Norwell pediatrician accused of sexual abuse. How to protect kids at the doctor's office

Allegations against Norwell pediatrician Richard Kauff, who is accused of sexually abusing two girls, have brought the issue of sexual abuse in health care settings back into the public discussion, raising questions for parents about how to protect their children from predators who abuse children under the guise of care.

Last year, the American Academy of Pediatrics released guidance on how to identify and prevent such abuse. The paper noted the high-profile case involving Michigan State University and USA Gymnastics team physician Larry Nassar, who was accused of abusing at least 265 girls over 22 years.

"Nassar's case shows that the trust placed in a physician can be manipulated to cover predatory behavior," the American Academy of Pediatrics says.

Nassar was convicted and is serving a sentence of up to 175 years in prison. In July, Nassar was stabbed multiple times in the Florida federal prison where he's incarcerated.

In the Nassar case, Olympic gold medalist and Needham native Aly Raisman came forward as one of dozens of gymnasts who were sexually abused by Nassar. Raisman has since worked to prevent child sexual abuse through her advocacy group, Darkness to Light.

Many girls said they were abused by Nassar during every visit, even when their parents were in the room, according to the guidance.

Kauff's accusers also say the abuse occurred annually during routine physical examinations. Both women who filed complaints with Norwell police said Kauff abused them while their parents were in the examination room by positioning his body to screen their view.

How common is sexual abuse of children by doctors and medical professionals?

The American Academy of Pediatrics' guidance says that in the United States, an estimated 15% to 25% of girls and 5% to 10% of boys suffer sexual abuse.

Victimization at the hands of health care professionals is a less understood subset of sexual abuse against children. Instances become known through litigation, reports to medical boards or accounts in the media. However, victims may not report out of fear of retaliation or not being believed, and some cases are settled out of court.

Predators may be drawn to the field of pediatrics by the trust and authority associated with the profession, as well as the access to children it affords, according to the guidance paper.

Because children and parents may not be able to distinguish medical care from abuse, many cases likely go unreported. In a 2017 interview with the CBS-TV show "60 Minutes," Raisman was asked if she thought she was receiving medical treatment while being abused.

"I didn't know anything differently," Raisman said. "We were told (Nassar is) the best doctor, he’s the United States Olympic doctor and the USA Gymnastics doctor and we were very lucky we were able to see him.”

Like Raisman, the women accusing Kauff of sexual abuse said they didn't understand what happened until much later in life. According to the police report, the two women, who were interviewed separately, said they thought it was a routine part of pediatric examinations, having no frame of reference to determine if something was abnormal.

What is part of a "normal" pediatric examination?

The American Academy of Pediatrics says examinations assess children's physical health and development, which includes genital health and puberty.

"(It is) often necessary to perform an examination of sensitive areas of the child," the guidance reads, such as the genitals, anus and breasts.

Routine intravaginal examinations and Pap smears are not recommended until age 21. Examination of the genitals and anus are only needed for specific complaints, the guidance says, and should be "guided by the specific concern."

The women who made the allegations against Kauff said they never raised issues of vaginal health during the time of the alleged misconduct, according to police.

The American Academy of Pediatrics says that in cases requiring examinations of sensitive areas, doctors should obtain consent from the patient or a parent, depending on age of the child. As part of the process, the doctor should explain why the examination is necessary and what it will entail.

What are signs of possible sexual abuse by medical professionals?

Health care professionals who sexually abuse patients often engage in "grooming behavior," the American Academy of Pediatrics says. Such behavior aims to win the confidence of children and their guardians.

This may include favors, gifts and repeated contact with unsupervised children. Raisman in her "60 Minutes" interview said Nassar gained her trust by bringing her desserts and gifts.

Inappropriate sexual conduct may "slowly escalate," the guidance says, from "seemingly harmless touches ... to more overt contact."

The American Academy of Pediatrics warns that perpetrators may target children they perceive as emotionally vulnerable, attention seeking, disabled or developmentally delayed.

The women who made the allegations against Kauff both told police that their older sisters, who were also treated by Kauff, didn't experience the same kind of abuse. According to the police report, one of the two women said her older sister was "more outspoken" than she was while they were growing up.

How do you talk to kids about bad touching?

Erin Robinson, media relations director for the Rape, Abuse, Incest National Network, said parents can teach their children the difference between “good” secrets and “bad” ones, the latter being those that an adult has told them not to discuss.

She said experts recommend teaching children to use anatomically correct terms for their body parts, equipping them to be able to say that they’ve been touched on their penis or their vagina.

“A child may be disclosing things to you but in a way that they understand, so if they’re able to use those terms with trusted adults it’s easier for adults to understand the nature of what’s happening,” she said.

Sometimes when children try to share information about abuse, it can be overlooked by adults who attribute it to imagination. Robinson said parents should be mindful when a child expresses a visceral reaction to, for example, visiting a certain relative.

“That may tell you something,” she said. “It should open the door to asking, ‘Why? Why do you feel that way? What makes you say that?’ And then listening. If a child is describing something like that, give it the credence it deserves. The most important thing parents can do is establish themselves as a safe and trusted place for that child to talk about these things.”

What are the enduring impacts of child sexual abuse?

Children who suffer sexual abuse have an increased risk of "emotional, behavioral, cognitive, social and general health impairments," according to American Academy of Pediatrics' guidance.

When abuse happens in a health care setting, the victim may be no longer able to trust medical professionals, and may not be able to seek necessary medical attention throughout their lives.

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This article originally appeared on The Patriot Ledger: American Academy of Pediatrics' guidance on sex abuse in health care