Archives of disease in childhood - Education & practice edition
A general practitioner (GP) refers to your general paediatric outpatient clinic a 6-year old girl... more A general practitioner (GP) refers to your general paediatric outpatient clinic a 6-year old girl with an intermittently sore vulva with occasional discharge. Her mother noticed her ‘vagina’/genitalia has been slightly red, and there is intermittent minimal white discharge. Clotrimazole (Canestan), prescribed by her GP, has not made any difference. In this article, we discuss the aetiology and initial assessment of vulval soreness and related symptoms in the prepubertal girl. The article does not include the differential diagnoses in the peripubertal and postpubertal adolescent cohort, thereby excluding conditions related to menstruation and pregnancy (see box 1). Box 1 ### Anatomy of prepubertal and pubertal girls The prepubertal girl’s anatomy is different from that of the pubertal girl. During puberty, labial fat pads begin to form; pubic hair grows; the vaginal mucosa becomes thicker and less thin-walled; and the squamous cells in the epithelial lining of the vagina undergo cornification, leading to increased protection against pathogens.4 Hormonal changes during puberty include oestrogenisation of the vulva, hymen and vaginal mucosa, and acidification of the pH, which was previously alkaline or neutral.7 Together, these changes decrease susceptibility to inflammation and infection. Vulval soreness, or pain, and discharge in prepubertal girls are common reasons for referral by primary care physicians to secondary care. It is often worrying for parents, particularly if symptoms are long-standing or disruptive to the child’s daily activities. Epidemiological data on vulval pain as a presenting symptom to primary or secondary care are sparse. One study from a UK district general hospital reported that 86% of new paediatric and adolescent patients were referred from primary care, and the the most common presentations were vulvovaginitis (18%), labial adhesions (14%) and abdominal pain (7%).1 This differs from data on children attending a UK tertiary referral centre, where one-third of patients presented with anomalies of the genital tract, with …
ObjectiveTo describe the presentation and management of children with suspected or confirmed fema... more ObjectiveTo describe the presentation and management of children with suspected or confirmed female genital mutilation (FGM) referred to a specialist paediatric clinic.MethodsData collected included referral source, age, ethnicity, circumstances of FGM and clinical findings in accordance with the WHO FGM classification.ResultsBetween September 2014 and January 2019, 148 children attended the clinic of whom 55 (37.2%) had confirmed FGM. Police or social care referred 112 (76%) children. The proportion of looked-after children (LAC) was significantly higher in the group with confirmed FGM (17/55, 31%) compared with children where FGM was not confirmed (5/93, 5%). In almost all children where FGM was confirmed, FGM was initially disclosed by the child or family (53/55, 96%) and of these 48/55 (87%) underwent FGM prior to UK entry. The remaining seven cases were British children, potentially meeting legal criteria under the FGM Act, and one resulted in a successful prosecution.Conclusio...
Introduction The multiagency response to allegations or suspicions of child sexual abuse (CSA) of... more Introduction The multiagency response to allegations or suspicions of child sexual abuse (CSA) often lacks coordination between and within agencies. Current management tends to focus predominantly on risk management with limited attention given to how resilience can be promoted as a means of overcoming adversity. We looked for the evidence around resilience in CSA in order to give support to a framework that may improve current practices. Methods A search strategy was devised and a systematic literature search of the major databases followed. Both qualitative and quantitative peer-reviewed studies that included resilience and its promotion in victims of CSA were included. The evidence found was critically appraised using standardised checklists. Furthermore, case studies of CSA from the UK and Malta were used to highlight limitations in the current response and follow up to CSA. Results Resilience post-CSA can be achieved through managing both risk factors and promoting protective factors, since these are cumulative. Risk management includes targeted intervention by professionals, noting that unnecessary interventions may dampen resilience. Risk management, including preventative strategies, aim at rendering the child safe from further harm and thus a means of promoting protective factors. Non-professional contribution in the form of support and stability, offer the major source of protective influences, thus the most powerful resilient promoting factor in CSA. Engaging in positive experiences at school and within communities also enhances resilience. Internal resilient promoting factors include positive self-esteem and better adaptive coping skills. The victimised child should not be over-sheltered by carers or services involved. Conclusions A resilience-based model to CSA is child-centred and advocates for services to work together in a timely fashion, aiming towards providing a holistic and ecological response to better meet the child’s needs. This model can be promoted through joint multiagency training by providing professionals with a better understanding of their role in CSA. It can serve to advocate for policy changes that provide services that better fit the needs of the child, prevent re-victimisation and which offer targeted interventions focussing on both inner and external resources that enhance resilience, including support of the carers. This response may be more cost-effective and improve outcomes.
