AAP Issues Guidelines on Chaperone Use During Pediatric Exam

From Medscape Education Clinical Briefs
News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD

April 27, 2011 — Using a chaperone during a pediatric physical examination should be a shared decision between the patient and pediatrician, according to the revised policy statement of the American Academy of Pediatrics (AAP) reported online April 25 and published in the May print issue of Pediatrics. The new guidelines, entitled "Use of Chaperones During the Physical Examination of the Pediatric Patient," highlight issues of patient comfort, privacy, and confidentiality.

"In the medical office setting, the physical examination of an infant, toddler, or child should always be performed in the presence of a parent or guardian," write Edward S. Curry, MD, FAAP, from the AAP Committee on Practice and Ambulatory Medicine, and colleagues.
"If a parent or guardian is unavailable or the parent's presence will interfere with the physical examination, such as in a possible case of abuse or parental mental health issues, a chaperone should be present during the physical examination.
If the patient is an adolescent or young adult and the examination requires inspection or palpation of anorectal or genital areas and/or the female breast, a chaperone is recommended."

In some states, the use of a chaperone during pediatric examinations is required by state regulations. In all cases, physicians should discuss in advance the scope, nature, and purpose of the physical examination to be performed with the pediatric patient, provided the child is old enough to understand, and/or his or her parent. Every effort should be made, such as using gowns or drapes to protect privacy, to relieve the physical or psychological discomfort of some examination procedures.

A nurse or medical assistant, rather than a friend or family member, is preferred as a chaperone during female breast, genital, or anorectal examinations, but offices are not required to have a chaperone.

Situations may arise in which a chaperone is not present because of patient preference or because a chaperone from the office is unavailable.

Situations in which a physician may request the presence of a chaperone may include evidence of mental health issues in the patient or parent; developmental issues; or the presence of anxiety, tension, or reluctance regarding the examination.

"For the rare situation in which the patient refuses an appropriate chaperone and the physician is concerned that providing the examination might result in false allegations or medicolegal risk, the physician is not obligated to provide further treatment," the statement authors write.

"...If a medical chaperone is indicated and the patient refuses, the patient or parent should be given alternatives, including seeking care elsewhere. Pediatricians should develop policy about the use of chaperones in the office or clinic setting and document in the medical record if they are unable to adhere to the policy or state medical board regulations."

Pediatrics. Published online April 25, 2011. Full text