● The child has sudden mood swings. ● The child leaves clues that seem likely to provoke discussion about sexual issues. ● The child writes, draws, plays, or dreams of sexual or frightening images. ● The child develops new or unusual fear of certain people or places. ● The child refuses to talk about a shared secret with an adult or older child. ● The child talks about a new older friend. ● The child suddenly has money, toys, or gifts without reason. ● The child thinks of self or body as bad or dirty. ● The child exhibits sexual behaviors, language, or knowledge. Signs in younger children include: ● An older child behaving like a younger child, for example, thumb-sucking or bed-wetting. ● Having new words for genitals. ● Resisting removing clothes during toileting, bathing. ● Asking other children to behave sexually or play sexual games. ● Mimicking adult-like behaviors with toys. ● Wetting and soiling accidents. Signs in adolescents include: ● Self-injury.
& Bennett, 2019a). It includes fondling and all forms of oral–genital, genital, and anal contact with the child (whether clothed or not), as well as nontouching abuses such as exhibitionism, voyeurism, and involving the child in pornography (Bechtel & Bennett, 2019a). In Pennsylvania, children younger than 13 years of age cannot give consent to sexual activity (Pennsylvania Coalition Against Rape [PCAR], 2021). Teenagers between the ages of 13 and 15 years cannot consent to sexual activity with anyone four years older than they are (PCAR, 2021). Individuals ages 16 years and older can legally consent to sexual activity with anyone they choose as long as it is not with an individual they know from school (teacher/coach), jail, personal care/group home, or other licensed residential facility serving youth (PCAR, 2021). Any of the following are offenses committed against a child (PCAR, 2021): ● Rape as defined in 18 Pa.C.S. § 3121. ● Statutory sexual assault as defined in 18 Pa.C.S. § 3122.1. ● Involuntary deviant sexual intercourse as defined in 18 Pa.C.S. § 3123. ● Sexual assault as defined in 18 Pa.C.S. § 3124.1. ● Institutional sexual assault as defined in 18 Pa.C.S. § 3124.2. ● Aggravated indecent assault as defined in 18 Pa.C.S. § 3125. ● Indecent assault as defined in 18 Pa.C.S. § 3126. ● Indecent exposure as defined in 18 Pa.C.S. § 3127. ● Incest as defined in 18 Pa.C.S. § 4302. ● Prostitution as defined in 18 Pa.C.S. § 5902. ● Sexual abuse as defined in 18 Pa.C.S. § 6312. ● Unlawful contact with a minor as defined in 18 Pa.C.S. § 6318. ● Sexual exploitation as defined in 18 Pa.C.S. § 6320. Self-Assessment Quiz Question #5 Based on the Child Protective Service Law definition, sexual abuse occurs in the case of consensual sexual contact between a 17-year-old male and a 14-year-old female.
● Poor personal hygiene. ● Drug and alcohol use. ● Sexual promiscuity. ● Truancy from home. ● Depression, anxiety. ● Suicide attempts.
● Fear of intimacy or closeness. ● Compulsive eating or dieting.
Consider the possibility of sexual abuse when the parent or other adult caregiver (Child Welfare, 2021) is unduly protective of the child or severely limits the child’s contact with other children, especially of the opposite sex; is secretive and isolated; or is jealous or controlling with family members. Evidence-based practice Studies have shown that the short- and long-term psychological outcomes of children who have experienced sexual abuse are better if they have supportive parental figures. Parental support is more important than abuse-related factors in predicting psychological recovery (Betchel & Bennett, 2019b).
a. True. b. False. Signs of sexual abuse
The following are possible signs and symptoms of sexual abuse that may be seen in a medical context, at school, or in a day care (Stop It Now! 2019): ● The child has nightmares or sleep problems. ● The child seems distant or distracted. ● The child has a change in eating habits, refuses to eat, or has trouble swallowing.
FACTITIOUS DISORDER IMPOSED ON ANOTHER (FDIA)
Factitious disorder imposed on another (FDIA), also known as Munchausen syndrome by proxy , is defined as a “child receiving unnecessary and harmful or potentially harmful medical care because of a caregiver's overt actions, including exaggeration of symptoms, lying about the history or simulating physical findings (fabrication), or intentionally inducing illness in their child” (Roesler & Jenny, 2018). FDIA is also known as medical child abuse and caregiver- fabricated illness in a child. With FDIA, the child receives unnecessary and harmful, or potentially harmful, medical care at the recommendation of the child’s caregiver (Roesler & Jenny, 2018). The essential feature of the condition is the caregiver’s falsification and
inducement of physical and/cor psychological symptoms or signs in a child that places the child at potential risk (Roesler & Jenny, 2018). FDIA is relatively rare, but best estimates suggest that nurses and other healthcare professionals will encounter at least one case during their career (Roesler & Jenny, 2018). Based on observational studies, the estimated annual incidence of FDIA is 0.4 to 1.2 per 1,000 children younger than age 16; however, this number is likely underestimated (Roesler & Jenny, 2018). In 2021, there were five allegations of medical child abuse in Pennsylvania, making up 0.1% of total allegations of child abuse (Pennsylvania Department of Human Services Annual Child Abuse Report, 2021).
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