All children who are suspected victims of child abuse should be assessed to determine the need for a medical evaluation. Medical evaluations should be required based on specific screening criteria developed by skilled medical providers or by local multidisciplinary teams which include qualified medical representation.
A medical evaluation holds an important place in the multidisciplinary assessment of child abuse. An accurate history is essential in making the medical diagnosis and determining appropriate treatment of child abuse. Recognizing that there are several acceptable models that can be used to obtain a history of the abuse allegations and that forensic interview techniques are specialized skills that require training, information gathering must be coordinated with the MDT. Because children learn early the helping role of doctors and nurses, they may disclose information to medical personnel that they might not share with investigators.
Physicians, nurse practitioners, physician assistants and nurses may all engage in medical evaluation of child abuse. Some CACs have expert evaluators as fullor part-time staff while others provide this service through affiliation with local hospitals or other facilities. Programs in smaller or more rural communities may not have easy access to qualified examiners and may develop mentoring or consultative relationships with experts in other communities. Photographic documentation of examination findings is the standard of care. Photodocumentation enables peer review, continuous quality improvement, and consultation. It may also obviate the need for a repeat examination of the child.