Child Protection Medicals - Why Do We Do Them?

Charlotte B Kirk^1,*, Angela Lucas-Herald², Jacqueline Mok³

¹ Community Child Health Department, Royal Hospital for Sick Children, Edinburgh, United Kingdom;
² University of Edinburgh, United Kingdom;
³ Department of Community Child Health, Royal Hospital for Sick Children, Edinburgh, United Kingdom

Correspondence to: Charlotte B Kirk, Royal Hospital for Sick Children, Edinburgh, Dept of Community Child Health, 10 Chalmers Crescent, Edinburgh, EH9 1TS, United Kingdom; charlotte{at}kirkfamily.co.uk

Accepted 29 September 2009

Introduction: Child protection guidelines highlight the importance of medical assessments for children suspected to have been abused. However, the contribution of the medical examination to the outcome for the child has not been evaluated.

Aim: To identify how medical assessments might contribute to a diagnosis of child abuse and to the immediate outcome for the child.

Method: Review of all notes pertaining to medical assessments between January 2002 and March 2006.

Results: There were 4549 child protection referrals during this period, of which 848 (19%) proceeded to a medical examination. 742 (88%) case notes were reviewed. Of the medical examinations, 383 (52%) were for alleged physical abuse, 267 (36%) for sexual abuse, 20 (3%) for neglect. 258 (67%) of physical abuse cases were considered to have diagnostic or supportive findings as compared to 61 (23%) of sexual abuse cases (chi-squared=146.31, P<0.001). In diagnostic or supportive examinations or where there were other potentially abusive concerns identified, 366 (73%) proceeded to further multi-agency investigation and 190 (41%) to case conference. 131 (69%) of these resulted in the registration of the child on the child protection register. Other health concerns were identified in 121 (31%) of physical and 168 (63%) of sexual abuse cases.

Conclusion: In this case series 465 (63%) out of 742 examinations showed signs diagnostic or supportive of alleged abuse or highlighted other abusive concerns. This endorses the view that medical examination is an important component in the assessment of child abuse as it provides information to support or refute an allegation and helps to identify health and welfare needs of vulnerable children.

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