitação do cirurgião-dentista nesse contexto, bem como a criação de políticas públicas que visam umaabordagem multidisciplinarquecontribuaparaa conscientização, prevenção e a promoção de ações voltadas à proteção das crianças e ao combate do abuso sexual infantil.Conclusão:O cirurgião-dentista desempenha um papel fundamental na identificação e no encaminhamento adequado das vítimas de abuso sexual infantil. É essencial que esses profissionais sejam devidamente capacitados e conscientizados sobre a importância desse tema, além de estabelecerem uma rede de colaboração com outros profissionais da saúde e serviços especializados.

Aim:To review the literature regarding the role of the dental surgeon in cases of child sexual abuse, addressing its importance in identifying and properly referring victims, in addition to discussing the need for awareness and implementation of public policies that address the issue. Literature review:The dental environment is a favorable environment for identifying signs of child sexual abuse, since the professional has direct contact with the oral and facial health of children. It plays a key role in observing and reporting these signs, contributing to the early identification and proper referral of victims. Discussion:Previous literature suggests the need to provide theoretical subsidies, in depth on the subject, to contribute to the expansion of knowledge in this area. It is important to raise awareness and training of dentists in this context, as well as the creation of public policies aimed at a multidisciplinary approach that contributes to awareness, prevention and promotion of actions aimed at protecting children and combating child sexual abuse. Conclusion:The dental surgeon plays a key role in identifying and properly referring victims of child sexual abuse. It is essential that these professionals are properly trained and aware of the importance of this topic, in addition to establishing a collaboration network with other health professionals and specialized services.

Influence of various factors on the legal outcome of cases of child abuse-experiences gathered at an interdisciplinary forensic examination center in Vienna, Austria.

BACKGROUND AND OBJECTIVE: To improve the currently low conviction rate in cases of child abuse a forensic examination center for children and adolescents (FOKUS) was established in Vienna, Austria. Besides a state of the art treatment combined with forensic documentation, one of FOKUS' key goals is to identify potential areas for improvements within the process legal proceedings in cases of child abuse through constant scientific monitoring. The accompanying study at hand includes all patients referred to FOKUS within a two year timeframe (n = 233), monitoring their progression from first contact with the medical professionals from FOKUS to the end of criminal proceedings. A detailed analysis of case files was performed in those cases that were reported to the legal authorities by the clinicians of FOKUS (n = 87). Aim of the study is to investigate which factors contribute to the initiation of legal proceedings and a successful conviction. RESULTS: Multivariate logistic regression analyses showed that main proceedings were opened more often in cases where the offender was an adult (p < 0.001) or admitted his guilt (p < 0.001) and if digital traces were available (p = 0.001) or trial support (p = 0.024) present. Furthermore, the combined occurrence of medical documentation and victim disclosure was related to a higher probability of opening main trials. CONCLUSION: These findings underline how challenging the successful persecution of an offender in cases of child abuse is.

The Viewing Reaction Time as a Diagnostic Tool of Pedohebephilia in the Dunkelfeld.

Diagnosing pedohebephilia is fraught with obstacles given the tabooed nature of this sexual preference. The viewing reaction time effect (VRT) provides a non-intrusive indirect measure of sexual interest in minors. In forensic populations, the ability of the difference between the latencies while viewing child and adult sexual stimuli (VRT index) to discern child sexual offenders from a range of control groups has been ascertained meta-analytically. Given that the effect has been studied almost exclusively in forensic samples, its dependence or independence on prior overt (deviant) sexual behavior remains unclear. The present study sought to examine the relationship of prior sexual and non-sexual behaviors with the VRT in a sample of 282 self-referring, help-seeking men with and without pedohebephilia with and without a history of prior child sexual offenses (CSO) or a use of child sexual abuse materials (CSAM) recruited outside a forensic context. We found that (1) the clinical diagnosis of pedohebephilia but not prior CSO or CSAM showed a significant association with the VRT index; (2) the discriminatory ability of the VRT index did not differ significantly between samples with and without a history of prior overt sexual behavior with children; (3) the VRT index correlated positively with a behavioral marker of pedohebephilia in a subsample of individuals with prior judicially detected or undetected overt sexual behavior with children; and (4) in the same subsample, the VRT index correlated positively with markers of sexual interests in minors or hypersexuality but not of antisociality. Equivalence testing failed to refute a potential effect of prior sexual behavior on the VRT index. Our study showed that the VRT may provide an unintrusive diagnostic tool for pedohebephilia. The effect of prior overt sexual behavior with children needs further examination.