Introduction There has been an 85% increase in the total number of police-recorded sexual offence... more Introduction There has been an 85% increase in the total number of police-recorded sexual offences against children and young people (CYP) in the UK, between 2010/11 and 2014/15. Many children delay disclosure, raising a question as to the clinical yield from anogenital examination in historic cases, as much research has focussed on findings following acute assessment of child sexual abuse (CSA). We sought to identify the clinical and CSA– related characteristics in children presenting non-acutely to a specialised historic CSA clinic. Methods CYP under 17 completed years presenting with a suspicion or historic allegation of CSA (one week to one year after the alleged episode) between October 2009 and November 2014 were included. Prospective data included referrer, perpetrator, type of abuse including penetrative or non-penetrative, disability, family history of CSA/domestic violence, and physical findings. Full history and examination including colposcopy (with dual reporting) were recorded on a standardised proforma. Results Among the 249 children (80% girls), most referrals originated from Social Care (56.5%), and the remainder from paediatricians (24%), primary care (9%), police (7%) and others (1%). Ages ranged from 0 –17 years (median 7, standard deviation 4.3). In 14% (36/249) cases, the child had a reported disability. There was a history of CSA in the mother in 17% (26/153) and domestic violence in 8% (12/153). Among the 70% (190/249) of cases with an alleged perpetrator, 66% (126/190) were from the victim’s family environment. Average age was significantly higher in those presenting with alleged penetration (p<0.001). Anogenital examination was carried out in 232/249 (93%) cases; seven refused, and nine had a prior examination. Anogenital findings supportive of CSA were found in 18 (7%) children, all of who were female, and had alleged penetration (p<0.001); 12/18 (66%) were over 13 years old. There were three children with sexually transmitted infections (STI). Conclusion There was a large portion of alleged intrafamilial perpetrators of historic CSA. Significant numbers of children had anogenital findings supportive of CSA and STIs were present, despite the historic nature of presentation. These findings reiterate the clinical and forensic importance of a comprehensive clinical examination, even in historical allegations.
ObjectivesDescribe cases of female genital mutilation (FGM) presenting to consultant paediatricia... more ObjectivesDescribe cases of female genital mutilation (FGM) presenting to consultant paediatricians and sexual assault referral centres (SARCs), including demographics, medical symptoms, examination findings and outcome.DesignThe well-established epidemiological surveillance study performed through the British Paediatric Surveillance Unit included FGM on the monthly returns.SettingAll consultant paediatricians and relevant SARC leads across the UK and Ireland.PatientsUnder 16 years old with FGM.InterventionsData on cases from November 2015 to November 2017 and 12 months later meeting the case definition of FGM.Main outcome measuresReturns included 146 cases, 103 (71%) had confirmed FGM and 43 (29%) did not meet the case definition. There were none from Northern Ireland.ResultsThe mean reported age was 3 years. Using the WHO classification of FGM, 58% (n=60) had either type 1 or type 2, 8% (n=8) had type 3 and 21% (n=22) had type 4. 13% (n=13) of the cases were not classified and non...
