Child Sexual Abuse (CSA)

In 2014, over 2,800 children were identified as needing protection from sexual abuse (NSPCC 2015). This page provides members with information and additional resources to support the assessment of child sexual abuse (CSA).

CSA includes physical contact, including penetrative and non-penetrative acts, non-contact activities such as exposure to sexually explicit material, and child sexual exploitation. 

It is acknowledged that most paediatricians will not have the individual expertise to assess or manage a child or young person when CSA is suspected but will refer to a clinician with more specialised child protection skills with specific training and competences in forensic assessments.

On this page:

Key documents

Child Protection Companion

Section 10 (member sign in required, or non-members can pay a subscription fee for access) of the Child Protection Companion provides a guide to the recognition of child sexual abuse (CSA) in clinical practice and ongoing management for all paediatricians.

The Physical Signs of Child Sexual Abuse

Any paediatrician undertaking assessment of children/young people referred for CSA must be familiar with The Physical Signs of Child Sexual Abuse.

This evidence-based review and guidance for best practice is a revision of the 2008 Royal College of Paediatrics and Child Health (RCPCH) publication 'The Physical Signs of Child Sexual Abuse’. Based on the best available evidence, it has been produced in collaboration with the American Academy of Pediatrics (AAP), the Royal College of Physicians of London (RCP) and The Faculty of Forensic and Legal Medicine (FFLM).

This publication is only available in hard copy – further information about obtaining a copy.

Educational resources

The Physical Signs of Child Sexual Abuse – Webinar Series

Session 5b – Introduction and methodology, Dr Amanda Thomas

Session 1a - Healing of anogenital injuries, Professor Jacqueline Mok

Session 1b - Anogenital signs in accidental injuries, Professor Jacqueline Mok

Session 2 – Genital bleeding in pre-pubertal girls, Professor Neil McIntosh

Session 3 – Anal abuse and genital abuse of boys, Professor Neil McIntosh

Session 4 – Female genital signs, an update from 2008, Professor Jacqueline Mok

Session 5a – Sexually Transmitted Infections, Dr Karen Rogstad

About the presenters:

Dr Amanda Thomas

Mandy is a Consultant Community Paediatrician at Leeds Community Healthcare NHS Trust. Mandy has worked in Community Child Health since 1986 and began specialising in the field of Child Protection in 1991 and was the RCPCH Officer for Child Protection from 2011 to June 2014.

Mandy was a member of the project board which produced for the 2008 edition of The Physical Signs of Child Sexual Abuse as well as a member of the Methodology working group and STI working group.For this update Mandy was Chair of the Project Board and was working group co-lead for the STI chapter, and member of the methodology working group.

Professor Jacqueline Mok

Jacqui was the Lead Paediatrician for Child Protection for the city of Edinburgh and the NHS Lothian University Hospitals Division from 1994 until 2011. Jacqui retired from clinical practice on 1 February 2011 and is the current Chair of the RCPCH (Scotland) Child Protection Subcommittee.

Jacqui was a member of the project board which produced for the 2008 edition of The Physical Signs of Child Sexual Abuse, co-chairing the working group on female genital signs. For this update Jacqui chaired 3 working groups: Female Genital Signs, Unintentional Anogenital injuries and Healing and was a member of the project board.

Professor Neil McIntosh

Neil is a retired neonatologist and Emeritus Professor of Child Life and Health, University of Edinburgh.

Neil was previous Vice President for Research at RCPCH and Chair of the 2008 Purple Book Project Board. For this update Neil was Chair of the anal and male genital working group and a member of the Project Board.

Dr Karen Rogstad

Karen Rogstad is a Consultant in HIV and Sexual Health at Sheffield Teaching Hospitals NHS foundation Trust and an Undergraduate Dean at the University of Sheffield Medical School.

Karen has a particular interest in young people with regards to HIV and HIV testing, sexual health, confidentiality and child sexual exploitation. She is a co-author of several guidelines including standards on young people, HIV testing, Standards for HIV services, Physical signs of Child Sexual Abuse and Reckless transmission of HIV.

For this update and the 2008 edition Karen was the STI working group co-lead and member of the project board.

CPD for RCPCH members

Learning from review of this series of webinars may be appropriate evidence for your RCPCH CPD records.  Learning from webinars best fits within the Personal CPD category. Broadly, 1 hour of learning from a webinar equates to 1 CPD credit. However, credits should be claimed based on personal reflection on learning value and application to practice.