Medical examinations

Consideration should always be given to the need for a medical examination of each child for whom there are concerns about abuse.

When co-ordinating child protection investigations there may be the need for a medical examination with the appropriate Medical Specialist Group paediatrician. Agreement needs to be reached on the timing and location of the examination. Although a medical examination is not a requirement in every investigation, it needs to be considered regardless of whether the child has any apparent or visible injuries or appears to have been neglected. The medical examination should be dispensed with only if those managing the investigation are satisfied that they can achieve the purposes of the investigation without it. Those reasons will need to be clearly recorded.

Presentation to GP

On any occasion when a child is presented at a GP surgery and suspicion is aroused as to whether injuries are non-accidental, the GP must refer the child to the Medical Specialist Group paediatricians and contact the MASH immediately.

Escorting a child to a medical examination

The GP, social worker and police need to consider who is best placed to take a child for a medical examination, balancing potential distress to the child and any evidence required for a criminal investigation. It is vital for the the child to be seen by the paediatrician as soon as possible.

Purpose of medical examination

The purpose of any medical examination or assessment is:

to ensure the child's condition is medically assessed 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.

Ensuring the child's welfare

The child's welfare is the paramount concern and the gathering of evidence must not become an additional source of abuse to the child.

The need for forensic evidence to be obtained should always be considered as secondary to the need for medical treatment of a child.

The examination is both clinical and forensic and should only be undertaken by a suitably qualified paediatrician or a forensic medical examiner. A joint examination may be necessary in some cases.

There should be liaison between police and social workers to avoid the need for repeated medical examinations. The investigating team should fully brief the examining doctor if he or she has been unable to attend the strategy discussion. The social worker will ensure that the appropriate consent for examination has been obtained and will be available for the examination. If consent is not given then legal advice should be sought.

Timescales

If the referral concerns physical injury or severe neglect a medical examination should be arranged, if possible, the same day. In cases of any alleged sexual abuse, which is reported to have occurred within the previous 5 days, a medical examination should be considered, as a matter of urgency. This will be to protect the health of the child and to secure and preserve evidence. Where a medical examination is required but not immediately, this can be arranged to suit the child, family and relevant professionals.

Consent

The doctor should explain the purpose of the examination to the child and parents. The child should have a parent or supportive adult present during the examination (unless he or she has given an informed refusal). The child needs to be told that information gained by examination will be shared with others and may also be read out in court or shared in the children's hearing. The child and parents should always be offered the opportunity of discussing any health issues with a doctor experienced in this work.

If the medical examination is of a child under 16 and concerns physical or emotional abuse or neglect, it is strongly recommended that the consent of the adult with parental responsibility is obtained. This consent must be informed and in writing. A young person of sufficient age and understanding can give his or her own consent but in the face of a refusal from a parent, care must be taken on accepting this consent. Where consent is not readily available or where it is refused by a parent, the matter should be discussed with a children's services lawyer in order to receive legal advice and possible action to obtain a valid consent.

If the medical and forensic examination concerns sexual abuse of a child under 16, the informed consent of the person with parental responsibility and, where appropriate, that of the child must always be obtained in writing by the examining paediatrician.

Where the child is already the subject of proceedings in a court, the consent of the same court is required.

Young people aged 16 to 18 are able to give their own consent. However when police statements are provided care should be taken that this is informed consent and there should also, preferably, be consent obtained from a person with parental responsibility.

In the case of a medical emergency, consent is not required. In exceptional circumstances where it would not be in the best interests of the child to seek the consent of a parent or carer before the medical examination, legal advice must be sought.