Abstract Child sexual abuse is a clear violation of children's rights with known lifelong dev... more Abstract Child sexual abuse is a clear violation of children's rights with known lifelong devastating consequences. It occurs across all ages, sexes and cultures. Cases are underreported and may not be disclosed at first due to its secretive and hidden nature. It is clear that children do try to disclose but are not always heard or believed. In this paper we delve deeper into the recognition and response to suspected cases of child sexual abuse and the importance of working within a multidisciplinary team to best safeguard the victims. We emphasize the importance of asking questions in a direct, empathic and developmentally appropriate manner, such that the child feels believed and supported. The physical and behavioural changes are described in suspected cases and possible differential diagnoses. We propose a resilience-based framework to the management and prevention of child sexual abuse.
Weston’s review of the law1 in relation to understanding the legal nuances in female genital muti... more Weston’s review of the law1 in relation to understanding the legal nuances in female genital mutilation (FGM) is important in the fight to end the practice. Yet in order to effect real change an understanding of practising populations’ attitudes and beliefs is needed. There have been a few studies in the UK asking professionals about their knowledge but little about the communities themselves. The commonly used questions from Unicef and the United States Agency for International Development (USAID) household surveys, which have been undertaken in 29 African and Middle Eastern countries from 2005 and 1995, respectively,2 3 are ideal to elicit attitudes of practising communities. Permission was granted from both agencies for use of their questions administered to women …
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, Jan 21, 2018
This pilot study researched the attitudes towards and the knowledge of female genital mutilation ... more This pilot study researched the attitudes towards and the knowledge of female genital mutilation (FGM) in adult women with FGM and their partners. The participant population consisted of English-speaking women and men over 18 years old attending specialist FGM clinics in two London hospitals. The participants completed a questionnaire on the attitudes and the knowledge of FGM, which were adapted with permission from the United Nations Children's Fund and the United States Agency for International Development household surveys. 54 participants (51 women, 3 men) took part in the surveys. 89% of participants thought that FGM should be stopped (95%CI: 0.81-0.97) and 72% said they knew FGM is illegal in the United Kingdom (UK). 15% reported that FGM caused no danger, or were unaware of any danger to women's health. This study demonstrates the opposition to FGM by participants, but some lack of knowledge regarding the legal and health implications. The exploration of attitudes in ...
Police-recorded sexual offences against children and young people (CYP) increased 85% in the UK b... more 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....
Archives of disease in childhood - Education & practice edition, 2016
It is now mandatory for health, social care professionals and teachers to report to the police al... more It is now mandatory for health, social care professionals and teachers to report to the police all under-18s where female genital mutilation (FGM) has been disclosed by the child or where physical signs of FGM are seen. Such referrals are likely to result in a request for medical examination. New multiagency statutory guidance sets out instructions for physical examination but provides no details how services should be set-up. This review gives practical guidance learnt from the first year of the UK&#39;s only dedicated children&#39;s FGM service.
IntroductionA perception exists that there are few benefits of a paediatric assessment in histori... more IntroductionA perception exists that there are few benefits of a paediatric assessment in historic child sexual abuse (CSA), as the likelihood of finding forensic evidence is low.AimTo determine the value of a comprehensive paediatric assessment in a dedicated clinic for children and young people who present following suspicion or allegation of historic CSA.MethodAll children with suspected or alleged historic CSA, defined as >7 days after the last episode of sexual assault in pubertal girls, or >3 days for prepubertal girls and all boys, were assessed in a specialised paediatric clinic. Clinic data were collected prospectively between October 2009 and November 2014 and through retrospective case note review.ResultsAmong the 249 children who presented with possible historic CSA, ages ranged from 0 to 17 years (median 7, SD 4.3). Of these children, 141 (57%) had a medical concern(s) related to the referral reason, 78 (31%) had an unrelated medical concern(s) and 55 (22%) had em...
