How to Keep Children Safe From Abuse at the Pediatrician’s Office

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How can parents know if a doctor is touching a child in an inappropriate way?

After scores of young women testified about being sexually molested by Dr. Lawrence G. Nassar, the former doctor for the American gymnastics team who was sentenced to 40 to 175 years in prison on Wednesday, their parents wondered how they could have missed the signs. Some were even in the exam room at the time but were unaware that anything was wrong.

Detecting sexual abuse in a medical setting can be challenging. We teach young children that doctors are among the only people allowed to touch their genitals. That can make it confusing if a patient encounters an abusive physician like Dr. Nassar.

“The natural inclination is to trust a doctor, especially when they tell you, ‘This is something that will make you feel better,’ ” said Scott Berkowitz, president of the Rape, Abuse and Incest National Network, or RAINN.

That said, parents should trust their instincts. If they’re alarmed by a health provider’s practices — frequent genital exams, unconventional medical treatments that involve genital manipulation, disregard for rules about using gloves during sensitive exams or having an adult chaperone present during a child’s exam, even inappropriate jokes or comments — they should question the doctor, get another opinion or switch doctors, experts said.

“If you’re in a situation where the physician does genital exams for medical complaints that don’t seem to warrant them, or does a genital exam that takes an extraordinary amount of time — it should really just be a quick look, unless there’s something notable, a specific reason — those are red flags,” said Dr. Cindy Christian, a co-author of the American Academy of Pediatrics’s policy on protecting children from sexual abuse by health care providers. “If the complaint is a sore throat or a hurt finger, there’s no need to examine the genitals.”

The most telling indication that something may be wrong is when a child signals discomfort or distress. Most physicians who treat children and adolescents go to great lengths to put their young patients at ease, talking the patient through an exam or procedure in advance so the child knows what to expect, explaining the reasons for the procedure, and making sure the child is on board.

“It’s very important that people not feel uncomfortable with what’s happening to them at the doctor’s office, particularly children and adolescents,” said Dr. Julia Potter, an adolescent medicine specialist at Boston Medical Center. “They should not be made to feel that something is happening to their body that is out of their control. If a child says, ‘I don’t want you to check my breasts,’ or, ‘I don’t want you to do a genital exam,’ that’s a valid opinion that most pediatricians would respect.”

And if your children share their distress with you, don’t dismiss it. “Believe your children when they tell you that what’s happening to them feels uncomfortable,” said Katelyn Brewer, president and chief executive of Darkness to Light, a nonprofit organization that educates adults on how to recognize and prevent child sexual abuse.

“Come straight out and ask your child: Did the doctor touch you in a way that you’re uncomfortable with?” Ms. Brewer said.

What’s Standard in the Exam Room

Annual physicals for children and teenagers usually entail a full-body examination, including a check of the genitals that can help monitor development as children go through puberty. But unless the child has a specific complaint, these exams are usually brief.

Boys usually have a testicular exam once a year, but should be able to opt out if they’re uncomfortable. These typically last less than a minute. The boy usually stands, removing only as much clothing as necessary; the doctor feels each testicle for masses and generally will use gloves, though there is no internal penetration of any part of the body.

Parents are usually in the room when young children are being examined, but teens may not want a parent present. Doctors should offer to have an adult chaperone come in during a sensitive procedure like a genital exam; if no one is available, the patient should have the option of postponing the exam, Dr. Christian said.

For girls, visual and manual breast exams may be done to assess growth and development during puberty, but manual exams are not required and should be carried out only with the adolescent’s permission.

A breast exam is done with the pads of the fingers, not the finger tips or palm of the hand, and the patient should wear a gown, with only one breast exposed at a time.

Even in a gynecological visit, there is rarely any reason to do an internal pelvic exam on girls younger than 21, the age when screening for cervical cancer is recommended. Unusual symptoms like pelvic pain could trigger a pelvic exam earlier, but the doctor should explain to the patient exactly what’s entailed, step-by-step, before initiating the exam, and always wear gloves.

What Parents Can Do

■ Talk with children — and listen, said Jenny Coleman, director of Stop It Now!, an organization that works to prevent child sexual abuse. “It’s never too early to talk to children about healthy sexual development and how their bodies work, and what’s private — and to make them feel comfortable asking questions, and know that you’re a trusted person to come to.”

■ If you’re unsure about an exam or treatment a doctor recommends for your child, ask if alternatives are available — there is almost always another option — or postpone it until you have more information. Get a second opinion, do your own research, and ask other parents, family members and trusted friends.

■ If you or your child have a bad feeling about your doctor, find a new one. Teenage girls often prefer a female pediatrician. But don’t forget that women may also be abusive or that boys can also be abused, and may be even less likely than girls to report it.

“You always have the right to change physicians if you’re unhappy or even just uncomfortable with your child’s care,” Dr. Christian said. “There might be nothing wrong — it just might not be the right doctor for you.”