Distinct age-related differences among victims in cases of suspected child abuse.

Evidence describing age-related differences among children with suspected physical and sexual child abuse is lacking. We describe findings in severe cases of suspected abuse. Cases with 756 children <15 years old were included during 2001-2013 at the Department of Forensic Medicine, Aarhus University, using forensic evaluation documents, medical records, and court proceedings. Eight percent of children <4 years old died from child abuse, 36% through violence resulting in death, and 64% by manslaughter, whereas 1% > 4 years old died, solely by manslaughter. External injuries were mainly located to head and torso in children <4 years old, changing to the upper and lower extremities in older children. Child sexual abuse was suspected in 52% of cases with living children <4 years old, 83% of children 4-7 years of age, 88% of children 8-11 years of age, and 93% of children >12 years old. Anogenital findings were mainly caused by other medical conditions in children <4 years old, hymenal clefts in the superior half of the hymenal rim were almost exclusively found in children between 8 and 11 years of age, whereas both superficial and complete hymenal clefts in the inferior half of the hymenal rim were found in children >12 years old. The present study describes age-related differences in victims of suspected child abuse. Fatal versus nonfatal child physical abuse and the significance of hymenal findings in child sexual abuse could be studied further.

A Non-Clinical Referral Tool to Help Identify Problematic Child Sexual Behavior: Development, Training, and Initial User Feedback.

Early identification of children and youth who engage in problematic sexual behavior is important for all parties involved, such as children who exhibit and are impacted by the behavior. There are several reliable and valid identification tools that can be used to recognize problematic sexual behavior in children and youth (PSB-CY) in clinical practice; however, professionals who work with children in non-clinical settings (i.e., child development centers, youth programs, and schools) often have limited resources and tools when they encounter PSB-CY. This paper describes the development, content, and user feedback of a referral tool (RT) that was designed to help identify incidents of PSB-CY for use with military agencies and schools. Specifically, the RT was designed to help professionals, who may have observed or who may have been made aware of sexual behaviors in children and youth, organize their observations of the behavior in alignment with evidence-based information about PSB-CY and consistently document these occurrences. The RT guides users in determining if the observed behavior is normative, cautionary, or problematic and promotes informed decisions about whether the behavior needs to be referred to those who have experience using clinical tools for further review and the identification of next steps for supporting the children and families involved. Early adopters provided feedback on the use of the RT. The feedback suggested that the tool was user-friendly, understandable, and helpful as they made objective decisions about how to identify and handle referrals of PSB-CY.

Caring for Domestic Minor Sex Trafficking Patients: Recommendations for Identification, Interventions, and Resources.

Domestic minor sex trafficking has increasingly gained awareness as a social phenomenon that affects adolescent health and safety. Healthcare providers are uniquely positioned to identify and facilitate supportive interventions for adolescents at high risk or involved in trafficking. A growing literature base and clinical experience provide recommendations on how to identify, engage trafficked youth, and provide beneficial linkages with community resources. A coordinated, multidisciplinary, and trauma-informed response that fosters therapeutic alliances promoting agency, safety, and trust are key components of successful care for this vulnerable adolescent population.

Psychological aftereffects experienced by sexually abused children: Psychopathological characteristics revealed by the K-CBCL.

Children who have been sexually abused may experience various short- and long-term psychological sequelae and behavioral problems. This study assessed the mental health of sexually abused children using the Korean-Child Behavior Checklist (K-CBCL) and examined differences from a control group. The participants were 97 children who had been sexually abused and who visited a local Sunflower Center, and 178 control participants. Data were collected via the K-CBCL and analyzed using SPSS version 25.0. T-tests, cross-tabulation, and logistic regression analyses were performed. Scores from the K-CBCL Problem Behavior Syndrome scale were compared between sexually abused children and the control participants. Significant differences were observed between the 2 groups in all the subscales. Compared to the control group, children who were sexually abused showed statistically significant differences in the total problem behavior, internalization, anxiety/depression, withdrawal/depression (withdrawn), somatic symptoms, externalization, rule-breaking behavior (delinquency), aggressive behavior, social immaturity, thought problems, attention problems, and other subscale scores. Sexual violence hurts the overall mental health of children who are abused, including their emotional, behavioral, and social factors. Our findings suggest that multidisciplinary assessment and treatment are required for children who have experienced sexual abuse.

