Education for Child Abuse Medical Providers, CHAMP Program, www.champprogram.com

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Child Abuse Case 21

The police brought a 4-year-old girl to a child advocacy center. She had disclosed that her mother's boyfriend had touched her genital area with his fingers. The incident occurred 75 hours prior to arrival at the CAC. She denies observing ejaculation or having genital-to-genital contact. She has bathed and changed her clothes. There are no suspicious ano-genital findings.

The medical staff should:

Not collect forensic evidence because the disclosure is of fondling.
Consider collecting forensic evidence because DNA may still be isolated despite a lack of factors associated with evidence detection.
Not collect forensic evidence because she has bathed and the incident occurred greater than 24 hours ago.
A and C

The answer is B.

Factors associated with identification of evidence of sexual assault include performance of the examination within 24 hours, collection of the evidence from an unbathed child, a history of perpetrator ejaculation and/or a history of genital-genital or genital-anal contact, acute ano-genital findings and perpetrator age greater than 18 years. However, forensic evidence can be detected when these factors are not present and there may be no other indicator for abuse other than a partial or incomplete disclosure.

Because children often have normal examinations even when sexual abuse has occurred, the lack of examination findings does not preclude collection of forensic evidence. The perpetrator’s saliva or semen may be found on the child’s body, clothing or linens. Evidence may be isolated even when the child has bathed. If forensic evidence is collected, it is important to ask the police to collect the clothing that the child was wearing at the time of the incident for inclusion in the evidence for the crime laboratory and DNA testing.

Local protocols using "time" since the incident as a major factor in determining whether or not to collect forensic evidence should be flexible and allow for collection beyond 24 hours. In some cases, DNA has been isolated several days after the event occurred. In most cases, a 96-hour limit is probably sufficient.

There is often a poor correlation between a child’s description of the acts and the isolation of forensic evidence. Therefore, in this case, there may have been additional, undisclosed sexual contact and answer A is incorrect. Because recent studies have demonstrated that conducting evidence collection in the pediatric population may result in the isolation of DNA beyond 24 hours, answer C is incorrect.

For further information regarding triaging cases of suspected sexual abuse, click on CHAMP Practice Recommendations: Triage in Resources below.

References
Jenny C. Emergency evaluation of children when sexual assault is suspected. Pediatrics. 2011;128(2):374-375.

Floyd R, Hirsh D, Greenbaum V. Development of a screening tool for pediatric sexual assaults may reduce unnecessary emergency department visits. Pediatrics. 2011;128(2):221-226.

Thackeray J, Hornor G. Benzinger E, Scribano P. Forensic evidence collection and DNA identification in acute child sexual assault. Pediatrics. 2011;128(2):227-232.

Girardet R, Bolton K, Lahoti S, et al. The collection of forensic evidence from pediatric victims of sexual assault. Pediatrics. 2011;128(2):233-238.

Resources
CHAMP Practice Recommendations: Triage (PDF)

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