Chaperones should be available for teens' exams

Teenagers should have the option of having a "medical chaperone" present when they are undergoing any kind of intimate physical exam, according to a new policy statement by the American Academy of Pediatrics.

In addition, the group says, pediatricians should have a medical chaperone on hand for younger children in cases where a parent is not there, or shouldn't be there -- such as when child abuse is suspected.

The policy statement, published in the AAP journal Pediatrics, updates the group's existing recommendations -- offering more details on when chaperones should be used and who should qualify as one.

"The chaperone should be a nurse or a medical assistant," said Dr. Edward S. Curry, who led the AAP committee that wrote the new statement. The chaperone should not be the office secretary, he told Reuters Health, or a friend or other family member of the patient.

One reason it should be a nurse or medical assistant is because of patient confidentiality, Curry said. Another is that they understand what is going on during a child's physical, and nurses can assist if needed.

The new policy also clarifies when chaperones should be offered to adolescent patients.

Doctors often see chaperones as necessary when performing a pelvic exam, but they are also recommended for other intimate exams, Curry said -- including breast exams and rectal exams.

"We wanted to make sure pediatricians are aware they should (have chaperones) when they do those exams as well," Curry said.

But while chaperones are recommended in these cases, it is up to teenage patients to decide if they want one. Some, Curry noted, may be uncomfortable with someone else present during the exam, even another medical professional.

With younger children -- up to around age 10 -- a parent should always be present for any kind of physical exam, the AAP says.

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But there are times when a chaperone is needed, according to Curry. That includes cases where child abuse is suspected or where the parent "is exhibiting mental health issues" that could interfere with the exam.

The point of chaperones is to help protect both children and pediatricians, Curry said. Sexual abuse by pediatricians is "rare," he noted, but it does happen. On the other hand, young patients could misunderstand a doctor's appropriate behavior during an exam and accuse him or her of abuse.

Curry said the bottom line is that parents and adolescent patients should know that they have the right to request a medical chaperone, or refuse one.

Ideally, a pediatrician would have a large enough staff to have a chaperone available when needed. But that will not always be the case, Curry said.

If a chaperone is not available, patients can refuse an exam, the AAP says. But the doctor should then offer alternatives, including referring them to another provider.

A few U.S. states require pediatricians to have medical chaperones present for certain exams, but most states have no mandates on the issue.