Health Professional Exams of Suspected Child Victims

Information vs. Training

Information regarding physical examinations of children presented in this resource is not intended to replace the extensive training that is required either within the area of the professional's credentials (RN, MD etc.), or specialized training specific to serving an abused population of patients. Health professionals, as is true of other professionals, should understand what they are, and what they are not qualified to do. Guidelines of practice should fall within the suggestions made by the professional organizations representing those professions, and also within the boundaries of the law. Becoming an expert in physical examinations of allegedly abused children generally takes significant additional training specific to working with that population.

Components of an abuse specific physical exam

An examination of a child who may have been sexually abused could include a number of different physiological systems. Specialized health care professionals need to be alert to the possibility of a need to evaluate the child in any or all of the following areas:

• Reproductive
• Abdominal
• Dermatologic
• Oral
• Musculoskeletal
• Cranial

The examination itself needs to consider the following issues that have both forensic and clinical significance:

• Handling and preserving specimens
• Positions for the examination
• Dating of injuries (e.g. bruises, scarring, etc.)
• Bite mark guidelines
• Burns
• Charting conditions that may mimic abuse
• Location of bruises as indicator of abuse
• Marks left by objects used in the abuse
• Creating a forensically sound written medical report

In Georgia, some health professionals can report/testify directly to the court those hearsay comments made by the child regarding his/her allegations of abuse. Interviewing health professionals should consider:

• Forming a connection with the child which encourages accurate disclosures
• Asking questions which include age appropriate language
• Using media appropriately (dolls, pictures, etc.)
• Conducting a forensically sound interview
• Interviewing the non-abusive caregiver
• Interviewing the abusive caregiver (when possible)

Specialized health professionals should familiarize themselves with protocols, inventories and guidelines that assist in accurate and forensically defensible conclusions including:

• Use of appropriate inventories
• Conducting a risk assessment protocol for child sexual abuse
• Following guidelines for determining the likelihood that child sexual abuse occurred
• Following guidelines for determining the likelihood that adolescent sexual abuse occurred

Specialized health professionals need to consider the proper use of photography and or videotaping of their findings and should become very familiar with the use of sexual assault kits. Specific training in the death review process is essential. The training needs to include those guidelines set up for our state, and how the guidelines fit into the county protocols on child abuse. On some occasions, child fatalities can be related to sexual abuse issues, and health professionals involved need special training and need to follow a proscribed outline of procedures.
In addition, specialized health professionals need training and experience in presenting their findings in a court procedure and should be aware that they are part of an entire team of interveners. They need to familiarize themselves with resources available:

• For professionals
• For caregivers and siblings of the victim
• For child sexual abuse victims
• For child sexual offenders