Pediatrics

Prepubertal (pediatric) childFor the purposes of this practice protocol, “the pediatric population are prepubescent children” (meaning those children under 18 years of age who have not reached puberty). “A child’s stage of pubertal development is determined by assessing secondary sexual characteristics rather than chronological age. Although the onset and timeline of the pubertal process is unique to each child, the stages are identifiable and predictable” (DoJ, 2016, p. 9). More: “The pediatric population addressed in this protocol are solely prepubescent children” under 18 years of age who have not reached puberty. “A child’s stage of pubertal development is determined by assessing secondary sexual characteristics rather than chronological age. Although the onset and timeline of the pubertal process is unique to each child, the stages are identifiable and predictable” (DoJ, 2016).

Child patients, under 18 years of age, should be seen by specially trained medical forensic professionalsA licensed medical professional (registered nurse, nurse practitioner, physician’s assistant or physician) who has completed forensic education and clinical requirements that meets or exceeds the Department of Justice recommended standards outlined in “A National Protocol for Sexual Assault Medical Forensic Examinations - Adults/Adolescents Second Edition,” and/or the minimum standards required for certification as outlined by the Texas Attorney General in "Initial SANE certification guide," which includes:
• Adult/adolescent patient
• 40 hours of didactic education that me... More. If there is not a specially trained medical forensic professional available, medical forensic history, assessment and acute evidence collection should be completed. Patient should then be referred to a pediatric forensic expert for additional assessment. Assessment findings and documentation should be reviewed and discussed with a pediatric forensic expert, if possible.

All prepubertal children should have an assessment regardless of:

• When the assault occurred (or was thought to have occurred), and
• What the child stated occurred. Sometimes children may give caregivers only a small portion of what occurred (McElvaney, 2015). Highly trained SANEs, specially trained medical forensic professionals and child abuse pediatricians have the expertise and training to establish trust with pediatric patients and ask questions more appropriate to obtaining a history.

Complete medical forensic assessment examinations can elicit:

• Additional medical findings,
• Patient’s history of new or additional information,
• Information regarding sexually transmitted infections, or
• The presence of other victims.

Additional References:

• A National protocol for sexual abuse medical forensic examinations: Pediatric (2016)
• National best practices for sexual assault kits, a multidisciplinary approach (2017)
• The biological evidence preservation handbook: Best practices for evidence handlers (2013)