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In this rapidly evolving field, there are limitations in the level of our knowledge that often preclude definitive statements about the prevalence of child sexual abuse (and possibly even child abuse-neglect in general). The AMA guidelines represent an attempt by the panelists to highlight some of the many varied signs and symptoms, both behavioral and physical, that are associated with the continuum of child maltreatment issues.The child victim of sexual abuse, may be initially seen with specific or nonspecific signs and symptoms of the abuse. Moreover, these manifestations may be physical ailments directly referable to the injury, or, more commonly, they may represent symbolic behavioral manifestations of the injury. As noted by the authors in their letter, the diagnosis of sexual abuse is often first recognized when a sexually transmitted disease is diagnosed in a symptomatic or asymptomatic child. It is problematic, however, to stipulate or provide
Levy HB. Child Abuse and Neglect-Reply. JAMA. 1986;255(9):1135-1136. doi:10.1001/jama.1986.03370090057010