1. The medical investigation as part of the assessment
Andrea Goddard
Consultant Paediatrician
London
Co-Funded by the European Union

2. Outline Medicolegal reasons- gathering evidence
Why do a medical assessment after disclosure of/or suspected child sexual abuse?
Medicolegal reasons- gathering evidence
Health issues arising from the abuse
General health issues
Reassurance = by far the most important!
Medical contribution to multi-agency planning for the child and judicial processes

3. My setting London Population: almost 9 million*
Children under 18 years: ~ 2 million*
Central acute, forensic sexual assault service ‘ The Havens’
Local services - 33 separate authorities or ‘boroughs’)
Childhouse initiative in London - come to my talk tomorrow

4. Medicolegal reasons- gathering evidence
Forensic/DNA - swabs taken by doctors, police undertake analysis
Injuries - intimate images - documentation and photography by doctors
Sexually transmitted infections - tested for as part of evidence gathering (and treatment/reassurance)
? Strength of evidence base in children

5. Health issues arising from Sexual abuse
Management of:
Risk of Pregnancy
HIV, Hepatitis B transmission
STI transmission (can = evidence also)

6. General health and welfare issues
Initial holistic health assessment
E.g ? Neglect - dental caries and/or other unresolved health issues that need sorting out
On going support- follow-up assessments, psychological support
Contribution re health issues to multi-agency planning for the child

7. THE MOST IMPORTANT REASON!
Reassurance that everything is normal (in > 90-95% cases of CSA in children)
Child and parent often traumatised by the idea of ‘damage’ to the body
Therapeutic to know from a medical assessment that all is normal - can be start of the victim’s and carer’s on-going coping with the psychological trauma of abuse
N.B important to include a strong statement that ‘normal is normal’ in child sexual abuse medical assessments in medico-legal correspondence

8. Thank you andrea.goddard@nhs.net References:
The Physical Signs of Child Sexual Abuse: An evidence-based review and guidance for best practice,
01 May 2015, Publisher: Royal College of Paediatrics and Child Health (RCPCH)
2. Sexual Assault – A Forensic Clinician’s Practice Guide. Catherine White, ISBN
3. Heger A, Ticson L, Velasquez O, Bernier R
Children referred for possible sexual abuse: medical findings in 2384 children.
Child Abuse Negl Jun;26 (6-7):