Medical Examination

Consideration should always be given to the need for a medical assessment of each child about whom there are concerns. Although a medical assessment is not a requirement in every case, it needs to be considered regardless of whether the child has any visible injuries or appears neglected. The medical assessment should be dispensed with only if those managing the investigation are satisfied that injuries/neglect are minor and the purposes of the investigation can be achieved without it. The reasons for dispensing with a medical assessment should be clearly recorded.

In cases where a medical examination is necessary, it is essential that it be conducted by a doctor who has experience/training in the recognition of abuse and the carrying out of forensic medical examinations in respect of children – i.e. a Consultant Paediatrician, a Specialist Registrar or a Community Paediatrician.

The purpose of any medical assessment is:

• To ensure the child’s condition is medically examined and treatment given as   appropriate;
• To re-assure the child as to his or her well-being;
• To obtain an assessment about possible indications of abuse;
• To ensure that any injuries or signs of neglect or abuse are noted for evidential purposes;
• To secure forensic evidence where sexual abuse is suspected

In cases of any alleged sexual abuse, which is reported to have recently occurred, a medical examination must be considered as a matter of urgency. This will be to protect the health of the child and to secure and preserve evidence. Consideration must be given to the gender of the doctor completing the medical examination. Consideration must also be given to the need for any other children in the household, or connected to the alleged perpetrator, to be medically examined.

The examination for suspected sexual abuse is both clinical and forensic and should only be undertaken by a suitably qualified paediatrician and a forensic medical examiner. The forensic examination itself is not abusive and is important to secure forensic evidence and provide treatment (if required) and reassurance. The child’s welfare must be the paramount concern and consideration should be given to the timing of the examination especially for non acute cases where forensic evidence will not be secured.

If the referral concerns physical injury or severe neglect a medical assessment of all the children in the household should be arranged on the same day. Reasons for excluding any of the children must be considered as part of the strategy discussion/meeting and included in the record of that discussion.

Medical examinations of children where abuse is suspected should be guided by
“Standards for Radiological Investigations of Suspected Non-accidental Injury,” (Royal College of Paediatrics and Child Health, 2008)

Following a past Serious Case Review in Cheshire, it was recommended that a Paediatric
Radiologist’s opinion be obtained for all skeletal surveys and Xrays where abuse is suspected, to support the report provided by a local general Radiologist.