Child sexual abuse I agree is definitely under reported. I feel if there was mandated universal screening of all children entering the health system there would be a higher level of detection and therefore reporting. As an emergency nurse I find it difficult to always assess for child sexual abuse (CSA). If the child is not presenting with any obvious signs of CSA there is a limit opportunity to question the child without parental presence. Most children who are being abused will not speak in front of the adult they are presenting with due to fear. Due to this it makes it very difficult. At the emergency department in which I work we do ask a universal screening question to all patients during the triage process regarding their feelings of safety and security in the environment in which they live. It has helped us to identify abuse victims who may have slipped through the cracks before.