Algorithm: Initial management of straddle injury in boys

* The clinician should have suspicion for child abuse if the following findings are present:

1. Extensive or severe trauma
2. Penetrating injury to the rectum without explanation
3. Presence of suspicious traumatic findings in addition to genital injury
4. Infants younger than 9 months of age
5. Genital lesions or secretions suggesting a sexually transmitted infection

Patients with these findings warrant evaluation for sexual abuse and reporting of possible child abuse to proper authorities. Refer to UpToDate topics on physical and sexual abuse in children and adolescents.
¶ Many boys initially refuse to urinate. If physical findings indicate that the bladder is NOT overdistended and that the likelihood of urethral injury is low, the clinician may encourage voiding by administering acetaminophen, local measures to reduce pain (eg, ice packs, if tolerated), and verbal reassurance.
Δ These injuries require emergent evaluation and operative care by a surgeon with pediatric urologic expertise.