Female genital mutilation (FGM) is an extremely harmful crime against women and girls involving i... more Female genital mutilation (FGM) is an extremely harmful crime against women and girls involving intentional altering of the female genitalia for non-medical reasons. It may have devastating health consequences. Performing, or assisting in the performance of, FGM in the UK or by taking a child abroad carries a maximum prison sentence of 14 years in the UK.1–3 However, there has yet to be a successful prosecution for FGM in the UK. On 31 October 2015, section 5B of the Female Genital Mutilation Act 2003 came into force. This legislation introduced a new duty on healthcare professionals4 to report cases of FGM in girls under the age of 18 years. The duty on the regulated professional is mandatory and …
ObjectiveTo describe the presentation and management of children referred with suspected female g... more ObjectiveTo describe the presentation and management of children referred with suspected female genital mutilation (FGM) to a UK safeguarding clinic.Design and settingCase series of all children under 18 years of age referred with suspected FGM between June 2006 and May 2014.Main outcome measuresThese include indication for referral, demographic data, circumstances of FGM, medical symptoms, type of FGM, investigations and short-term outcome.ResultsOf the 47 girls referred, 27 (57%) had confirmed FGM. According to the WHO classification of genital findings, FGM type 1 was found in 2 girls, type 2 in 8 girls and type 4 in 11 girls. No type 3 FGM was seen. The circumstances of FGM were known in 17 cases, of which 12 (71%) were performed by a health professional or in a medical setting (medicalisation). Ten cases were potentially illegal, yet despite police involvement there have been no prosecutions.ConclusionsThis study is an important snapshot of FGM within the UK paediatric populati...
A literature review of outcomes of physical punishment in children confirms the polarised views r... more A literature review of outcomes of physical punishment in children confirms the polarised views resulting from various studies. This is mainly attributed to the limitations in the methodology and study designs used, confounding factors that were unaccounted for and the different ways in which physical punishment was defined by researchers. Researchers that provide evidence to discourage the use of physical punishment highlight the risk that this mode of discipline can easily cross over to physical abuse. This is challenged by other researchers who argue that alternative disciplinary techniques investigated with similar analyses to physical punishment have similar outcomes. Malta recently became one of the 39 countries worldwide that outlawed the use of physical punishment in children, in keeping with the United Nations Convention of the Rights of the Child. The focus of legally banning the use of physical punishment is not to increase the number of parental prosecutions but to safeg...
Archives of disease in childhood - Education & practice edition
A general practitioner (GP) refers to your general paediatric outpatient clinic a 6-year old girl... more A general practitioner (GP) refers to your general paediatric outpatient clinic a 6-year old girl with an intermittently sore vulva with occasional discharge. Her mother noticed her ‘vagina’/genitalia has been slightly red, and there is intermittent minimal white discharge. Clotrimazole (Canestan), prescribed by her GP, has not made any difference. In this article, we discuss the aetiology and initial assessment of vulval soreness and related symptoms in the prepubertal girl. The article does not include the differential diagnoses in the peripubertal and postpubertal adolescent cohort, thereby excluding conditions related to menstruation and pregnancy (see box 1). Box 1 ### Anatomy of prepubertal and pubertal girls The prepubertal girl’s anatomy is different from that of the pubertal girl. During puberty, labial fat pads begin to form; pubic hair grows; the vaginal mucosa becomes thicker and less thin-walled; and the squamous cells in the epithelial lining of the vagina undergo cornification, leading to increased protection against pathogens.4 Hormonal changes during puberty include oestrogenisation of the vulva, hymen and vaginal mucosa, and acidification of the pH, which was previously alkaline or neutral.7 Together, these changes decrease susceptibility to inflammation and infection. Vulval soreness, or pain, and discharge in prepubertal girls are common reasons for referral by primary care physicians to secondary care. It is often worrying for parents, particularly if symptoms are long-standing or disruptive to the child’s daily activities. Epidemiological data on vulval pain as a presenting symptom to primary or secondary care are sparse. One study from a UK district general hospital reported that 86% of new paediatric and adolescent patients were referred from primary care, and the the most common presentations were vulvovaginitis (18%), labial adhesions (14%) and abdominal pain (7%).1 This differs from data on children attending a UK tertiary referral centre, where one-third of patients presented with anomalies of the genital tract, with …
ObjectiveTo describe the presentation and management of children with suspected or confirmed fema... more ObjectiveTo describe the presentation and management of children with suspected or confirmed female genital mutilation (FGM) referred to a specialist paediatric clinic.MethodsData collected included referral source, age, ethnicity, circumstances of FGM and clinical findings in accordance with the WHO FGM classification.ResultsBetween September 2014 and January 2019, 148 children attended the clinic of whom 55 (37.2%) had confirmed FGM. Police or social care referred 112 (76%) children. The proportion of looked-after children (LAC) was significantly higher in the group with confirmed FGM (17/55, 31%) compared with children where FGM was not confirmed (5/93, 5%). In almost all children where FGM was confirmed, FGM was initially disclosed by the child or family (53/55, 96%) and of these 48/55 (87%) underwent FGM prior to UK entry. The remaining seven cases were British children, potentially meeting legal criteria under the FGM Act, and one resulted in a successful prosecution.Conclusio...
