An updated AAP clinical report on
how to assess and care for adolescents
who have been sexually assaulted includes guidance on the importance
of offering routine screening and prevention messages.
Teens and young adults ages 12-34 years have the
highest rates of sexual assault, according to Care of
the Adolescent After an Acute Sexual Assault from the
AAP Committee on Child Abuse and Neglect and
Committee on Adolescence. The clinical report is
available at http://bit.ly/2kCPg9T
and is published in the March issue of
A sexual assault includes any situation
in which there is nonvoluntary sexual
contact. An acute assault is defined
as occurring within the past 72 hours
(some jurisdictions go back as far as 10
Talking to teens
The report notes that it is important for pediatricians to “have an increased awareness that sexual
assault is a prevalent issue that can affect any of their
patients, regardless of gender.” Teens — including
those with disabilities — should be asked if they
have any history of sexual violence, dating violence
and sexual assaults.
During visits in the high school and college years,
a H.E.A.D.S.S. assessment can help guide discus-
sions on Home, Education/Employment, Activities,
Drugs, Sexuality and Suicide/Depression.
When exploring substance use, for example, bring
up the link between impairment and vulnerability to
sexual assault. Adolescent victims (and perpetrators)
of sexual assault are more likely than adult victims
to have used alcohol or other drugs. However, vol-
untary use of these substances around the time of
the assault “is common and should not influence
the perceived legal status of the event or result in
reductions in standards of care for presenting vic-
tims,” the report states.
General advice for teens on avoiding risky situations includes not walking alone at night, not
attending social events with unknown people and
not drinking from a glass that has been unattended.
“Buddying up” can help friends watch out for each
A prime opportunity to bring up these safety issues is at the pre-college visit, according to Elizabeth M. Alderman, M.D., FAAP, a lead author of
the report and member of the AAP Committee on
“As pediatricians, we are poised to provide
anticipatory guidance not only around sexual
assault itself but the fact that being cognitively
impaired with alcohol and drugs puts someone
at risk for being assaulted,” she said. “And no
one is really immune — it happens to boys, too.
“I think you just need to give your patients
the skills to keep them safe and encourage them
… to keep their friends safe,” Dr. Alderman added.
Pediatricians should advise adolescents that if they
are ever sexually assaulted, they should seek medical care immediately, even before changing clothes,
bathing, eating/drinking, urinating, etc. The report
emphasizes timely collection of toxicology samples,
which usually occurs separately from collection of
physical forensic evidence. It is critical to obtain the
victim’s informed consent before toxicology sample
Those who reveal an assault also should be ques-
tioned about commercial sexual exploitation.
Differences among victims
Compared with older adults who have been assaulted, adolescents are more likely to delay medical
care, and they are less likely to press charges when
given a choice — especially if they know the perpetrator.
Most victims do know their perpetrators. A
younger victim’s assailant often is a member of the
victim’s extended family, whereas most older teens
know their perpetrator from a social encounter.
Only half of high school victims ever tell anyone
about a sexual assault. Overall, as few as 10% of
sexual assaults may be reported to authorities.
That reporting rate drops to 4% for teens with
developmental disabilities, who have a much higher
risk of sexual assault and acquaintance rape: As many
as 68%-83% of these women are likely to be sexually
assaulted in their lifetime.
Identification of a sexual assault may help less-
en the likelihood of it happening again, reduce the
stigma, and provide the victim with medical, psy-
chological and supportive care, the report concludes.
• Routinely ask adolescents about any history
of sexual violence, dating violence and sexual
assaults. Those who disclose an assault should be
questioned about commercial sexual exploitation.
• Know reporting requirements related to sexual
assault and state laws ensuring the right of teens
to obtain medical care at a sexual assault or rape
• Be familiar with community resources and
when/where to refer adolescents for forensic
medical examinations and care after an assault.
• Clinicians who feel unqualified to care for such a
patient should arrange for an immediate evalu-
ation by an appropriate experienced health care
• Screening for sexually transmitted infections,
postexposure prophylaxis, treatment and follow-up should be provided per guidelines of
the Centers for Disease Control and Prevention,
• Offer emergency contraception to female adolescents who disclose sexual assault if reported
within 120 hours of the assault. Documentation of pregnancy status should occur at the
time of evaluation and at follow-up.
• Consider that “date rape” drugs may have been
used in the assault.
• Be prepared to offer emotional support and
referral for additional counseling.
• Support evidence-based sexual violence preven-
tion activities in local high schools, colleges and
Report on caring for teens after sexual assault
calls for screening, anticipatory guidance
• Find sexual assault reporting laws by state on the Child
Welfare Information Gateway, http://bit.ly/2kouw63.
• Information for victims and health care professionals,
including sexual assault reporting laws by state, is
available on the RAINN (Rape, Abuse & Incest National
Network) website, http://bit.ly/2kxwILP.
• “Teen Sexual Assault: Information for Parents” from The
National Child Traumatic Stress Network is available
If a patient discloses a sexual assault, she should
be questioned about commercial sexual exploitation,
according to an AAP clinical report. Pediatricians
also should know reporting requirements related
to sexual assault and be familiar with community
resources to which they can refer adolescents for
forensic medical examinations and care.
Tools to prevent youth violence
Youth violence, including bullying, fighting, sexual assault and homicide, is a global
public health problem, according to the World
Health Organization. During Youth Violence
Prevention Week, April 3-7, pediatricians can
raise awareness and educate their communities
on effective preventive strategies.
Daily messages will be offered by supporting
partners throughout the first week of April.
On April 4, the Academy will focus on how
to manage anger by promoting activities
such as creating a bully-free pledge, exercise
to release anger and stress, and more. Follow
@AmerAcadPeds and #violencefree on Twitter
to participate. Other daily challenges focus on
respect and tolerance, peaceful conflict resolution, safety and unity. For information, visit