In the aftermath of a shocking case of child abuse by a pediatrician in Delaware, the American Academy of Pediatrics (AAP) has published a new policy statement on protecting children from sexual abuse by health care providers.

“Pediatricians and other health care providers are entrusted with the responsibility to improve the health and well-being of children,” according to the policy statement. “However, recent allegations of the sexual abuse of hundreds of children by a pediatrician in the United States have reminded us that some among the pediatric profession may use their position of authority and trust to take advantage of their patients.”

In the case cited by the article, a Lewes, Delaware, pediatrician was found guilty this summer on all 24 counts in his trial for 2nd-degree rape and sexual assault. Delaware Attorney General Beau Biden originally announced a 471-count indictment against the doctor, including charges that he raped or assaulted 103 patients over a decade, videotaping many of the crimes. Those were later consolidated into 24 counts.

The AAP’s Committee on Child Abuse and Neglect made the following recommendations in its policy:

• Medical students should be trained on appropriate provider-patient boundaries and appropriate use of chaperones for examinations.
• Employees of medical facilities for children should be screened for previous abuse of a child, using state registries and contact with previous employers.
• Pediatricians should be educated about the indications and techniques of genital examinations and when they are appropriate to perform.
• Parents and verbal children should be told why pediatricians are performing each element of the examination.
• Patients’ need for modesty should be respected by providing appropriate draping and allowing privacy while changing.
• Pediatricians should offer chaperones and provide them whenever requested or required as part of standard practice and local regulations or when the provider feels that a chaperone is needed.
• Medical facilities should have policies and procedures in place to train staff on boundaries, chaperone use, and the responsibility to immediately report concerns of patient abuse by other staff members.
• Parents should be informed that they have a right to request chaperoned examinations and that they should report any concerns about sexually inappropriate behavior by a provider to the facility’s administration or to their state’s protective service for investigation, if the administrator’s response is inadequate.
• Policies and procedures also should be in place to ensure that health care providers and institutions know they are legally obligated to report suspicions of child sexual abuse. Protections and support should be in place for whistle blowers.

Guarding against sexual abuse is “particularly important for pediatric patients, who have greater developmental vulnerability than adults,” according to the policy.

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