Resumo

QUENAN-N, Natalia E  e  SAMUDIO-DOMINGUEZ, Gloria Celeste. Sexual Child Abuse: Epidemiology and a Study of Pediatrician Case Management before and after Supplementary Training. Pediatr. (Asunción) [online]. 2013, vol.40, n.2, pp.125-132. ISSN 1683-9803.

Introduction: Child sexual abuse is the involvement of a child in sexual activities that are not appropriate to their stage of development. Objective: To describe the social, demographic, clinical, and legal characteristics of case management and care of pediatric victims of sexual abuse consulting at the Hospital Nacional of Paraguay from January 2009 to December 2011.Methodology: A prospective and retrospective, cross-sectional, observational, and descriptive study including educational intervention.  Pediatric patients diagnosed as victims of sexual abuse were included. We consulted clinical, laboratory, and legal records of patients treated at the Hospital Nacional between January 2005 and December 2011. The study consisted of two stages: the first, from January 2005 to March 2009, and the second, from April 2009 to December 2011. Upon concluding the first stage, educational intervention was performed consisting of counseling and discussion of standards for approach, diagnosis, and management of child sexual abuse for all staff physicians and residents from the hospital pediatric departments. Results: We included 85 patients, 42 in the first stage and 43 in the second. Average age of patients was 9.2 years in the first stage, and 7.9 years in the second. In both stages, abuse was found predominantly in female patients (90%). In most cases (first stage: 62%; second stage: 83%), the aggressor was known to the victim. Acute sexual abuse was seen in 29 cases in the first stage and 28 in the second. External lesions were found in 86% in the first stage, and 60% in the second. In the first stage, investigation of signs of abuse was deficient in 100% of cases; in 36 patients only HIV and VDRL tests were performed; in 4 patients no investigation was performed. In the second stage, investigation was adequate In all cases. Behavioral symptoms were the most common sequelae (first stage 80%; second stage 77%). In both periods all cases were reported to the legal department; in the first stage legal follow-up occurred in only 40% of cases, while in the second stage legal follow-up was performed in 100%. Conclusions: Females were more commonly affected, without victim age differences found, and the perpetrator was most often a near family member. Acute sexual abuse with external lesions was the most common form. Behavioral sequelae were very evident in most cases. Adequate adherence to the guide for management of child sexual abuse following the educational intervention.

Palavras-chave : Child sexual abuse; child molestation; hospital utilization; therapy standards; therapy utilization; pediatrics; child; sexual abuse education.

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