Introduction The multiagency response to allegations or suspicions of child sexual abuse (CSA) of... more Introduction The multiagency response to allegations or suspicions of child sexual abuse (CSA) often lacks coordination between and within agencies. Current management tends to focus predominantly on risk management with limited attention given to how resilience can be promoted as a means of overcoming adversity. We looked for the evidence around resilience in CSA in order to give support to a framework that may improve current practices. Methods A search strategy was devised and a systematic literature search of the major databases followed. Both qualitative and quantitative peer-reviewed studies that included resilience and its promotion in victims of CSA were included. The evidence found was critically appraised using standardised checklists. Furthermore, case studies of CSA from the UK and Malta were used to highlight limitations in the current response and follow up to CSA. Results Resilience post-CSA can be achieved through managing both risk factors and promoting protective factors, since these are cumulative. Risk management includes targeted intervention by professionals, noting that unnecessary interventions may dampen resilience. Risk management, including preventative strategies, aim at rendering the child safe from further harm and thus a means of promoting protective factors. Non-professional contribution in the form of support and stability, offer the major source of protective influences, thus the most powerful resilient promoting factor in CSA. Engaging in positive experiences at school and within communities also enhances resilience. Internal resilient promoting factors include positive self-esteem and better adaptive coping skills. The victimised child should not be over-sheltered by carers or services involved. Conclusions A resilience-based model to CSA is child-centred and advocates for services to work together in a timely fashion, aiming towards providing a holistic and ecological response to better meet the child’s needs. This model can be promoted through joint multiagency training by providing professionals with a better understanding of their role in CSA. It can serve to advocate for policy changes that provide services that better fit the needs of the child, prevent re-victimisation and which offer targeted interventions focussing on both inner and external resources that enhance resilience, including support of the carers. This response may be more cost-effective and improve outcomes.
Introduction There has been an 85% increase in the total number of police-recorded sexual offence... more Introduction There has been an 85% increase in the total number of police-recorded sexual offences against children and young people (CYP) in the UK, between 2010/11 and 2014/15. Many children delay disclosure, raising a question as to the clinical yield from anogenital examination in historic cases, as much research has focussed on findings following acute assessment of child sexual abuse (CSA). We sought to identify the clinical and CSA– related characteristics in children presenting non-acutely to a specialised historic CSA clinic. Methods CYP under 17 completed years presenting with a suspicion or historic allegation of CSA (one week to one year after the alleged episode) between October 2009 and November 2014 were included. Prospective data included referrer, perpetrator, type of abuse including penetrative or non-penetrative, disability, family history of CSA/domestic violence, and physical findings. Full history and examination including colposcopy (with dual reporting) were recorded on a standardised proforma. Results Among the 249 children (80% girls), most referrals originated from Social Care (56.5%), and the remainder from paediatricians (24%), primary care (9%), police (7%) and others (1%). Ages ranged from 0 –17 years (median 7, standard deviation 4.3). In 14% (36/249) cases, the child had a reported disability. There was a history of CSA in the mother in 17% (26/153) and domestic violence in 8% (12/153). Among the 70% (190/249) of cases with an alleged perpetrator, 66% (126/190) were from the victim’s family environment. Average age was significantly higher in those presenting with alleged penetration (p<0.001). Anogenital examination was carried out in 232/249 (93%) cases; seven refused, and nine had a prior examination. Anogenital findings supportive of CSA were found in 18 (7%) children, all of who were female, and had alleged penetration (p<0.001); 12/18 (66%) were over 13 years old. There were three children with sexually transmitted infections (STI). Conclusion There was a large portion of alleged intrafamilial perpetrators of historic CSA. Significant numbers of children had anogenital findings supportive of CSA and STIs were present, despite the historic nature of presentation. These findings reiterate the clinical and forensic importance of a comprehensive clinical examination, even in historical allegations.
