Child and Adolescent Victims

General Information

  • The Technical Guidelines generally address the health care response to, and evidence collection procedures for, adult sexual assault patients. Health care personnel should adapt the procedures set forth in these Technical Guidelines to the special circumstances involved in performing pediatric sexual abuse/assault examinations.
  • Although some children are victims of traumatic sexual assaults, many children are sexually abused in various ways over long periods of time. For the purposes of this section, all types of child sexual abuse will be referred to as child sexual abuse/assault.
  • Several issues are briefly discussed below. The information contained in these sections is not intended to be an exhaustive inventory of concerns or directions. It is intended to provide guidance for health care facilities that examine child sexual abuse/assault patients.

Initial Response – Triage and Intake

  • Children and adolescents whose last sexual contact occurred greater than 72 hours prior to the E.D. visit and who are asymptomatic should be examined by a regional expert medical examiner. If the patient is not examined, arrangement of follow-up care is critical.
  • Typically, a child is brought to the facility by an adult (e.g., police officer, parent or guardian). The accompanying adult should immediately be directed to the emergency/pediatric department, and should be asked to provide a brief history of the abuse/assault to the examiner. It is preferable to have children examined by a healthcare provider trained and experienced in evaluating child sexual abuse/assault victims.
  • In cases involving young children, an accompanying parent or guardian should also be asked to provide the child’s medical history.
  • Adolescents and older children should be encouraged to provide much of their own medical history, as appropriate. Children often will tell examiners things they may not tell in the presence of parents or other adults. To avoid multiple interviews of children about the abuse/assault, a “minimal facts” interview of the child may be appropriate. This type of interview would be especially appropriate if the child’s exam is deferred.
  • Inform the child and her/his parents/guardians about the general nature of the physical examination.

Counseling and Support

A child sexual abuse/assault patient should never be left alone. Arrangements should be made to ensure the presence of a support person who can establish a good rapport with the child. Each sexual assault crisis service has an advocate specially trained to provide support to children.

A support person of the same gender as the child may provide needed reassurance for the child.

Consent for Police Notification-Mandatory Reporting Requirements

  • Known or suspected child sexual abuse/assault should be reported to the police and to the Department of Children and Families (DCF). [CGS §17a-101] (See page 14 and Appendix E)
  • Consult your facility’s policies and procedures and DCF guidelines for making mandated reports. (See Appendix E for sample reporting forms.)

Consent for Examination

  • Consent for the evidence collection examination (verbal will suffice) should be obtained from the parent/guardian of every child under the age of 18 (except as described below). Consent also should be obtained from any sexual abuse/assault patient capable of consenting. No patient should be forced against her/his will to undergo a sexual assault evidence collection examination.
  • In the rare event that the parent/guardian refuses to consent to the examination of the child, and when the child is in danger from her/his surroundings and requires immediate attention, the attending physician can take the child into custody at the hospital for 96 hours. [CGS §17a- 101(g)] This will allow health care personnel to provide diagnosis and treatment, and will allow child protective and law enforcement agencies to investigate any sexual abuse/assault and to protect the child from further immediate danger.
  • Consult your facility’s policies and procedures and DCF guidelines regarding refusals of consent by parents/guardians, and consent from mature minors.

Medical Report Forms and Interviews

The CT100 Medical Report Forms were designed for the documentation of all sexual abuse/assault examinations, regardless of whether the Kit is completed, and regardless of the patient’s age. Additional sheets likely will be necessary for documentation of the interview of a child patient. Any additional sheets should be attached to the Medical Report as instructed. (See pages 22 through 27)

Often, the health care person is the first to interview a child patient about the event(s). Interviewing children about any type of abuse/assault requires skill and patience. Interviewing of young children should be deferred to persons experienced in interviewing young children. These interviews are usually conducted by a forensic interviewer with DCF and police observing behind a one-way mirror.

Record the patient’s answers accurately and completely, using the patient’s words. Use additional sheets as necessary to record the patient’s responses.

Presence of Parent or Guardian

The health care person in charge should decide whether the presence of a parent/guardian during the interview or examination is desirable. Some issues to consider are:

  • Whether the presence will cause further confusion and additional trauma;
  • Whether the presence will result in censorship of information sought during an interview;
  • Whether to risk an emotionally distraught or disbelieving response that will negatively impact the child and the interview/examination process.
  • Whether the parent or guardian is the suspected perpetrator. (See below.)
  • If the child expresses a need for support from a parent/guardian, and the parent/guardian is not suspected of being the perpetrator, her/his presence may be appropriate if s/he is supportive to the child.
  • If a parent/guardian is excluded from the interview or examination, s/he should be taken to a private area and provided with support and comfort. The local sexual assault crisis service can provide support for parents as well as children.
  • The interview or examination should never be done in the presence of a parent/guardian who is suspected of being the perpetrator.

Medical/Evidence Collection Examination

  • The medical examination of a child patient should consist of a general physical examination, a genital examination, and where appropriate, the collection of physical evidence. (See below for guidelines regarding when completion of a Kit is appropriate.) Special care and discretion should be exercised in determining when the completion of a Kit is appropriate if the patient is a child.
  • Valuable evidence can be obtained through the physical examination and interview of the child patient. It is important that such an examination and interview be performed, and that the Forms be completed, whether or not the Kit is completed.
  • If the abuse/assault occurred within the prior 120 hours, or if the time frame could not be established, a careful evaluation of the case must be made to decide what, if any, physical evidence should be collected. Evidence should be collected according to the instructions given for adults, on pages 32 though 50, but with the following modifications:
    • Pediatric needles and vacutainers may be substituted.
    • Swabs may be used one at a time rather than using two simultaneously.
    • If a female child patient is too traumatized to undergo a full vaginal/pelvic examination, external vaginal areas should be swabbed. Internal and speculum exams should not be done on pre-menarcheal children.
    • It is recommended that head hair standards not be pulled from a child patient at the time of the initial examination. They can be gathered later, if needed.
    • It is recommended that pubic hairs standards not be pulled from a child patient at the time of the initial examination. They can be gathered later, if needed.

Testing for Sexually Transmitted Infections (STI’s)

  • The presence of a sexually transmitted infection in children is a strong indication of sexual abuse/assault, and the presence of certain STIs might help to link the perpetrator to the crime.
  • Although many infections, such as gonorrhea and Herpes Simplex, can be transmitted to an infant at birth by an infected mother, children beyond the first few months of infancy should be suspected as having been sexually abused/assaulted if an STI is present.
  • A physician or facility must report to DCF upon the consultation, examination or treatment for STI of any child under age thirteen. [CGS §19a-216]