Physicians are encouraged to offer trained chaperones during sensitive physical examinations of children and adolescents, according to a new policy statement from The American Academy of Pediatrics.
Their guidance aims to promote patient comfort and clinician protection during medical encounters involving inspection or palpation of genital, breast, or anorectal areas. These examinations, while medically necessary, may be perceived by young patients as intrusive or distressing. The presence of a chaperone can offer emotional support, reinforce professional boundaries, and reduce the risk of misunderstandings.
The recommendations call for shared decision-making among the clinician, patient, and caregivers. “Open discussion can help engender confidence in patients, caregivers, and clinicians regarding the appropriateness of the examination and/or procedure,” said AAP members on the Committee on Practice and Ambulatory Medicine.
Clinicians are advised to explain the role of the chaperone, reassure the patient, and offer the option to decline when appropriate. Clinicians should document the chaperone’s name, role, and presence in the patient’s chart, particularly if the patient declines a chaperone or a non-clinical person fulfills the role.
Preferred chaperones are clinical staff such as nurses, physician assistants, or medical assistants. These individuals are familiar with procedures and professional standards and can help identify and respond to any concerns. If clinical staff are unavailable, a trained non-clinical staff member or a family member requested by the patient may serve as a chaperone, noted the AAP.
Patient preferences may vary based on age, gender, prior experiences, and cultural background. Research cited in the policy shows many adolescents and caregivers prefer a parent over a medical chaperone, with female patients often favoring a same-sex parent for sensitive exams. While chaperone gender was not found to significantly affect satisfaction, individual preferences should be respected.
Special considerations apply to vulnerable populations, including youth in foster care, patients with developmental disabilities, and those with a history of trauma or exploitation. In these cases, a chaperone is strongly recommended. For patients unable to assent—due to age, disability, or substance use—a chaperone should be present unless the situation involves a medical emergency.
For telemedicine visits involving sensitive issues, an in-person visit is generally preferred. When not feasible, chaperones may join remotely, or the session may be recorded.
The AAP acknowledged staffing challenges in smaller practices but encouraged integrating chaperone use as standard protocol to improve care quality and reduce liability. Suggested strategies include designating a chaperone for each clinic session or using an opt-out model, where chaperone use is assumed unless it is declined.
The authors reported no conflicts of interest.
Source: Pediatrics