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Arch Dis Child. 2018 Jun;103(6):533-539. doi: 10.1136/archdischild-2017-313676. Epub 2017 Nov 7.

Clinical characteristics of children presenting with a suspicion or allegation of historic sexual abuse.

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Department of Paediatrics, University College London Hospital, London, UK.
Department of Paediatrics and Adolescent Health, Mater Dei Hospital, Msida, Malta.
Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.



Police-recorded sexual offences against children and young people (CYP) increased 85% in the UK between 2010/2011 and 2014/2015. Many children delay disclosure, but little data are available regarding characteristics of CYP presenting with historic child sexual abuse (CSA).


To identify the clinical and CSA-related characteristics of CYP presenting with a suspicion or allegation of historic CSA.


Data were collected on all CYP<17 years presenting with suspected or alleged historic CSA (ie, >3 days since last sexual assault in prepubertal children, >7 days pubertal girls) between October 2009 and November 2014.


source and indication for referral, alleged perpetrator, physical findings. Findings supportive of CSA were peer reviewed for consensus agreement.


χ2 test, Fisher's exact test and logistic regression.


Among 249 CYP, presentation with physical/behavioural symptoms was associated with age <13 years (p<0.01), and alleged penetration with ages 13-17 years (p<0.01). Where known, time since alleged CSA ranged from 1 week to 13 months. Anogenital findings supportive of CSA were present in 7% of examined children (16/233), significantly associated with alleged penetration (p<0.01) and more likely with increasing age (OR 1.46, 95% CI 1.23 to 1.72). Additionally, where tested, sexually transmitted infections (STI) were detected in 2.6% CYP (3/116). Alleged perpetrators were intrafamilial in 66% (126/190). No associations were identified between perpetrator type and gender (p=1.0), age (p=0.7) or indication for referral (p=0.35).


Despite significant time delay since the alleged CSA, this study highlights the persistence of anogenital findings supportive of CSA in 7% and STIs in 2.6% of CYP.


Child Abuse; Comm Child Health; General Paediatrics; Social Work

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