This summary guide is aimed principally at the police officer and/or social worker who have referred a child for a paediatric medical assessment following suspected sexual abuse, and at those conducting the assessment. It explains what they can do to best support the child before, during and after the assessment.
It is also relevant to other practitioners involved in supporting the child and their family, to help them understand what a medical assessment involves.
What is a paediatric medical assessment?
In any situation where there are concerns that a child has been sexual abused, whether the abuse last took place within the last seven days (known as ‘acute’ or ‘recent’ cases of abuse) or longer ago, a paediatric medical assessment – also known as a forensic medical examination – should be considered.
A medical assessment is more than just a physical examination. It:
- 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
The decision to conduct a medical assessment or not should be made in consultation with a health clinician who has expertise in child sexual abuse.
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 about what has happened to them and want to ask questions.
It is important that the child understands that they can make choices, and that thye assessment is about ensuring their health and wellbeing. They can bring along a parent or other adult to support them if they wish.
How can the child best be helped before the medical assessment?
If you are the Officer in the Case and/or social worker involved in making the referral, there are many ways to help the child:
- Establish how soon the examination or assessment will happen.
- During the multi-agency strategy discussion or meeting, consider the child’s wishes and worries, any immediate health or wellbeing concerns, any complex or communication needs, and what is needed to ensure their safety.
- Help the child prepare for the medical assessment. Watch our video to familiarise yourself with what will happen, so you can answer any questions the child has – and if the assessment will take place at a sexual assault referral centre (SARC) or a children’s health clinic, find out whether it has age-appropriate literature which you can share with the child.
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.
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 (if anything) they have said.
- 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 the police and children's social care.
- Establish who has parental responsibility for the child in relation to consent.
- Consider the child's communication needs.
- Think about how you ask questions, the language you use and your body language.
- Consider how the child’s personal characteristics might increase their vulnerability and shape their response to their abuse.
- Give the child choice throughout the assessment, 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 assessment/examination.
- Take the child’s wishes, concerns and expectations into account, and listen to and address any worries they have.
- Do not ask the child 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.
- Look for possible signs of other forms of harm such as neglect, physical abuse, or domestic abuse.
- Document your observations in line with guidelines.
- Make a contemporaneous record of any new information that the child spontaneously offers, 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 assessment, 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 same day that you have carried out the medical assessment:
- Provide feedback (in writing) to the referring and relevant agencies. This may be a brief summary of the assessment’s findings and any recommendations.
- Consider writing to the child too.
As soon as possible, share a safeguarding medical report with relevant agencies.
External links
- Achieving best evidence in criminal proceedings: Guidance on interviewing victims and witnesses, and guidance on using special measures [Ministry of Justice]
- Authorised Professional Practice: Further investigation [College of Policing]
- The Victims’ Code [Ministry of Justice]
- Guide to establishing urgency of sexual offence examination [Faculty of Forensic & Legal Medicine]
- Consent to treatment: Children and young people [NHS]
- Guidance for best practice for the management of intimate images which may become evidence in court [Faculty of Forensic & Legal Medicine/Royal College of Paediatrics and Child Health]