CHAMP Referral Guidelines

These guidelines are intended to assist in deciding when to seek medical consultation for suspected child maltreatment. They serve only as guidelines and sound judgment is needed in every situation.

Sexual Abuse/Assualt

If there is suspicion that a child has been sexually abused or assaulted with direct physical contact, an evaluation by a child abuse medical professional is recommended.


Urgent Evaluations


In the following situations, the child should be evaluated immediately:

  • The last suspected abuse or assault occurred recently (within past 72 hours for children under age 13 or within past 120 hours for those age 13 and older)
  • The child is reporting genital/anal pain or bleeding
  • The child is exhibiting significant mental health concerns (e.g., self-harm, suicidal behavior)

The urgent medical evaluation should include consideration of the possible need to gather forensic evidence. The evaluation should be done at the closest center with experience in evaluating acutely (or recently) sexually abused/assaulted children.


Non-Urgent Evaluations


Outside of the above time frames or serious conditions, evaluations should occur at the most experienced, child friendly environment within the community. Typically, this is the local children’s advocacy center. The timing for these evaluations should be the next available appointment.


Sexual abuse/assault evaluation center locations can be found at:

Physical Abuse

A child’s medical and mental health status, aside from possible forensic concerns, may require an immediate medical evaluation. In addition, there may be forensic reasons to gather evidence as soon as possible.


Urgent Evaluations


Any indication of physical injury and suspected child abuse should be evaluated immediately at the nearest emergency department. In the following situations, the child should be evaluated immediately:

  • Any sign of a possible head injury (e.g., lethargy, irritability, change in consciousness, difficulty walking or talking)
  • Recent burns
  • Possible broken bones
  • A child with abdominal pain, abdominal bruising, or other reason to suspect abdominal trauma
  • A child with a recent ingestion of a toxic or illicit substance


Non-Urgent Evaluations


In the following situations, the child should be evaluated within 48 hours, preferably by a child abuse medical professional*:


  • Any bruising in an infant who cannot “cruise” (walk holding onto objects)
  • A concerning or absent explanation for an injury
  • Pattern bruise marks (e.g., loop marks)
  • Any other suspicious bruises
  • Healing burns (eg, from a cigarette, iron)


*If unable to refer directly to a child abuse medical professional, a physician with expertise in evaluating suspected child abuse or neglect, photographs should be obtained for later review. Information on locating child abuse medical professionals in Maryland can be located can be found at:

Child Neglect

There are many circumstances when the assessment and management of child neglect can be enhanced with medical consultation by a physician with expertise in evaluating suspected child abuse or neglect. Unless a child demonstrates an altered mental status or a clearly urgent medical condition, an assessment by a physician expert is usually not urgent. The following are circumstances for which expert medical consultation is recommended:

  • CPS report for medical neglect (e.g., failure/delay to seek medical care, failure to adhere to recommendations for evaluation or treatment)
  • Neglect in children with a chronic disease or condition
  • Neglect in children with a disability or mental health problem
  • Supervisory neglect related to injuries, ingestions, fatalities o Growth concerns – e.g. failure to thrive, severe obesity
  • Concerns of dental neglect

For assistance in locating a child abuse medical professional in your region, please email