Why does my child need a medical evaluation?
We recommend that all children who may have been abused receive a medical examination by a pediatric child abuse specialist in a child-friendly environment. These physicians have special training in performing and documenting these special types of exams. The overall purpose of the medical evaluation is to ensure the health and well being of your child. The doctor should be able to diagnose and treat medical conditions related to abuse and to distinguish these from conditions that mimic abuse. Children who have been abused often worry that they are different from other children. The exam will reassure your child that everything is OK with their body. The medical evaluation is also an opportunity to document any significant physical and forensic findings. The exam is recommended even if the abuse happened long ago.
What should I do to prepare my child for the visit?
Do not question your child about the concerns of abuse. That information is best obtained by the forensic interviewer. It is fine to say to your child, “You can tell them anything that’s bothering you; it’s OK.” Reassure your child that you are not angry or upset with them. Explain to your child that they are going to a special doctor for a checkup of their whole body, including their private parts. Reassure them that you will be with them during the exam if that is what they wish. Have your child bring a favorite toy or comfort item. It helps if your child is well rested and has had a snack. The more relaxed you are, the more relaxed your child will be.
What will happen during the visit?
First, you will check in with our family advocate or the doctor for the appointment. Please bring your child’s Medicaid card or insurance card if you have one. The doctor will weigh, measure, and take vital signs as per routine. The doctor may want a urine sample from your child, so please tell the advocate or the doctor before your child uses the bathroom in the medical room. You should not have to wait long for the doctor, but expect the entire visit to the clinic to be as long as 2 hours.
The doctor will speak to you and your child together briefly to explain what will happen. Depending on the age of your child, the doctor may want to speak to you and your child separately. During this time, the advocate can sit with your child while the doctor speaks with you alone.
In most cases, you will be allowed to stay with your child during the exam. An exception might be if your child is old enough and requests to be alone during the exam. Your child will receive a general head to toe physical exam, much like what they experience when seeing their own doctor. If there are physical injuries visible, the doctor will probably take digital photographs. When parents or caregivers are in the exam room, they are asked to focus on supporting their child and to refrain from asking questions about physical findings or answering questions the doctor asks directly to the child.
The genital exam involves an external look at your child’s genital area using an instrument called a colposcope. The colposcope does not touch your child’s body and is not felt by your child, but provides good light and magnification as well as the ability to photograph injuries if needed. While the colposcope is not inserted into the child’s body and does not touch the skin, the doctor will need to touch the child’s genital and anal areas. The exam does not hurt your child. It is important to understand that a child’s genital exam is different and less invasive than an adult pelvic exam. No speculum will be used to examine the vagina. Children are never forced and are given as much time as necessary to feel comfortable with the exam. If your child is very resistant, the exam can be rescheduled for a later date or not done at all. A child will often allow the exam to proceed when reassured that the decision to have the exam is entirely their own. Know that your child will be treated with respect and dignity.
Will the exam show if my child has been sexually abused?
Not necessarily. Research shows most children have no physical injuries to their genital and/or anal area following abuse. The vast majority of exams will result in a normal and healthy finding for your child. This does not mean or “prove” that no sexual abuse or contact occurred. The medical exam can, however, help to corroborate what a child has said happened.
What happens after the exam?
Your doctor will speak with you after the exam to explain any findings and any further tests or treatments needed. The doctor may recommend testing your child for sexually transmitted diseases or pregnancy, which can be done at the end of your visit. With your consent, in several days the doctor will share the medical report with your child’s primary care physician and any relevant investigating agencies. Remember that in order to protect children, health care providers are mandated by law to report suspicion of child abuse. Your physician may share your child’s medical record with law enforcement or the Department of Human Services.
What should I tell my child after the exam?
Some children are embarrassed about having a medical exam. It is helpful to explain to your child that the doctor is there to make sure their body will be fine and to keep them healthy. Your child does not have to share private information about their body with others after their exam if they do not want to. If your child is young, you will want to make sure your child understands this exam was not a game to be played with others at home. There are children’s books that can help explain privacy and safe touch to your child.