AAP Issues Guidelines on Chaperone Use During Pediatric Exam

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

Pediatrics. Published online April 25, 2011

The purpose and extent of the physical examination in a pediatric patient should be communicated clearly from the physician to the patient and parents. In infants, toddlers, or children, the examination should be performed with a parent or guardian present or, in certain cases, with a chaperone present.

This policy statement from the AAP Committee on Practice and Ambulatory Medicine addresses the use of chaperones during the physician examination of the pediatric patient.

Study Highlights

The physician should clearly communicate the extent of the physical examination to the patient and parents to prevent misunderstanding about the purpose and conduct of the examination.
In case of possible physical or psychological discomfort during the examination, measures to preserve privacy should be used for patient and parent support.
Some state medical boards have regulations regarding chaperone use.
A chaperone is recommended for adolescents or young adults who require inspection or palpation of the anorectal or genital areas or of the female breast.
The chaperone serves to reinforce the professional nature and content of the examination and as a witness in case of any misunderstandings.
The decision to use a chaperone should be shared between the patient and the physician.
The patient's preference should have highest priority.
It is advisable that male clinicians have a chaperone for the female anorectal, genital, or breast examination.
Chaperones can be indicated for same-sex examinations.
The patient's wishes and comfort should determine the sex of the chaperone.
The chaperone should be a nurse or medical assistant.
Family members or friends should not be chaperones unless requested by the patient and, if possible, in the presence of another chaperone.
Reasons that patients might not want a chaperone present include belief that privacy and confidentiality are compromised and embarrassment and vulnerability.
Reasons that pediatricians might find use of a chaperone problematic include the need for additional staff or inability to provide either a male or a female chaperone.
Reasons for a physician to request a chaperone include patient or parent with mental health issues, developmental issues, and anxiety, tension, or reluctance about the examination.
Physicians should explain to the patient and parent why a chaperone is required in these circumstances.
If the patient refuses a chaperone and the physician is concerned about possible false allegations or medicolegal risk, then the physician is not obligated to provide further medical care.
If the patient requests a chaperone, but a chaperone is not available, then the patient can refuse further treatment, and the physician should discuss risks of not receiving care and offer alternatives to care.
Pediatricians should develop a policy about chaperone use for the office or clinic setting. The chaperone's respect for privacy and confidentiality should be included in this policy.
Medical record documentation should reveal that the scope and findings of the examination were reviewed with the patient and parents, the name of the chaperone, whether the patient declines a chaperone, if the patient's request for a chaperone cannot be accommodated and alternatives offered, and if the office policy or state medical board regulations on chaperones cannot be followed.

Clinical Implications

A chaperone for an adolescent or young adult in the medical office is recommended when the physical examination requires inspection or palpation of anorectal or genital areas or of the female breast.
The decision to use a chaperone for the physical examination of an adolescent or young adult in the medical office setting should be shared between the patient and the physician. The chaperone should be a nurse or medical assistant, and the sex of the chaperone should be determined according to the patient's wishes and comfort level.