0095

SEXUAL ABUSE OF CHILDREN

AB van As, M Withers, AJW Millar, H Rode

Trauma Unit, Child Accident Prevention Foundation of Southern Africa, Department of Paediatric Surgery, Institute of Child Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

Introduction Sexual abuse of young children is unfortunately common in our violent society. There appears to be an increase over the last few years.

Aim To document the incidence, presentation, pattern of physical injury, management and outcome of child rape.

Materials and methods The records of 152 sexually assaulted children presenting to our unit over a five year period were examined. Information was gathered about the assailant, the circumstances of the injury, the extent of the physical injury, investigations, management and outcome.

Results The majority of victims were female (87%), while the majority of the assailants were male (99%). In 59% the assault took place at home or close to it. Significant injuries were noted in 69%. Surgical repair was required in 33%. Twenty one children presented with 2^nd degree tear, while 2 children required colostomy for a 3^rd degree tear. Medical consequences of the sexual assault included HIV sero-conversion, infection with other sexually transmitted diseases. Long term consequences included pregnancy, dysuria, urinary and faecal incontinence and perineal infection.

Although 70% of the assailants were not related, 58% were known to the victim.

Conclusion Violent sexual assaults occur frequently. Careful documentation is essential, with accurate examination under anaesthesia and proper collection of evidence data. At present the channels of care for raped children, as well aftercare and collecting evidence for later court cases is inadequate and requires review.

There should be close co-operation between the health care workers (doctors, nurses, social workers), the police (Child Protection Unit) and the Judicial system.