By Regan Doleac
APRIL IS NATIONAL CHILD ABUSE PREVENTION MONTH
More than 600,000 children are abused in the U.S each year, according to the National Children’s Alliance. National Child Abuse Prevention Month highlights the importance of families and communities working together to prevent child abuse and neglect. Learn more about efforts to protect children and strengthen families, and how you can get involved, at www.childwelfare.gov/preventionmonth.
The term “forensic medical exam” during a child abuse investigation can invoke a sense of dread and fear in a caregiver’s mind. Misconceptions abound surrounding what the exam and the experience look like. However, these misconceptions are exceptions, not rules, when it comes to the crucial role that the process plays in the investigation of child abuse.
The forensic medical exam serves three primary purposes: providing a reassurance of normality, as able; addressing any ongoing or chronic medical issues; and collecting forensic evidence, as needed. The top priority always is the child’s health, safety and wellbeing. The exam is designed to ensure that the family receives the care they deserve in what is, undoubtedly, one of the hardest things they’ve ever collectively experienced.
PROVIDING REASSURANCE
The ability to understand the physical aspect of what has happened to them, and the reassurance of normality, are paramount factors in a child’s ability to process the events surrounding their abuse. It is important for children to understand that they are not bound by the trauma they’ve experienced and that they, most likely, still look just like other children their age. This understanding alone can be a moving force in the healing process and can alleviate a child’s fear of permanent change.
These factors alone are reason enough to ensure that every suspected child abuse victim has access to, and receives, a child-friendly, developmentally appropriate, non-traumatic physical examination, with the offering of complete laboratory testing for sexually transmitted infection, under the direction of providers who are well versed in the aspects of child maltreatment and pediatric care.
ADDRESSING MEDICAL ISSUES
The need to address any ongoing or chronic medical issues is, by and large, a standard of care for both the forensic evaluation and the evaluation of child abuse. Many children referred for forensic exams may not have access to routine well-child care, and the examination process includes developmentally assessing both the child’s physical, environmental and mental health needs.
Children’s mental and physical health often are deeply intertwined, and while children can’t always tell us what is bothering them, their physical exams often lead us to access other resources for them and their families. The forensic medical provider is, in many cases, the only provider a child has or will encounter. The exam offers a wonderful opportunity to ensure both a child’s acute and preventive care are maintained at a baseline that encourages their health and wellness. The access to proper medical care to address issues amid a life crisis is simply a piece of the puzzle we can’t ignore if we want to offer the best outcome for the child.
COLLECTING EVIDENCE
The forensic medical exam often offers a setting more conducive to acute collection of evidence post sexual assault and a platform for efficient and timely evaluations of physical abuse. The access to forensic photography freezes those findings in time, allowing for thorough investigation despite often lengthy periods of time passing. Sometimes many months, or even years, pass before cases are heard. Photo documentation offers the best evidence of what the child looked like on the day of examination. The immediate evaluation of those children with suspicion of acute trauma or acute abusive incident may just save a life.
While a primary part of the criminal investigation of child abuse, the forensic exam also offers the best opportunity to see the child not simply as a victim of abuse, but as a whole person who deserves the very best medical care available.
Regan Doleac, is a certified nurse practitioner and a certified sexual assault nurse examiner – pediatric with the Children’s Safe Center – University of Mississippi Medical Center. The Children’s Safe Center offers forensic medical evaluations across the state to children who may have been abused or neglected.