____________________________ Child Abuse Identification and Reporting: The Pennsylvania Requirement
Sexual Abuse/Exploitation Definitions (23 Pa.C.S. § 6303) Sexual abuse or exploitation includes any of the following [45]: • The employment, use, persuasion, inducement, enticement, or coercion of a child to engage in or assist another individual to engage in sexually explicit conduct, which includes, but is not limited to, the fol- lowing: – Looking at the sexual or other intimate parts of a child or another individual for the purpose of arousing or gratifying sexual desire in any indi- vidual – Participating in sexually explicit conversation either in person, by telephone, by computer, or by a computer-aided device for the purpose of sexual stimulation or gratification of any individual – Actual or simulated sexual activity or nudity for the purpose of sexual stimulation or gratification of any individual – Actual or simulated sexual activity for the purpose of producing visual depiction, including photo- graphing, videotaping, computer depicting, or filming The above does not include consensual activities between a child who is 14 years of age or older and another person who is 14 years of age or older and whose age is within 4 years of the child’s age. • Any of the following when committed against a child: – Rape (as defined in 18 Pa.C.S. § 3121, relating to rape) – Statutory sexual assault (as defined in 18 Pa.C.S. § 3122.1, relating to statutory sexual assault) – Involuntary deviate sexual intercourse (as defined in 18 Pa.C.S. § 3123, relating to involuntary devi- ate sexual intercourse) – Sexual assault (as defined in 18 Pa.C.S. § 3124.1, relating to sexual assault) – Institutional sexual assault (as defined in 18 Pa.C.S. § 3124.2, relating to institutional sexual assault) – Aggravated indecent assault (as defined in 18 Pa.C.S. § 3125, relating to aggravated indecent assault) – Indecent assault (as defined in 18 Pa.C.S. § 3126, relating to indecent assault)
Indicators of bodily injury include: • Fear of going home • Fear of parent or caregiver
• Extreme apprehensiveness/vigilance • Pronounced aggression or passivity • Flinches easily or avoids being touched • Play includes abusive talk or behavior • Unexplained injuries
• Unbelievable or inconsistent explanations of injuries • Injuries inconsistent with a child’s age/developmental level • Unable to recall how injuries occurred or account of injuries is inconsistent with the nature of the injuries • Multiple bruises in various stages of healing • Bruises located on face, ears, neck, buttocks, back, chest, thighs, back of legs, and genitalia • Bruises that resemble objects such as a hand, fist, belt buckle, or rope • Burns Fractures that result from abuse might be found on the child’s skull, ribs, nose, or any facial structure. These may be multiple or spiral fractures at various stages of healing. When examining patients, note bruises on the abdominal wall, any intestinal perforation, ruptured liver or spleen, and blood vessel, kidney, bladder, or pancreatic injury, especially if accounts for the cause do not make sense. Look for signs of abrasions on the child’s wrists, ankles, neck, or torso. Lacerations might also appear on the child’s lips, ears, eyes, mouth, or genitalia. If violent shaking or trauma occurred, the child might experience a subdural hematoma [9; 34].
According to the American College of Radiology, fractures highly suggestive of physical abuse include rib fractures, classic metaphyseal lesions, those unsuspected or inconsistent with the history or age of the child, multiple fractures involving more
than one skeletal area, and fractures of differing ages. (https://acsearch.acr.org/docs/69443/Narrative. Last accessed December 9, 2024.) Level of Evidence : Expert Opinion/Consensus Statement
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