Assignment
Polly Davis is a 5-year-old, Caucasian female who is brought to you by her father Jeremiah today for concerns of crying with urination and repeated complaints of "pain down there," which seems to be getting worse. Jeremiah is a single father who works nights at a local warehouse. Polly's grandmother used to babysit Polly each night while her dad worked, but she passed away two months ago. Since that time, Polly's uncle has been watching Polly overnight. Jeremiah has noticed that Polly has become unusually clingy, crying when he leaves for work. He reports that recently she has been soiling herself, which is a new finding. On exam, you notice significant vulvovaginitis with some purulent vaginal discharge; there also appears to be some hymenal tearing along with some suspicious bruising on her buttocks. You suspect Polly is being sexually abused.
Task
A. What are your immediate concerns for Polly? How would you address these concerns?
B. What are the reporting requirements for pediatric abuse in your state? If you are required to report suspected pediatric abuse, who do you report your suspicions to? What is the required timeline for reporting?
C. How would you conclude this visit? In addition to referring Polly to the ER, what other types of referrals might you need to consider as her primary care provider?
D. How would you document this visit?