Accusations that hospital staff have abused pediatric patients

Protecting children from sexual abuse by health care providers

Sexual abuse or exploitation of children is never acceptable. Such behavior by health care providers is particularly concerning because of the trust that children and their families place on adults in the health care profession. The American Academy of Pediatrics strongly endorses the social and moral prohibition against sexual abuse or exploitation of children by health care providers. The academy opposes any such sexual abuse or exploitation by providers, particularly by the academy's members. Health care providers should be trained to recognize and abide by appropriate provider-patient boundaries. Medical institutions should screen staff members for a history of child abuse issues, train them to respect and maintain appropriate boundaries, and establish policies and procedures to receive and investigate concerns about patient abuse. Each person has a responsibility to ensure the safety of children in health care settings and to scrupulously follow appropriate legal and ethical reporting and investigation procedures.

Toward instituting a chaperone policy in outpatient pediatric clinics

OBJECTIVES

We sought to evaluate child, parent and medical provider preferences for chaperones for outpatient encounters and to evaluate the acceptability and frequency of utilization following institution of a chaperone policy. Secondarily, we sought to understand what medical history and examinations teens consider "sensitive."

DESIGN

We conducted an observational study 1 month before and 1 month after institution of outpatient clinic chaperone policy. Post clinic questionnaires were used for patients > or =12 years old, parents, and clinicians. A research assistant observed chaperone use.

SETTING

Adolescent Medicine, Urology, and Rehabilitation Clinics at a regional, tertiary-care pediatric hospital, in a major metropolitan area were studied.

PARTICIPANTS

Convenience sample: 117 clinic patients during control period and 119 after policy implementation.

MAIN OUTCOME MEASURES

Preferences for and satisfaction with chaperone use were documented.

RESULTS

Although non-parent chaperones were usually declined (99.6%), offers were appreciated. Non-parent chaperone use increased modestly (5.3-18.1%). Most patients preferred not to have non-parent chaperones. This preference was greater among older patients (88%), than early teens (52%). After experiencing sensitive examinations, more young adolescent patients (89%) wished their parent had been present than older patients (38%). Patients' opinions about what constitutes "sensitive" questions and examinations and chaperone preferences varied widely. Providers often did not recognize issues patients and parents considered sensitive questioning (21% agreement), but recognized sensitive physical examinations better (74% agreement). Providers felt chaperones had been a detriment to examination and exams would have gone better without one only 1% of the time.

CONCLUSIONS

Although usually declined, offers of chaperones were appreciated and use of non-parent chaperones increased modestly. Offering chaperones for sensitive examinations may remind providers about appropriate, respectful patient encounters. Implications for children's hospitals' patient safety and satisfaction, and institutional staff protection and costs are significant.

PRACTICE IMPLICATIONS

Questions and examinations which patients consider sensitive vary widely. Asking patients for their preferences for examination chaperones may reassure them about the appropriateness of examinations, remind staff to conduct respectful examinations and protect providers from accusations of impropriety. Since most chaperone offers are declined, the cost of asking is likely to be minimal.

Child sexual abuse

Child sexual abuse is a worldwide concern. It is an insidious, persistent, and serious problem that, depending on the population studied and definition used, affects 2-62% of women and 3-16% of men as victims. Pain and tissue injury from child sexual abuse can completely heal in time, but psychological and medical consequences can persist through adulthood. Associated sexually transmitted diseases (such as HIV) and suicide attempts can be fatal. All physicians who treat children should be aware of the manifestations and consequences of child sexual abuse, and should be familiar with normal and abnormal genital and anal anatomy of children. This aim is best accomplished through training and routine examination of the anus and genitalia of children. Because as many as 96% of children assessed for suspected sexual abuse will have normal genital and anal examinations, a forensic interview by a trained professional must be relied on to document suspicion of abuse.