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Potential healthcare providers should be screened for a history of child abuse issues, according to a guideline from the American Academy of Pediatrics (AAP).

In the recommendation on preventing the sexual abuse of children in healthcare settings, AAP emphasizes that sexual encounters with patients under 18 years are "destructive and strictly forbidden and unlawful."

The specialty of pediatrics may draw sexual predators due to the position of power, access to children, and the trust in a physician that can be used to cover up predatory behavior, wrote Antoinette Laskey, MD, MPH, MBA, of the University of Utah School of Medicine in Salt Lake City, and colleagues in the AAP Council on Child Abuse and Neglect, in .

As an example, they cited the case of , the former USA Gymnastics team physician who pled guilty to charges of criminal sexual conduct and child pornography charges.

Laskey's group noted that less than 1% of predators have a criminal record, so internal institutional measures are necessary in preventing abuse, such as "increasing the perceived effort of committing the abuse, increasing the perceived risk of discovery, and removing internally generated justifications for behaviors that are abusive."

On the patient-provider level, the council advised that "pediatricians and healthcare professionals should be trained to recognize and abide by appropriate provider-patient boundaries," including education on professional interactions during sensitive discussions or exams, and when and how to use a chaperone.

When exams of sensitive areas of pediatric patients are necessary, Laskey and colleagues advise a discussion with parents and children. If the child is old enough, then verbal consent should be obtained from the patient, and patients should also be provided with privacy while disrobing and be draped appropriately during the exam.

They pointed out that abused children carry an increased risk of many emotional, behavioral, cognitive, social, and general health impairments. Past victims of sexual abuse are also at greater risk of further sexual abuse. Parents and children may lose faith in healthcare professionals and not seek out necessary medical treatment later in life, Laskey's group cautioned.

If a case of alleged sexual abuse by a healthcare provider arises, institutions should provide assessment and treatment by a physician who specializes in evaluating and treating child sexual abuse, along with possible counseling by a qualified mental health professional. In addition, appropriate legal and ethical reporting and investigating should be done, with a reporting process that is clearly defined.

For accused employees, institutions should provide "independent, confidential support and counseling services during the investigation," the guideline states.

The recommendation highlights that "all employees in the healthcare setting, including those not directly providing patient care, [should be trained] on their role in the safety of children in the healthcare setting, and their specific duty to report concerns to Child Protective Services and/or police." The authors explained that mandated reporting laws have low thresholds for reporting, such as "reasonable suspicion" and "cause to believe" as long as reports are made in good faith. Conversely, there may be penalties for not reporting suspected abuse.

"Everyone has a responsibility to ensure the safety of children in healthcare settings and to scrupulously follow appropriate legal and ethical reporting and investigation procedures," according to the recommendation.

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