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Befunde und Klassifikation

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Kindesmisshandlung

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Zusammenfassung

Bei der überwiegenden Mehrzahl sexuell missbrauchter Kinder lassen sich keine auffälligen körperlichen Befunde erheben. Die korrekte Erhebung, Dokumentation und auf aktueller Evidenz basierende Interpretation der Gesamtsituation kann dennoch erhebliche Implikationen für den Schutz und die umfassende ärztliche Betreuung betroffener Kinder haben. Die medizinische Untersuchung kann dazu beitragen, ein durch den Missbrauch verursachtes pathologisches Körperselbstbild durch die ärztliche Bestätigung körperlicher Normalität und Integrität zu entlasten. Voraussetzung für eine fachgerechte medizinische Betreuung sind kinder- und jugendgynäkologische und forensische Kenntnisse. Dazu kommt die Kenntnis der methodischen Einschränkungen und Aussagefähigkeit medizinischer Befunde und die Berücksichtigung aktueller Empfehlungen, Leitlinien und Klassifikationen. Die Gründe für die hohe Rate an Normalbefunden (> 90%) bei sexuellem Kindesmissbrauch müssen jedem Arzt bekannt sein, um Fehleinschätzungen der Aussagen der Opfer aufgrund fehlender Verletzungsbefunde zu vermeiden. Beweisend sind massive, akute anogenitale Verletzungen, die nicht akzidentell erklärbar sind, eine gesicherte Gonorrhö, Syphilis oder HIV-Infektion (nach Ausschluss einer angeborenen Infektion), eine Schwangerschaft oder der Nachweis von Sperma in oder auf dem Körper eines Kindes. Für eine Reihe von Befunden, die als missbrauchsverdächtig gelten, ist die Zuordnung mit Unsicherheiten behaftet, da die Datenlage für eine definitive Bewertung noch unzureichend ist. Trotz des hier skizzierten Stellenwertes der medizinischen Diagnostik beruht die Diagnose des sexuellen Missbrauchs von Kindern nach wie vor in erster Linie auf einer qualifiziert erhobenen Aussage des Kindes.

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Author information

Authors and Affiliations

  1. Klinik für Kinder- und Jugendmedizin, Klinikum Kassel GmbH, Mönchebergstr. 43, 34125, Kassel, Deutschland

    Dr. med. B. Herrmann

  2. Inst. Rechtsmedizin, Universitätsklinikum Gießen, Frankfurter Str. 58, 35392, Gießen, Deutschland

    Prof. Dr. med. Dr. jur. R. Dettmeyer

  3. Institut für Rechtsmedizin, Universität Köln Medizinische Fakultät, Melatengürtel 60-62, 50823, Köln, Deutschland

    Dr. med. S. Banaschak

  4. Kinder- und Jugendmedizin, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    Prof. Dr. med. U. Thyen

Authors
  1. Dr. med. B. Herrmann
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  2. Prof. Dr. med. Dr. jur. R. Dettmeyer
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  3. Dr. med. S. Banaschak
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  4. Prof. Dr. med. U. Thyen
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© 2016 Springer-Verlag Berlin Heidelberg

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Herrmann, B., Dettmeyer, R., Banaschak, S., Thyen, U. (2016). Befunde und Klassifikation. In: Kindesmisshandlung. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-48844-7_9

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  • DOI: https://doi.org/10.1007/978-3-662-48844-7_9

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-48843-0

  • Online ISBN: 978-3-662-48844-7

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