A nurse is assisting with the development of an education program about child maltreatment. Which of the following findings should the nurse include in the program as a possible indication of sexual abuse?

Recurrent urinary tract infections (UTIs) in a child are a recognized indicator of possible sexual abuse. Trauma or repeated exposure to sexually transmitted organisms in the genital and urethral area can predispose a child to repeated UTIs, and healthcare providers are taught to consider sexual abuse when a child presents with recurrent, unexplained UTIs. Lack of subcutaneous fat is more consistent with neglect or nutritional deprivation rather than sexual abuse specifically. Unexplained illness is a broad, non-specific finding that may suggest various forms of abuse or factitious disorder imposed on another (medical child abuse), but it is not a hallmark indicator of sexual abuse in particular. Poor personal hygiene is more indicative of physical neglect. When developing education programs about child maltreatment, distinguishing the signs of each abuse category is essential. Sexual abuse indicators include age-inappropriate sexual knowledge, genital trauma, sexually transmitted infections, difficulty walking or sitting, and recurrent UTIs. Recognizing recurrent UTIs as a potential warning sign allows nurses and caregivers to initiate appropriate assessments and referrals to child protective services, improving early detection and intervention.