An ounce of prevention or two… providing anticipatory guidance regarding personal space and privacy. A commentary.

C. Henry Kempe’s, 1977, C. Anderson Aldrich seminal lecture “Another hidden pediatric problem: the sexual abuse of hildren” was the clarion call awakening pediatricians to the issue of the sexual victimization of children. Almost 40 years ater pediatricians and society at large continue to grapple with how best to reduce the risk of sexual victimization. Although o one denies the reality of sexual abuse of children the topic remains a challenge. While there is no group more vested in the ealth and welfare of children than pediatricians—whose raison de’tre is to assure a child’s healthy development—there has een limited success in addressing the issue of child sexual abuse (CSA) within the context of routine health care. There is a ignificant body of literature, the Adverse Childhood Experiences Studies (ACE’s) that elucidates the potential for long term erious adverse medical and mental health consequences to childhood trauma. This body of literature reinforces the need to mbark on universal prevention by developing new and creative public health strategies to further reduce the vulnerability f children to sexual abuse (Fellitti et al., 1998). National prevention strategies in the United States have focused primarily on offender management and school-based ducation which has garnered a lot of public attention and approval yet child sexual abuse remains a prevalent problem. chool based programs promote disclosure, reduce self blame but remain insufficient to fully address this pervasive public ealth problem. The development of a comprehensive health and safety promotion curriculum for medical professionals ould be complementary to existing school based strategies (Finkelhor, 2009). At present, pediatricians do not hesitate to provide anticipatory guidance regarding back to sleep safety, car and bicycle afety, water and environmental safety, and a myriad of others to their patients; yet, the topic of a child’s right to personal pace and privacy is sub-optimally addressed. While this may be due to the difficult nature of the topic, avoiding discussing he issue of personal space and privacy with children and their caretakers may only further perpetuate the problem of CSA. e must respond to the issue, and embark on an initiative to introduce anticipatory guidance about personal space and rivacy throughout a child’s life in developmentally appropriate ways. I propose that we do so under the euphemism of a hild’s right to “Personal Space and Privacy” (PSP) rather than CSA prevention. The first step is to educate parents and children about the right to PSP, and provide caretakers with age appropriate anguage so they can comfortably talk about the importance of PSP with children throughout childhood. Too many parents till believe that talking to children about stranger danger, registered sex offenders, and the risk of abuse in organized ports, educational institutions, and religious organizations is sufficient for protecting them from sexual victimization. This isconception contributes to the unfortunate reality that children are uneducated about how to recognize and respond to ituations in which their personal space and privacy is invaded by someone who they know and should trust. The heightened vulnerability of young children, due to reasons such as their need for genital/perianal care and bathing ssistance, provides even more reason to educate children early and in a consistent manner about their PSP. In fact, caretakers ay use these opportunities to send context-appropriate anticipatory guidance messages to their children about PSP. If aretakers teach their children about the difference between “okay” and “not okay” touching when providing genital/perianal are and bathing assistance, then children will possess the knowledge to recognize when someone is invading their PSP and