ObjectivesDescribe cases of female genital mutilation (FGM) presenting to consultant paediatricia... more ObjectivesDescribe cases of female genital mutilation (FGM) presenting to consultant paediatricians and sexual assault referral centres (SARCs), including demographics, medical symptoms, examination findings and outcome.DesignThe well-established epidemiological surveillance study performed through the British Paediatric Surveillance Unit included FGM on the monthly returns.SettingAll consultant paediatricians and relevant SARC leads across the UK and Ireland.PatientsUnder 16 years old with FGM.InterventionsData on cases from November 2015 to November 2017 and 12 months later meeting the case definition of FGM.Main outcome measuresReturns included 146 cases, 103 (71%) had confirmed FGM and 43 (29%) did not meet the case definition. There were none from Northern Ireland.ResultsThe mean reported age was 3 years. Using the WHO classification of FGM, 58% (n=60) had either type 1 or type 2, 8% (n=8) had type 3 and 21% (n=22) had type 4. 13% (n=13) of the cases were not classified and non...
Abstract Child sexual abuse is a clear violation of children's rights with known lifelong dev... more Abstract Child sexual abuse is a clear violation of children's rights with known lifelong devastating consequences. It occurs across all ages, sexes and cultures. Cases are underreported and may not be disclosed at first due to its secretive and hidden nature. It is clear that children do try to disclose but are not always heard or believed. In this paper we delve deeper into the recognition and response to suspected cases of child sexual abuse and the importance of working within a multidisciplinary team to best safeguard the victims. We emphasize the importance of asking questions in a direct, empathic and developmentally appropriate manner, such that the child feels believed and supported. The physical and behavioural changes are described in suspected cases and possible differential diagnoses. We propose a resilience-based framework to the management and prevention of child sexual abuse.
Weston’s review of the law1 in relation to understanding the legal nuances in female genital muti... more Weston’s review of the law1 in relation to understanding the legal nuances in female genital mutilation (FGM) is important in the fight to end the practice. Yet in order to effect real change an understanding of practising populations’ attitudes and beliefs is needed. There have been a few studies in the UK asking professionals about their knowledge but little about the communities themselves. The commonly used questions from Unicef and the United States Agency for International Development (USAID) household surveys, which have been undertaken in 29 African and Middle Eastern countries from 2005 and 1995, respectively,2 3 are ideal to elicit attitudes of practising communities. Permission was granted from both agencies for use of their questions administered to women …
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, Jan 21, 2018
This pilot study researched the attitudes towards and the knowledge of female genital mutilation ... more This pilot study researched the attitudes towards and the knowledge of female genital mutilation (FGM) in adult women with FGM and their partners. The participant population consisted of English-speaking women and men over 18 years old attending specialist FGM clinics in two London hospitals. The participants completed a questionnaire on the attitudes and the knowledge of FGM, which were adapted with permission from the United Nations Children's Fund and the United States Agency for International Development household surveys. 54 participants (51 women, 3 men) took part in the surveys. 89% of participants thought that FGM should be stopped (95%CI: 0.81-0.97) and 72% said they knew FGM is illegal in the United Kingdom (UK). 15% reported that FGM caused no danger, or were unaware of any danger to women's health. This study demonstrates the opposition to FGM by participants, but some lack of knowledge regarding the legal and health implications. The exploration of attitudes in ...
