Referral characteristics and clinical findings in children presenting with suspected historical sexual abuse

Katharine Jamieson

Guy's and St Thomas' NHS Foundation Trust

Katharine Jamieson is a neonatal and paediatric trainee working in London. She studied medicine at Oxford university, graduating in 2006, and has undertaken her paediatric training in London, with 2 additional years working in Melbourne, Australia. She has a keen interest in child protection, and has worked with Deborah Hodes for 18 months during her training, including regular assistance at a UCLH clinic for assessment of children with complex safeguarding presentations including historic sexual abuse.

Deborah Hodes

University College London NHS Foundation Trust

Dr Deborah Hodes is a Consultant Community Paediatrician and the Designated Doctor for Safeguarding in Camden, United Kingdom. She has many decades of experience in child protection and child development and has pioneered many initiatives in London to promote the wellbeing of vulnerable children and improve the standards of child protection clinical practice. She has a particular interest in culturally diverse population groups and promoting the child's voice in the clinical setting. Dr Hodes has many publications and presentations in the field of safeguarding and child protection. She is internationally renowned for her work on clinical assessment and social support for children who have experienced female genital mutilation.

Abstract

Introduction There has been an 85% increase in the total number of police-recorded sexual offences against children and young people (CYP) in the UK, between 2010/11 and 2014/15. Many children delay disclosure, raising a... [ view full abstract ]

Introduction There has been an 85% increase in the total number of police-recorded sexual offences against children and young people (CYP) in the UK, between 2010/11 and 2014/15. Many children delay disclosure, raising a question as to the clinical yield from anogenital examination in historic cases.

Objectives We sought to identify the clinical and CSA–related characteristics in children presenting non-acutely to a specialised historic CSA clinic.

Methods CYP under 17 completed years presenting with a suspicion or historic allegation of CSA (one week to one year after the alleged episode) between October 2009 and November 2014 were included. Prospective data included: referrer, perpetrator, type of abuse (penetrative or non-penetrative), disability, family history of CSA/domestic violence, and physical findings.

Results Among the 249 children (80% girls), most referrals originated from Social Care (56.5%), and the remainder from paediatricians, primary care, police and others. Ages ranged from 0-17 years (median 7, standard deviation 4.3). Average age was significantly higher in those presenting with alleged penetration (p<0.001). In 14% (36/249) cases, the child had a reported disability. There was a history of CSA in the mother in 17% (26/153) and domestic violence in 8% (12/153). Among the 70% (190/249) of cases with an alleged perpetrator, 66% (126/190) were intrafamilial perpetrators. Anogenital examination was carried out in 232/249 (93%) cases; seven refused, and nine had a prior examination. Anogenital findings supportive of CSA were found in 18 (7%) children, all of whom were female, and had alleged penetration (p<0.001); 12/18 (66%) were over 13 years old. Three children had sexually transmitted infections (STI).

Conclusion There were a large proportion of alleged intrafamilial perpetrators of historic CSA. Evidence of anogenital findings supportive of CSA and STIs were found. These findings reiterate the clinical and forensic importance of a comprehensive clinical examination, even in historical allegations.

Authors

Sarah Al-Jilaihawi (Central and Northwest London NHS Foundation Trust)
Kevin Borg (University of Warwick)
Katharine Jamieson (Guy's and St Thomas' NHS Foundation Trust)
Sabine Maguire (Institute of Primary Care and Public Health, Cardiff University)
Deborah Hodes (University College London NHS Foundation Trust)

Topic Area

Sexual Abuse

Session

Oral 24 » Session 3- Child Sexual Abuse (16:15 - Tuesday, 3rd October, South America Room)

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