More Information about Child Protection and Well-Being
Medical evaluations may take place in an outpatient clinic, or in the hospital for those children who need inpatient hospitalization. We usually see clinic patients on the 10th floor of Doctors’ Office Tower, and visit inpatients in their hospital rooms.
Each medical evaluation takes at least an hour but is often longer depending on the situation, and includes:
- A detailed history from each caregiver present;
- A developmentally appropriate history from the child, if possible;
- A thorough physical examination;
- Photography of any visible injuries;
- Review of lab results and radiology studies already performed or additional studies ordered as needed; and
- A discussion of the findings with the caregivers present.
After the in-person medical evaluation, our clinicians review all the available information, including medical records, lab results and images. We speak with other medical specialists as needed to reach the most accurate medical diagnosis.
Teaching is an important part of our role. Every day we teach families about injuries and the effects of violence and neglect on a child. We also educate other medical professionals about signs and symptoms of abuse and neglect. We instruct investigators about injury mechanisms, and help those involved in child care recognize and respond to concerns about abuse and neglect. We are frequently subpoenaed as expert witnesses in court, helping judges and juries understand child abuse and neglect.
How is a child referred for evaluation?
Inpatient consultations require referral from one of the medical providers on the child’s treatment team. This referral may be suggested by DCS, SW or family, but the medical team will make the ultimate decision.
Outpatient (clinic) consultations require referral from the child’s primary care provider or another medical provider, or from an investigating agency (Child Protective Services or law enforcement). A referral form should be completed and sent to our office for review prior to scheduling the appointment.
Why does my child have to be seen by you? We like our regular doctor.
Unfortunately, this area of medicine requires special training and expertise that many clinicians – no matter how good – don’t possess. Our physicians have gone through fellowships in the field, and our nurse practitioners have had extensive training and experience. Our clinicians do more of these evaluations in a month than most providers do in years.
Also, we are a truly multidisciplinary team, working closely with pediatric social workers, radiologists, intensive care physicians, pediatric orthopedists and pediatric surgeons among others as needed.
What should I tell my child?
That will depend on your child’s age and level of understanding. You can tell your child that the evaluation may be longer than those at the regular doctor, and that there will be a lot of talking. Most importantly, you can tell your child that this is to help keep him or her as healthy and safe as possible.
Although it is natural to want your child to tell you what happened, our clinicians are trained to ask questions in a specialized way to get the important details while minimizing additional trauma.
If your child does tell you about what happened, be a supportive listener by reassuring your child of your love, and that it’s not your child’s fault.
How else can I prepare for an appointment in your clinic?
Since the clinic visit may be long, please bring any necessities for your child, such as formula, snacks, diapers, books or toys.
You may be asked to bring recent medical records or X-rays ahead of time for our clinicians to view.
Your will need your child’s insurance card at registration.
Will this traumatize my child? He/she has already been through enough.
We recognize this important issue and will take any steps necessary to minimize trauma. We watch carefully for signs of emotional trauma and may change the order of the evaluation or skip parts if necessary. Our social worker can help with this, and our hospital’s Child Life staff may also become involved.
Why do you need to see medical records?
We look carefully for any signs or symptoms of a medical condition that could mimic abuse, prior concerning injuries and medical evaluations that may have already been performed.
Why does my child need X-rays if there are no signs of a broken bone?
Young children, especially those under 2, may have fractures (broken bones) that caregivers do not know about. Young children may not be able to tell you that something hurts inside. Sometimes the symptoms they show could be confused with normal childhood problems such as colic or viral infections.
Do you only see abused and/or neglected children?
Children are referred to us because someone became concerned about the possibility of abuse and/or neglect. After a full evaluation our team may be able to diagnose a child with something else, such as an accidental injury or a medical condition that may look like abuse and/or neglect. In some cases, uncertainty remains even after the evaluation.
Will my child have to come back to see you again?
In most situations, children are seen in our clinic only once. In specific circumstances we do request repeat visits to monitor weight or healing of injuries, depending on your child’s issues. For children seen by us while in the hospital, we will follow along with the primary team during the hospitalization and, depending on the circumstances, may see the child as an outpatient for follow-up.