Police-recorded sexual offences against children and young people (CYP) increased 85% in the UK b... more 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....
Archives of disease in childhood - Education & practice edition, 2016
It is now mandatory for health, social care professionals and teachers to report to the police al... more It is now mandatory for health, social care professionals and teachers to report to the police all under-18s where female genital mutilation (FGM) has been disclosed by the child or where physical signs of FGM are seen. Such referrals are likely to result in a request for medical examination. New multiagency statutory guidance sets out instructions for physical examination but provides no details how services should be set-up. This review gives practical guidance learnt from the first year of the UK&#39;s only dedicated children&#39;s FGM service.
IntroductionA perception exists that there are few benefits of a paediatric assessment in histori... more IntroductionA perception exists that there are few benefits of a paediatric assessment in historic child sexual abuse (CSA), as the likelihood of finding forensic evidence is low.AimTo determine the value of a comprehensive paediatric assessment in a dedicated clinic for children and young people who present following suspicion or allegation of historic CSA.MethodAll children with suspected or alleged historic CSA, defined as >7 days after the last episode of sexual assault in pubertal girls, or >3 days for prepubertal girls and all boys, were assessed in a specialised paediatric clinic. Clinic data were collected prospectively between October 2009 and November 2014 and through retrospective case note review.ResultsAmong the 249 children who presented with possible historic CSA, ages ranged from 0 to 17 years (median 7, SD 4.3). Of these children, 141 (57%) had a medical concern(s) related to the referral reason, 78 (31%) had an unrelated medical concern(s) and 55 (22%) had em...
Female genital mutilation (FGM) is an extremely harmful crime against women and girls involving i... more Female genital mutilation (FGM) is an extremely harmful crime against women and girls involving intentional altering of the female genitalia for non-medical reasons. It may have devastating health consequences. Performing, or assisting in the performance of, FGM in the UK or by taking a child abroad carries a maximum prison sentence of 14 years in the UK.1–3 However, there has yet to be a successful prosecution for FGM in the UK. On 31 October 2015, section 5B of the Female Genital Mutilation Act 2003 came into force. This legislation introduced a new duty on healthcare professionals4 to report cases of FGM in girls under the age of 18 years. The duty on the regulated professional is mandatory and …
ObjectiveTo describe the presentation and management of children referred with suspected female g... more ObjectiveTo describe the presentation and management of children referred with suspected female genital mutilation (FGM) to a UK safeguarding clinic.Design and settingCase series of all children under 18 years of age referred with suspected FGM between June 2006 and May 2014.Main outcome measuresThese include indication for referral, demographic data, circumstances of FGM, medical symptoms, type of FGM, investigations and short-term outcome.ResultsOf the 47 girls referred, 27 (57%) had confirmed FGM. According to the WHO classification of genital findings, FGM type 1 was found in 2 girls, type 2 in 8 girls and type 4 in 11 girls. No type 3 FGM was seen. The circumstances of FGM were known in 17 cases, of which 12 (71%) were performed by a health professional or in a medical setting (medicalisation). Ten cases were potentially illegal, yet despite police involvement there have been no prosecutions.ConclusionsThis study is an important snapshot of FGM within the UK paediatric populati...
A literature review of outcomes of physical punishment in children confirms the polarised views r... more A literature review of outcomes of physical punishment in children confirms the polarised views resulting from various studies. This is mainly attributed to the limitations in the methodology and study designs used, confounding factors that were unaccounted for and the different ways in which physical punishment was defined by researchers. Researchers that provide evidence to discourage the use of physical punishment highlight the risk that this mode of discipline can easily cross over to physical abuse. This is challenged by other researchers who argue that alternative disciplinary techniques investigated with similar analyses to physical punishment have similar outcomes. Malta recently became one of the 39 countries worldwide that outlawed the use of physical punishment in children, in keeping with the United Nations Convention of the Rights of the Child. The focus of legally banning the use of physical punishment is not to increase the number of parental prosecutions but to safeg...
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Papers by deborah hodes