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The article by Al-Jilaihawi and colleagues1 is an important reminder of the scale of child sexual abuse (CSA), both acute and non-acute. As paediatricians, our understanding and clinical management of ‘historic’ child sexual abuse leave much to be desired. The authors identified clinical characteristics of children and young people presenting with a suspicion or allegation of historic CSA, which they define as ‘within 7 days of the last episode of sexual assault in pubertal girls, or within 3 days for prepubertal girls and boys of all ages’. This definition appears to be based on the timing of forensic samples after the last sexual act.
Definitions and terminology
Most CSA cases do not reach the attention of statutory services. Sexual abuse by a family member or someone connected to the family is estimated to account for two-thirds of all CSA. This is the most important barrier to children and young people accessing help, leading to disclosure being delayed for months if not years. The definition of what constitutes a ‘historic’ case is complex, and the term has been criticised because it implies a lack of urgency. In some parts of the UK, ‘historic’ has been abandoned in favour of ‘non-acute’.
How quickly a non-acute or historical case needs to be seen will vary according to clinical need. The recommendation from the Royal College of Paediatrics and Child Health2 is that non-acute cases should be seen for paediatric assessment within 2 weeks of a decision being made that an assessment is required, usually following an investigative interview of the child or young person. The decision on the timing of the paediatric assessment must involve medical personnel with the necessary experience and skills, ideally at the strategy/interagency referral discussion.
In the USA, Adams and colleagues3 describe the urgency of the medical evaluation as …
Competing interests The author was a member of the working groups for the following RCPCH publications: Service specification for the clinical evaluation of children and young people who may have been sexually abused. Revised September 2015. The physical signs of child sexual abuse: an evidence-based review and guidance for best practice. Lavenham Press 2015.
Provenance and peer review Commissioned; internally peer reviewed.