Pediatric sexual abuse is an overwhelming problem in the United States. It is estimated that 25% of females and 16% of males in the United States are sexually abused before the age of 18. The emergency department (ED) is frequently the point of entry for care of sexually abused children and adolescents. Personnel from the ED are usually the first "reporters" of sexual abuse, propelling these issues into the medicolegal system. Therefore, it is critical for ED practitioners to have the knowledge and skill set required to provide thorough, comprehensive care for this patient population. The ED holds a powerful position in the multidisciplinary approach to pediatric sexual abuse, involving social workers, child protective services, and law enforcement. This article presents the essential information required to assume a leadership role in the medical management of the sexually abused child/adolescent in the ED, including mandatory reporting, triage, assessment, treatment, and follow-up.