Treatment and Follow-up : Follow-Up Care After Acute Sexual Assault in Children and Adolescents
Why Follow-Up Matters
Follow-up care is critical for children and adolescents after an acute sexual assault. Unfortunately, ensuring this care, particularly after emergency department visits, can be challenging. Proper follow-up offers reassurance, supports emotional recovery, and ensures any injuries or infections are effectively treated.
Goals of Follow-Up Care
- Reassure and Support the Child and Family
Even when there are no visible injuries or infections, a follow-up appointment can reassure the child or adolescent and their caregivers that there is no lasting physical harm. Follow-up care also provides continued emotional support and education for families. - Monitor and Treat Identified Conditions
For those with documented injuries or infections, follow-up ensures appropriate healing and compliance with treatment. - Conduct Additional Testing When Needed
Follow-up in 2 weeks is often recommended by experts, even when empiric treatment for STIs was given.
Recommended Follow-Up Testing for STIs
According to the Centers for Disease Control and Prevention Sexually Transmitted Infections (STI) Treatment Guidelines, certain tests and evaluations may need to be repeated over time. For example:
- Syphilis, HIV, Hepatitis B: Repeat testing at 4–6 weeks and again at 3 months.
- Symptoms of new infection: Any child who develops new symptoms post-assault should be re-evaluated immediately.
- High-risk exposure: Children evaluated within hours to one week of the assault and considered at increased risk for STIs may need scheduled follow-up testing. For more information, see LABORATORY: Who Should be Tested.
- Hepatitis B vaccine status: Children already vaccinated may require additional booster doses depending on timing and exposure.
Emotional and Psychological Support
A child’s emotional response to abuse may change and intensify over time and the emotional impact of trauma may not be evident initially. Symptoms of short- and long-term trauma can include:
- Depression and low self-esteem
- PTSD
- Behavioral issues
- Difficulties in relationships or school
- Risk of future victimization or acting out abuse
Mental Health Support and Referrals by Healthcare Professionals after Child/Adolescent Sexual Abuse
- Assess the need for urgent mental health support
- Refer to skilled mental health professionals when appropriate
- Ensure that families receive clear written instructions on next steps
- Maintain close follow-up to monitor progress
Settings for Ongoing Follow-Up Care
- Child Advocacy Centers (CACs)
- These offer the most comprehensive multidisciplinary support and may include medical, psychological, legal, and social services under one roof.
- Medical Home
- If a CAC is not accessible due to distance, scheduling, or family preference, the child’s pediatrician or family doctor may be the most practical option for continued care.
