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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Child sexual abuse presentation and referral

Paediatrics and child health · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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Recent assault with acute medical or protection needs

Major bleeding, strangulation symptoms, severe pain, loss of consciousness, intoxication, suicidal crisis, pregnancy risk, possible HIV exposure or immediate access by an alleged perpetrator requires urgent coordinated care.

Action: Stabilise urgent injury and mental-health risk, call senior paediatrics and the regional child sexual assault or paediatric forensic service, and contact children's social care and police through the emergency pathway. Preserve clothing and potential samples without delaying treatment; specialist teams assess forensic timing, emergency contraception, infection prophylaxis and safe placement.

Synopsis

Respond safely to possible child sexual abuse, hear disclosures without leading, identify urgent medical and forensic needs, obtain specialist examination through the correct pathway, preserve evidence and coordinate protection, treatment and follow-up.

  • Believe the seriousness of the disclosure without declaring facts proven; listen calmly and prioritise the child's immediate safety.
  • Ask only minimal open questions needed for urgent care and referral, then record the child's words and your questions verbatim.
  • Do not promise secrecy, confront an alleged perpetrator or ask the child to repeat the account to multiple professionals.
  • Treat bleeding, strangulation, intoxication, severe pain and mental-health crisis immediately while contacting specialist safeguarding services.
  • Seek early advice from the regional paediatric sexual assault or forensic medical service before bathing, changing clothes or taking non-essential samples.
  • A normal genital or anal examination neither disproves abuse nor reduces the importance of the child's account and context.
  • Specialists assess forensic opportunities, pregnancy, STI testing, hepatitis vaccination, emergency contraception and HIV post-exposure prophylaxis.
  • Refer to children's social care and coordinate police involvement; arrange trauma-informed follow-up with a named professional and safe communication method.

Key red flags

A child directly or indirectly describes sexual contact, requests help, names an unsafe adult or communicates through age-incongruent sexualised behaviour.

Genital or anal injury, bleeding, pain, discharge, pregnancy or a sexually transmitted infection may require specialist assessment, although examination is often normal.

Strangulation, sedation, threats, filming, multiple perpetrators, trafficking or exploitation creates additional acute medical and evidential risk.

Sudden fear, self-harm, regression, sleep disturbance, school change, avoidance of a person or unexplained gifts can be contextual clues but are not specific alone.

The alleged person retains access to the child, siblings or other children, making immediate multi-agency safety planning essential.

A caregiver's disbelief, pressure to retract or repeated questioning can increase harm and should prompt careful protection of the child's voice.

Investigation priorities

01
Specialist paediatric forensic examinationFirst step

Assess injury, wellbeing, evidence opportunities and treatment needs sensitively.

Management branches

Initial responseListen, stabilise and limit questions

A child discloses abuse or presents with acute concerning features.

  1. Treat injury, strangulation effects, intoxication and mental-health emergencies.
  2. Listen calmly and ask only open questions required for safety.
  3. Record exact words, prompts, timing, companions and observed behaviour.
  4. Ensure the child is not left with a person who may pose risk.

Key medicines

Ulipristal acetate emergency contraceptionGive 30 mg orally as a single dose within 120 hours of unprotected sexual exposure when clinically appropriate, after specialist assessment of pregnancy risk, interactions and consent.Discuss copper intrauterine contraception as the most effective option where suitable; check enzyme inducers, severe asthma treated with oral glucocorticoids, breastfeeding advice, vomiting and interaction with subsequent hormonal contraception.
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Sources and review status3 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • NICE NG76 Child abuse and neglectNational recommendations inform recognition, supportive communication, referral and therapeutic response after suspected sexual abuse.
  • RCPCH Child Protection Evidence sexual abuse reviewsSystematic reviews support specialist interpretation of physical signs and the limitations of normal examination findings.
  • UK government child sexual exploitation definition and guideThe national guide describes exploitation, power imbalance and professional safeguarding response for children and young people.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom