Situations à risque de maltraitances sexuelles intrafamiliales chez le mineur. Rôle du médecin généraliste. Étude de 58 dossiers du tribunal de grande instance de Toulouse

Although child sexual abuse within families is common and serious, it is underestimated because of a lack of knowledge of how to identify it. The general practitioner has a crucial part to play in the early identification of high-risk families. Indeed he can detect risk factors when making home calls and mainly according to the reasons for visiting these children. Fifty-eight cases of child sexual abuse in the county court of Toulouse have been analysed, all of them being only incest cases. Only cases of physical violence with sexual abuse have been studied in this work. Girls are more often victims of sexual abuse than boys (69% and 31%, respectively), with children between 7 and 12 years old most at risk. In 95% of cases, their abuser is male and most often the child's stepfather or father. One quarter of the victims' mothers were subject to such abuse in their own childhood and almost one woman in two had their first child at the age of 20 or even younger. Conjugal violence and child physical violence are observed in respectively 47% and 43% of cases. Alcoholism is a characteristic of 41% of adult-abusers. Stepfamilies with lots of children are more affected. In all types of families, the eldest or the second eldest children are the most frequent victims. In total, 43% of these families have often been identified as at risk before sexual abuse occurs. The general practitioner is a major actor in the identification of high-risk families and the prevention of child sexual abuse.