10.12.02.04

.04 Alleged Child Sexual Abuse Victim Care.

A. The professional involved in the care of the victim of alleged child sexual abuse shall make every effort to minimize additional physical or emotional trauma to the child.

B. The following protocol is recommended for the initial assessment:

(1) A history of the child shall be obtained from the parent, guardian, or custodian separately from the child, if possible, and shall:

(a) Minimize repetitive questioning of the child;

(b) Recognize that the child is often threatened and afraid to tell; and

(c) Include a review of behavior relevant to sexual abuse;

(2) A physician or forensic nurse examiner shall perform a thorough pediatric physical examination on the child in the presence of a supportive adult not suspected of being party to the abuse and a physician or forensic nurse examiner shall:

(a) Use gentleness, time, sedation, or general anesthesia if absolutely necessary;

(b) Note evidence of physical abuse and injuries;

(c) Avoid internal anogenital examinations except when internal injuries are suspected;

(d) Perform a gender specific examination on the male child to include:

(i) Examining thighs, penis, scrotum, testes, and anus for evidence of injury and infection, and

(ii) Noting Tanner stage;

(e) Perform a gender specific examination on the female child to include:

(i) Examining thighs, labia majora and minora, clitoris, urethra, hymen and vaginal wall (especially posteriorly) for evidence of injury and infection and noting horizontal hymenal opening diameter;

(ii) Maintaining a frog-leg position during the examination; and

(iii) Noting Tanner stage;

(f) Perform a routine pelvic examination on the postpubertal female child only if the victim has had a previous pelvic examination;

(3) Depending on the specifics of the individual case and exercising best professional judgment, a physician or forensic nurse examiner may perform a rape examination if the child is seen within 120 hours of alleged sexual abuse, and the examination shall:

(a) Include only applicable parts of the rape kit; and

(b) Maintain the chain of custody of evidence;

(4) The physician or forensic nurse examiner shall obtain laboratory tests when the tests are indicated from information obtained through the child's history or physical examination;

(5) A psychological assessment shall include:

(a) A review of what happened to the child from the child's perspective;

(b) The use of play, dolls, or drawings as a way for the younger child to communicate what happened to the child;

(c) An assessment of the effect of the alleged sexual abuse on the child; and

(d) A developmentally age-appropriate description of the psychological findings and any indications for follow-up care;

(6) An interview with a parent, guardian, or custodian shall include a:

(a) Review from the parent's, guardian's, or custodian's understanding of the alleged child abuse;

(b) Description of any behavioral manifestations that may be observed in the child such as fears, clinging, sleep disturbances, bed-wetting, somatic complaints, or school problems; and

(c) Discussion of anticipated medical or investigative follow-up, or both, pursuant to Family Law Article, Title 5, Subtitle 7, Annotated Code of Maryland;

(7) Professionals qualified to gather information and evidence as part of the initial assessment include:

(a) A physician;

(b) Qualified hospital health care personnel;

(c) A mental health professional; and

(d) An interdisciplinary team expert in the field of child abuse.