Interpretation of medical findings in suspected child sexual abuse: An update for 2023.

Health care professionals who examine children who may have been sexually abused need to be able to recognize, and photo-document any physical signs, and to have access to expert reviewers, particularly when signs concerning for sexual abuse are found. Although the general consensus among practitioners is that children will show few signs of sexual abuse on examination, there is considerable variability and rates of positive exam findings among practitioners of different professions, practice settings, and countries. This review will summarize new data and recommendations regarding the interpretation of medical findings and sexually transmitted infections (STIs); assessment and management of pediatric patients presenting with suspected sexual abuse or assault; and testing and treating patients for STIs. Updates to a table listing an approach to the interpretation of medical findings are presented, and reasons for changes are discussed.

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.

Caregivers' Perceptions of Child Trauma Symptomatology, Stress, and Child Abuse Disclosures.

Caregivers consider child abuse disclosures stressful life events, but research has not investigated whether this stress affects caregiver ratings of child trauma symptomatology. Secondary data from a Child Advocacy Center in the Midwestern United States between the period of January 1, 2018, and April 31, 2019, stepwise logistic regression models, and change in estimate calculations were used to assess (1) the relationship between child abuse disclosure(s) and caregiver stress and (2) the association between caregiver stress disclosure and clinically significant ratings on the Trauma Symptom Checklist for Young Children (TSCYC). While a child's physical abuse disclosure was associated with caregiver stress and caregiver stress was significantly associated with clinically significant ratings for child depression and anger/aggression TSCYC scales, abuse disclosure did not affect the relationship between caregiver stress and TSCYC scale ratings. Moving forward, caregiver-reported stress should be considered when utilizing caregiver-completed child trauma symptom screens.

Children, Sexual Abuse and the Emotions of the Community Health Practitioner in England and Wales, 1970-2000.

A survivor of child sexual abuse felt that doctors missed opportunities to notice her distress when, at fourteen, she had an unexplained illness that lasted for a year. The cause, she wrote, was "explained by Doctors as psychological, but nobody questioned further. WHY??? … If adults don't listen[,] then we have no one to turn to." For decades, community health practitioners have been identified as an important group in protecting children from maltreatment, but survivor testimony and agency statistics demonstrate that they rarely receive verbal disclosures or recognize the physical or behavioural warning signs of sexual abuse. The accounts we have of the 1980s tell of swiftly heightening professional awareness, followed by a visceral backlash in the latter part of the decade that discouraged practitioners from acting on their concerns. This article uses trade and professional journals, training materials, textbooks, and new oral histories to consider why community-based doctors and nurses have struggled to notice and respond to the sexually abused child. It will argue that the conceptual model of child sexual abuse that community health practitioners encountered in the workplace encouraged a mechanical and procedural response to suspicions of abuse. In a highly gendered and contested workplace, practitioners' feelings about how survivors, non-abusing family members, and perpetrators should be understood were rarely debated in training or in practice. The emotional cost to the practitioners of engagement with sexual abuse, and their need for spaces of reflexivity and structures of support, were ignored.

Sexual abuse of children - some recommendations from a forensic gynaecologist's expert experience.

Prompt and better primary examination of victims accompanied by meticulous note-taking in cases of suspected child sexual abuse are needed to improve both conviction rates and to avoid inappropriate criminal investigations and proceedings. The majority of child sexual abuse victims are female. More training is needed for gyaecologists in this field.

Elaborations and Denials in Children's Responses to Yes-No Any/Some Questions in Forensic Interviews.

