This guide is aimed principally at police and/or social care professionals who have referred a child for a paediatric medical examination following suspected sexual abuse, and in part, at those conducting the examination.
It is also relevant to other professionals involved in supporting the child and their family, to help them understand what a medical examination involves.
What is a paediatric medical examination?
In any situation where there are concerns that a child has been sexual abused, a paediatric medical examination – also known as a forensic medical examination or a medical assessment – should be considered.
A medical examination:
- is an opportunity to look for supportive evidence and gather forensic samples in some cases.
- allows for a holistic conversation and assessment of the child’s general wellbeing and health needs.
- should take into account the child’s wishes and worries, any symptoms of concern, and any evidential opportunities.
- should be made in consultation with a health clinician who has expertise in child sexual abuse.
If the child’s last contact with the person of concern was within the previous seven days, the child’s case is designated as ‘acute’ or ‘recent’. If the last contact was more than seven days ago, the case is designated as ‘non-recent’.
How may the child be feeling?
The child is likely to be feeling a range of complex emotions. They may:
- feel generally anxious about having an examination.
- Worry it will hurt.
- Not want to show parts of their body, especially teenagers.
- Feel uncertain about what it will involve or what to expect.
- Welcome the examination if they have been worried and want to ask question.
How can all professionals best help the child before the medical examination?
There are many ways to help the child:
- Establish how soon the examination or assessment will happen.
- Consider the child’s wishes and worries; any immediate health or wellbeing concerns; any complex or communication needs; the child's safety needs during the multi-agency strategy discussion or meeting.
Help the child prepare for the medical assessment or examination
We have developed an informative, evidence-based resource for frontline practitioners in social care, health and police to explain the paediatric medical examination that takes place when there is an disclosure or suspicion of child sexual abuse.
It is important that the child understands that they can make choices and this is about their health and wellbeing. They can bring along a parent or other adult to support them if they wish.
How can the examining health professional best help the child?
The assessment or examination should only be undertaken by a suitably qualified medical professional.
- Try to obtain all the information you can about the child, what the concerns are and what they have said (if relevant).
- It’s important to know the language used by the child to describe the abuse.
- In particular, the police should have given you information from their formal (Achieving Best Evidence) interview with the child, if this has already taken place.
- Be aware of any planned actions by police and children's social care.
- Establish who has parental responsibility for the child for matter relating to consent.
- Consider the child's communication needs.
- Think about how you ask questions, the language you use and your body language.
- Consider diversity and how personal characteristics might increase vulnerability and shape the response to child sexual abuse.
- Take the child’s wishes, concerns and expectations into account, and to listen to and address any worries they have.
- The child should not be asked to repeat the details of the abuse during the examination – but you may need to ask specific additional questions.
- If the child gives you any information during the examination that raises new safeguarding concerns (about additional suspects or victims, for example), share this immediately with the police and/or children’s social care.
- Consider the child's therapeutic and support needs.
- consider referrals for sexual health follow-up support if necessary.
- Consider other forms of harm such as neglect, physical abuse, or domestic abuse.
- Document your observations in line with guidelines.
They should be given choice throughout the examination, including about:
- which aspects (if any) of the physical examination, offered tests and aftercare options they want.
- who (if anyone) they want with them during the examination.
Make a contemporaneous record of any new information that is spontaneously offered by the child, as it may be needed later if the case goes to court. Ensure this is recorded in the child’s own words.
At the end of the examination, provide some immediate age-appropriate feedback.
If the medical examination has not found physical evidence of sexual abuse, take care to explain clearly to the child and any accompanying adult(s) that this is very common, and does not mean that the abuse didn’t occur.
On the day of the medical examination:
- Provide feedback (in writing) to the referring and relevant agencies. This may be a brief summary of the examination’s findings and any recommendations.
- Consider writing to the child too.
- As soon as possible, share a safeguarding medical report with relevant agencies.