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There are several functions of medical examination. They include collecting and documenting physical evidence of child abuse, providing treatment to the abused children, and collecting history relevant in making the diagnosis a success. They also reassure children by addressing serious concerns, help the Child Protective Services (CPS) in making decisions, and help prosecutors and police in making a determination.
Equipment
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Medical records
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Audio visual recording machines
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Deoxyribonucleic acid
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Kits, such as rape kits for cases of sexual assaults
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Medical facilities
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Clinical assessment tools
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Screening tools
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A colposcope
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Optical glass binocular magnifiers
Recommended Practice
Preparation of children with allegations of child abuse
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The child should be prepared mentally by briefing them on what to expect in medical examination. He or she must be informed and made aware that the examination will not hurt him or her and that the medical examiners will notify them of anything they would like to know. This will shield the child from embarrassment, worry, or feeling uncomfortable during the examination.
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The nurses conducting the examination must create an environment which is conducive for the child. This will make the child open up and talk about the whole incident without fear.
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Take the child into the examination room after ensuring that he or she is not nervous, and is willing to collaborate with the examiners.
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Avail all the necessary resources for the examination so as to make the examination a success.
Procedures
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Take the child with allegations of child abuse to an examiner after he or she makes a statement of abuse, or after people witness the abuse. The child must be accompanied by a law enforcement professional for assessment as part of their investigation. People ought to take the assaulted children for medical examination in order to be examined, gather evidence, and get the best remedies of managing the crisis.
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The examiner ought to interview the child with allegations of child abuse in order to know the history of the case. The examiner engages the child in a friendly discussion with a primary focus of acquiring information to guide him or her while performing the medical examination. The parents of the child are not allowed to be present during the interview in order to allow un-interrupted interrogation by the medical examiner.
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The examiner then records data about the medical history and dubious injuries. Information relating to past occurrences of a similar or related nature of abuse must be recorded. The menstrual history where the child is female and there are allegations of sexual assault should also be recorded.
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The medical officer conducting the examination shows the time and examinations to be conducted on the child. It also indicates how the observations should be analyzed. He or she indicates the medical and mental health services that the child needs in the document. A medical record, an audio tape or a video tape can be used to record the interview in coordination with an attorneys office with regard to the law.
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After the interview, the medical examiner can go ahead and conduct a physical examination of the child. Before the examination is carried out, the medical officer ought to notify the child about the nature of tests that will be conducted. Considering that a child might be anxious about being interrogated or examined, the examiner keeps on reminding him or her on what is to come next and how long the whole process will take.
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The health care officer assesses the degree of physical assault and neglect. Other factors such as self-inflicted injuries must also be investigated. Equipment like the optical glass binocular may be used to assess the degree of abuse.
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Any sign or behavior related to child abuse noted after the careful assessment is documented. This may include injuries inflicted during the course of an assault or the behavior of the child after the assault.
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On occasions where a child refuses to collaborate and the examination must be conducted due to a high probability of trauma or infection, the child is seduced. In these circumstances, close monitoring of the child is required.
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The examiner then employs different techniques in examining the child with allegations of child abuse. This can help him or her make a relevant and a reliable determination after evaluating the findings in the examination.
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The next step after the physical examination is to conduct tests to confirm the findings. For instance, for a sexually assaulted child, the examiner can perform a test for STDs or AIDS. Here, the examiner must consider which STD or AIDS test to be used. This can be determined by factors such as the age of the child, the time lapse from the last instance the child was sexually assaulted and suggestive symptoms of STD among others. Pregnancy tests can also be conducted to determine if the sexually abused child got impregnated after the assault, or if the girl has developed menarche.
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The next step is diagnosis. The medical examiner in collaboration with a multi-disciplinary team must come up with the most efficient and reliable option in diagnosing the child. The multi-disciplinary team approach plays a significant role in providing guidelines or solutions to child abuse cases.
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They can seek advice from child abuse specialists to get information about evaluation and treatment in difficult cases.
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The medical examiners then provide relevant feedback concerning the progress of the child. They can do this by conducting follow-ups and comforting the victim, as well as the family.
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Mental health professionals are also invited to support children with allegations of child abuse by providing them with moral support.
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The next step is to seek legal and child protective services agencies. The people involved in assaulting children must not go unpunished. They are criminals and ought to be punished for their evil acts.
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After reporting the child abuse case to the agencies, medical examiners then provide the evidence related to the case to the relevant authorities. They provide detailed records, audio or visual recordings, and photographs among others to the social services or protective agencies. With this evidence, the medical examiners testify in a court or during civil cases as this will determine the fate of the suspected abusers.
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Legal proceedings can take effect after finding the criminals guilty of child abuse acts.
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The medical personnel continue with follow-ups so as to reassure the child and his or her parents.
References
Adams, J., A. (2001). Evolution of a classification scale: medical evaluation of suspected child sexual abuse. Child Maltreat, 6(1), 3136.
Friedrich, W.N., Fisher, J.L., Dittner, C.A., Acton, R., Berliner, L., Butler, J.,& Wright, J. (2001). Child sexual behavior inventory: normative, psychiatric, and sexual abuse comparisons. Child Maltreat. 6(1), 37 49.
Heger, A., Emans, S., J., & Muram, D. (2000). Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas. 2nd ed. New York, NY: Oxford University Press.
Heger, A., Ticson, L., Velasquez, O., Bernier, R. (2002). Children referred for possible sexual abuse: medical findings in 2384 children. Child Abuse Neglect. 26(6-7), 645659.
Heppenstall-Heger, A., McConnell, G., Ticson, L., Guerra, L., Lister, J., Zaragoza, T. (2003). Healing patterns in anogenital injuries: a longitudinal study of injuries associated with sexual abuse, accidental injuries, or genital surgery in the preadolescent child. Pediatrics, 112(4), 829 837.
Krugman, R., D., & Bross, D., C. (2002). Medicolegal aspects of child abuse and neglect. Neurosurg Clin N Am. 13(2), 243246.
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