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:
CHAMP Locating Professionals |
LifeBridge Health
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:
CHAMP Locating Professionals |
LifeBridge Health
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 CHAMP@lifebridgehealth.org