Sharing and using information before and after a paediatric medical assessment

In any situation where there are concerns that a child is being or has been sexually abused, even if the suspected abuse is not recent, a paediatric medical assessment of the child should be considered. Often taking place at a sexual assault referral centre (SARC) or a children’s health clinic, this assessment is conducted by a specially trained clinician, usually assisted by one or two other practitioners such as crisis workers or play specialists. Its purpose is to:

• assess and support the child’s immediate health and wellbeing
• identify and treat any physical injuries or health needs
• document clinical findings that may be relevant to safeguarding or legal processes
• provide reassurance to the child and caregivers that the child’s body is healthy, where this is the case
• collect forensic samples, when appropriate and with consent.

A paediatric medical assessment is a holistic process. It is not solely about identifying physical signs of abuse; in many cases, the examination of the child finds no forensic evidence even when abuse has occurred. The assessment should be trauma‑informed and considered part of the overall safeguarding response.

In most cases, children are referred for a paediatric medical assessment by the police or children’s social care. A clinician with expertise in child sexual abuse should be involved in deciding whether to make a referral, taking into account the child’s wishes and worries, any symptoms of concern, and any evidential opportunities.

Unless the child has acute healthcare needs (such as bleeding, significant intoxication or other physical injury), a multi-agency strategy discussion between practitioners should take place before the paediatric medical assessment. This discussion should include an appropriate health representative who has clinical experience in assessment where recent or non‑recent child sexual abuse is suspected – or, as a minimum, has consulted a practitioner with that expertise.

Before the assessment, the clinician should obtain as much information as possible about the child, the nature of the concerns, and what (if anything) the child has said. A holistic history will be taken as part of the assessment, but the referring practitioner(s) may be able to provide information in advance which will prevent the need for the child to repeat their account. If other sources of information such as medical records are available, these may provide additional information (about any special educational needs, for example).

It’s important for the clinician to know the language used by the child to describe the abuse. If an Achieving Best Evidence interview with the child has already taken place, information from this should be shared. The clinician also needs to be aware of any actions (e.g. court orders, arrests, legal proceedings) taken or planned by other agencies around the child’s safety and aftercare.

As well as giving the child and their parent(s)/carer(s) advice and information about what will happen next, and providing the opportunity for them to ask questions, the clinician will need to share information from the assessment with other practitioners.

On the same day as the assessment, the referring practitioner(s) should receive a provisional report containing some findings and recommendations. This report sets out the clinician’s professional opinion at that time of the likelihood of abuse, based on the history and examination of the child. This may have an impact on investigations and safeguarding actions, and may include suggestions for siblings or other children. In particular, the provisional report should highlight any immediate safety concerns.

As soon as possible afterwards, a child protection medical report should be sent to children’s social care and/or the police. It contains the clinician’s professional opinion of the likelihood of sexual abuse being the cause of the child’s presenting signs and symptoms, and how they came to arrive at that opinion.

While the exact content will vary for every child, the child protection medical report typically includes the following:

Background information

• Reason for referral.
• Relevant medical and developmental history.
• Any disclosure or account given by the child or caregiver (not a formal interview).

Assessment details

• Who was present during the assessment.
• The child’s presentation, behaviour or emotional state.
• Findings from a physical, genital, anal and/or general health examination (even if no physical signs of possible abuse were found), including findings of sexually transmitted infections.
• Any injuries or marks noted, with diagrams or photographs where appropriate.

Forensic elements (when applicable)

• Whether forensic samples were taken.
• Type of samples (e.g. clothing, swabs).
• Any considerations about timing and evidential value. (Being aware of forensic timelines will help the police to conduct their investigation.)

Medical interpretation

• Professional opinion and explanation of how the findings should be understood within safeguarding practice.

Health needs and follow‑up

• Treatment provided (e.g. emergency contraception).
• Mental health or emotional wellbeing concerns.
• Recommendations for follow‑up medical care.

Safeguarding recommendations

• Risks identified.
• Suggested actions for the multi‑agency partnership.

Not all members of the multi-agency network will need access to the full report, or to the detail contained within it. Children’s social care or the police should ensure that access to the information in the report is proportionate and guided by the child’s needs, the safeguarding purpose, and legal requirements.

Finally, a court report may be written if the case goes to court; it often takes the form of answering specific questions put to the clinician by the court.

Information that should not be shared with all partners includes:

• full diagrams or photographs (usually for police and clinical teams only).
• highly sensitive details that do not impact another agency’s safeguarding role.
• information not relevant to the purpose for which it has been requested.

Different pieces of information from the paediatric medical assessment will be more of less relevant to different agencies, and the following is not intended as an exhaustive list.

Social work practitioners can use the information to:

• complete robust risk assessments by understanding whether injuries, medical findings or the child’s presentation raise concerns about ongoing risk from the person of concern or others
• plan effective safety measures such as supervision arrangements, protective actions or immediate safeguarding steps, based on any medical indicators of harm or neglect
• identify unmet health or emotional needs, so that the wider impact of the abuse can be understood and referrals can be made to appropriate support services
• contextualise the child’s voice and behaviour, as the medical findings may help explain anxiety, distress or health symptoms that appear during social work involvement with the child.

The officer in the case will rely on medical information to:

• inform their investigative strategy, including decisions about suspect interviews, timing of Achieving Best Evidence interviews, and prioritisation of forensic opportunities
• understand forensic timelines, helping to determine whether evidence may still be recoverable, or guiding decisions about additional forensic actions
• ensure victim care during investigations, as awareness of the child’s health or emotional needs enables police to adapt their engagement with the child appropriately.

Schools may need selected information in order to:

• adjust safeguarding arrangements such as supervision plans, restrictions on contact with certain individuals, or increased monitoring
• support attendance and learning, especially if the child has physical symptoms, medical follow-up appointments or emotional responses which may affect their ability to learn or access education
• provide appropriate pastoral support, ensuring that – without accessing unnecessary medical detail – staff understand when the child may be more vulnerable, distressed or in need of reassurance.

Other health practitioners benefit from access to relevant information so they can:

• be aware of the child’s health issues such as sexually transmitted infections, other physical health issues, and emotional wellbeing concerns
• ensure continuity of care such as follow-up testing, vaccinations, mental health support or treatment of injuries
• coordinate with specialist services so that timely referrals are made to paediatric follow-up, child and adolescent mental health services (CAMHS), sexual health services, physiotherapy, or therapeutic support.
• monitor developing symptoms or needs, particularly where the medical findings may indicate the need for longer-term emotional, psychological or physical health interventions.

Early Help and community-based practitioners can use information from the assessment to:

• provide targeted support linked to the child’s wellbeing, such as emotional regulation, family support or practical assistance.
• understand the child’s vulnerabilities, so that interventions such as safety planning and community activities can be tailored appropriately.
• avoid re‑traumatisation, as practitioners can approach conversations sensitively and avoid unnecessary repetition if they know that the child has undergone a paediatric medical assessment.