This study examined 379 4- to 12-year-old children's answers to any/some and other yes-no questions in forensic interviews about sexual abuse (N = 10,041). Yes-no questions that include the terms any/some (e.g., "Did he say anything?") often implicitly ask for elaboration when the answer is yes ("What did he say?"). However, children may give unelaborated responses to yes-no questions, fail to recognize implicit requests, and falsely respond "no." As predicted, children gave more wh- elaborations in response to any/some questions than other yes-no questions, but younger children elaborated less often than older children. Also as predicted, children responded "no" more often to any/some questions than to other yes-no questions, and more often to "any" than to "some" questions. "No" responses were also more common when children were asked potentially vague anything/something questions and else/other/different questions. The results highlight the potential risks of asking children any/some questions.

Anogenital HSV in Children: Should Providers Be Concerned for Sexual Abuse?

OBJECTIVE: Anogenital herpes simplex virus (HSV) is most commonly acquired via sexual transmission, although other nonsexual modes of transmission have been proposed. When a child presents with a first-time outbreak of anogenital HSV, providers must consider sexual abuse. There are currently no evidence-based consensus guidelines to inform management of these patients. The purpose of this study was to describe how child abuse pediatricians (CAPs) evaluate children with anogenital HSV infection and determine whether any consistent practice patterns are followed. PARTICIPANTS AND SETTING: The patients included in this study were children between the ages of 0 and 12 years with a first-time outbreak of anogenital HSV who were medically evaluated by a CAP. METHODS: Patient charts were retroactively reviewed for the period of January 1 2004 to May 1 2020. RESULTS: Twenty-two cases were referred for evaluation by a CAP in the chosen time frame. Fifteen were seen in person. Ten of these patients were interviewed, 15 had an anogenital exam with colposcopy, and 14 were tested for at least one other sexually transmitted infection. A diagnosis of sexual abuse was made for 1 patient. CONCLUSION: This study demonstrates that although nonsexual transmission of anogenital HSV may be possible, providers must still consider sexual abuse. Children with a first-time outbreak of anogenital HSV should have a comprehensive evaluation for sexual abuse, including interview, physical exam, and testing for sexually transmitted infections. Evidence-based concerns for sexual abuse should be reported to child protective services.

Sociodemographic and Clinical Characteristics of Child Sexual Abuse Reported to an Urban Public Hospital in Southern India, 2019-22.

OBJECTIVES: To describe the profile of child sexual abuse (CSA) reported to a tertiary care hospital. METHODS: A retrospective analysis of CSA reported in children aged below 18 years from January, 2019 to June, 2022. RESULTS: Out of the 231 cases of sexual abuse reported, 115 (49.8%) were children below 18 years. Most of the victims were children from 10 to 15 years (37.4%), and there were only two male victims. In 89.6%, the perpetrator was known to the victim. Revictimization was seen in 31%. The reported perpetrators were friends (27%), neighbors (34.8%), strangers (10.4%), or fathers (7.8%). Penetrative abuse was seen in 58.3% of reports. External injuries were seen in 6.96%. Eight victims were pregnant and HIV screening was positive in one victim. CONCLUSION: Early identification of CSA is important to prevent revictimization. Children from all age groups can be victims of CSA. Perpetrators can hail from all walks of life of the children.

Child sexual abuse in Kaduna State, Northwestern Nigeria: A review of 420 police-reported cases.

Child sexual abuse affects millions of children globally but in Nigeria, hospital-based studies continue to report few cases, making it difficult to assess the magnitude and quality of care. This study aimed to overcome this challenge by reviewing police medical reports instead of hospital records. A total of 420 reports were retrieved from one police area command in Kaduna State, Northwestern Nigeria, between 2018 and 2021. The majority of the victims were females (65.5%), 5-14 years (70.2%), and familiar with their assailants (71.4%). Most of the assailants were men (99.0%), 20-40 years (29.1%), who acted alone (86.7%). Most of the reports contained history (79.3%), physical examination (49.6%), and laboratory results (>90%). Among female victims, the commonest genital findings were absent hymen (25.6%) and normal findings (17.6%). Among male victims, the commonest anal findings were normal findings (41.7%) and anal dilatation (23.6%). The victims tested positive for HIV (0.5%), hepatitis B (4.7%), hepatitis C (1.0%), and syphilis (0.8%). Higher positivity rates were noted among assailants. Treatments offered to the victims included antibiotics (30.2%), analgesics (11.9%), emergency contraception (6.7%), and psychotherapy (67.4%). The review calls for improved reporting, use of comprehensive treatment guideline, and training of service providers to improve the quality of care.

