Sexual abuse of children.

Sexual abuse of children is a pervasive and growing problem, which has demanded the attention of several professional groups. Because most children never reveal the abuse, understanding the psychodynamics involved is fundamental to the detection of these victims. Physicians should be aware of the masked clinical and behavioral indicators of sexually abused children that signal the need for further questioning. Through appropriate inspection of genitalia and anus in routine examination of the child, the physician can establish rapport and a foundation of trust critical for disclosure of abuse. The history the child gives is the most important evidence and is most credible when spontaneous, consistent, and detailed. Physicians must report any suspicion of child abuse to the Texas Department of Human Services (TDHS) and/or law enforcement agencies. Finally, physicians can help prevent such sexual abuse by providing anticipatory guidance for parents and caretakers of children.