HJAR Nov/Dec 2024

CHILD SEXUAL ABUSE 10 NOV / DEC 2024 I  HEALTHCARE JOURNAL OF ARKANSAS to see a healthcare provider model con- versations about privacy and body safety. Opening the conversation by asking a child what they call the parts of the body “where they pee and poop”can turn into education and information about recognizable names for body parts and may prompt a conversa- tion about privacy and rules about touching and looking at their vagina, penis, or bot- tom. We also provide important modeling to help children understand that they are in charge of their body and that if we do any- thing that makes them hurt or uncomfort- able, they should tell us. We can emphasize that we do not complete these exams with- out permission from them and their care- giver, and we want to continuously model messaging about body autonomy even when an exam is needed. Our strategies for open communication, discussions of sexual development, and anogenital exams may vary based on the developmental stage of the child but remain important throughout all stages of childhood and adolescence. Remaining open and responsive to ques- tions about a patient’s sexual development provides a safe space for children and teens to report concerns that they have. After a healthcare provider or care- giver recognizes or suspects child sexual abuse, responding in a calm, supportive, and non-judgmental manner is critical. A disclosure or suspicion of sexual abuse evokes understandably strong emotions. However, demonstrating those feelings of anger, fear, or disgust to a child may be misinterpreted by the child as having said or done something wrong. As healthcare providers, it is our responsibility to iden- tify any urgent health or safety concerns with non-leading questions and report suspected sexual abuse to the child abuse hotline. After a report is completed, inves- tigations of child sexual abuse in Arkansas are most frequently completed through a statewide network of Child Advocacy Cen- ters where children and teens can receive a developmentally appropriate interview as well as advocacy services, mental health, and medical referrals for the evaluation of sexual abuse. 7 Recognition and response to child sexual abuse requires all of us to do our part, and knowing our partners in this mission helps provide optimal outcomes for children and families. Acknowledging the trauma that occurs to thousands of children in our state is difficult. As a child abuse pediatrician in Arkansas, I see cases of child sexual abuse to children on a nearly daily basis. To say the work can be challenging is an understatement, but I also love my job. I am inspired by the chil- dren, families, and partners I work with. I see children thrive when they are believed and supported. I see parents who are empowering their children to say “no” to unwanted touches, and I see partners work- ing together to teach children and families that talking about normal and healthy sex- ual development is necessary to protect our children. Healthcare providers are uniquely positioned to discuss sensitive and private matters and with the right information and skills, we serve a critical role in interrupting cycles of trauma through our recognition and response to child sexual abuse. n REFERENCES 1 Centers for Disease Control and Prevention. “Child Abuse and Neglect Prevention: About Child Sexual Abuse.” Accessed Oct. 11, 2024. https://www.cdc.gov/child-abuse-neglect/ about/about-child-sexual-abuse.html 2 Heger, A.; Ticson, L.; Velasquez, O.; Bernier, R. “Children referred for possible sexual abuse: medical findings in 2384 children.” Child Abuse & Neglect 26, issues 6-7 (June 2002): 645-659. DOI: 10.1016/s0145-2134(02)00339-3 3 Anderst, J.; Kellogg, N.; Jung, I. “Reports of Re- petitive Penile-Genital Penetration Often Have No Definitive Evidence of Penetration.” Pediat- rics 124, No. 3 (Sept. 1, 2009):e403-e409. DOI: 10.1542/peds.2008-3053 4 Oates, K. “Can we believe what children tell us?” The Howard Williams Oration, Journal of Paediat- rics and Child Health 43, No. 12 (December 2007): 843-847. DOI: 10.1111/j.1440-1754.2007.01243.x 5 Malloy, L.; Mugno, A.; Rivard, J.; et al. “Fa- milial Influences on Recantation in Substanti- ated Child Sexual Abuse Cases.” Child Maltreat- ment 21, No. 3 (August 2016): 256-261. DOI: 10.1177/1077559516650936 6 Kellogg, N.; Committee on Child Abuse and Ne- glect. “Clinical Report — The Evaluation of Sexual Behaviors in Children.” Pediatrics 124, No. 3 (Sept 1, 2009): 992-998. DOI: 10.1542/peds.2009-1692 7 Children’s Advocacy Centers of Arkansas. Ac- cessed Oct. 11, 2024. https://cacarkansas.org/ LizaC.Murray,MD, isanassociateprofessorof pediatricsand thedirectorof theUAMSSection forChildrenat Risk. Since2018,MurrayhaspracticedasachildabusepediatricianatArkansas Children’s Hospital, where she provides consultation and clinical evaluations for suspected maltreatment of all typesand leads theclinical teamthat supportsvulnerablechildren.Murray routinelyevaluateschildrenandadolescentsaffectedbysexual abuseandregularlyeducates families, medical professionals, and community partners regarding prevention, recognition, and response to child sexual abuse. Recognized as an expert in child abuse and neglect, she has published multiple articles, contributes to ongoing research in the field of maltreatment, and presents at local, regional, and national conferences regardingmaltreatment of all types. The David M. Clark Center for Safe and Healthy Children at Arkansas Children’s is dedicated to the care and treatment of neglected and abused children and their families. It is a single, safe place for children to receive medical, psychological, and social health services. For more information on the David M. Clark Center for Safe and Healthy Children, visit www.archildrens.org/clarkcenter. Anyone suspecting abuse or neglect of a child should contact the Arkansas Child Abuse Hotline at 800-482-5964.