Sexually transmitted infections in suspected child sexual abuse.

Making associations between sexually transmitted infections (STIs) and child sexual abuse can be controversial. To contribute to the paucity of research in this field, this service evaluation aims to (1) define the prevalence of STIs in children aged 0-13 years seen at a regional Children's Sexual Assault Referral Centre, (2) determine whether sexual transmission is the most likely mode of transmission for diagnosed STIs, (3) identify factors affecting application of STI screening and (4) assess follow-up. Methods consisted of retrospective analysis of an anonymous database for all patients seen between 1 July 2016 and 1 July 2019. Of 241 children seen, 114/241 (47.3%) received STI screening and 10/114 (8.8%) tested positive (4.1% of children seen overall). No asymptomatic child was diagnosed with an STI. Sexual transmission was the most likely mode of transmission based on child disclosure and physical examination findings for 6/10 children diagnosed with an STI.

Novel Forms of Reluctance Among Suspected Child Sexual Abuse Victims in Adolescence.

Adolescents tend to be neglected in research examining child sexual abuse (CSA) interviews, yet are often said to be particularly reluctant. This study examined reluctance among 119 10- to 17-year-old females questioned about suspected CSA (n = 25,942 responses), utilizing a scheme identifying previously overlooked types of reluctance in commercially sexually exploited (CSE) youth. In contrast to the CSE youth in a prior study, in which 26% of responses were reluctant, only 8% of CSA victims' responses expressed reluctance. Reluctance was unrelated to age, abuse characteristics, and don't know (IDK) responding. Greater reluctance (but not IDK responding) was related to disclosure of fewer characteristics of abuse. Virtually all youth (93%) had disclosed prior to the interview, in contrast to previous studies examining reluctance among adolescent victims of internet-initiated sexual abuse and CSE. The way in which abuse is discovered may better explain reluctance than the age of the alleged victims.

Chlamydia trachomatis conjunctivitis in the pre-pubertal child.

Much is reported in the literature about the transmission and presentation of Chlamydia trachomatis conjunctival infection in the neonate; however, there is a paucity of information available on infection in the older pre-pubertal child (>3 years of age). We present the case of a 7-year-old girl, referred for assessment at the sexual assault referral centre following the diagnosis of unilateral C. trachomatis conjunctivitis. This child underwent a rigorous multiagency child protection process, with input from medical professionals, social services and the police to investigate the possibility of child sexual abuse (CSA). However, a group consensus was reached that non-sexual close contact transfer of C. trachomatis from the mother was the most likely mode of transmission and cause of infection. We aim to take the reader through the complex path to this conclusion, the approach to sexually transmitted infections and potential CSA and what is currently known about chlamydial conjunctivitis in children beyond the neonatal period.

Psychometric Properties of the Korean Version of the Child Sexual Behavior Inventory.

This study examined the psychometric properties of the Korean version of the child sexual behavior inventory (CSBI) for children under 10 years of age. Participants comprised a community sample (CS) of 652 children aged three to nine years and 226 sexually abused (SA) children in the same age range. Parents rated the CSBI, the child behavior checklist (CBCL), and the traumatic symptom checklist for young children (TSCYC). We examined internal consistency as a measure of reliability and conducted ANOVA for discriminant and Pearson's correlations for convergent and divergent validity. The reliability coefficient indicated internal consistency (α = .59-.97). There was a significant correlation between sexual behaviors and internalizing and externalizing behavior problems in both samples (r = 0.30-0.48, p < .001). The correlation between post-traumatic stress disorder symptoms and sexual concern in the SA sample was very high (r = 0.56-0.66, p < .001). There was a significant difference in sexual behavior between the CS and SA. These findings demonstrate the reliability and validity of the Korean version of the CSBI and its usefulness in identifying children suspected of sexual abuse. However, the research identified cultural differences in the sexual behavior of the CS.