Consider a medical examination

A medical examination is a physical, psychiatric, psychological or dental examination, assessment or procedure. It includes forensic examination and an examination or assessment carried out by a health practitioner, as defined in the Child Protection Act 1999, schedule 3.

During the investigation and assessment, a medical examination, or a specialist assessment by a health professional may be considered necessary to:

• ensure the child’s immediate health and safety
  or
• inform the investigation and assessment outcome.

Wherever possible, before the medical examination or assessment, speak to the child about the incident or injury of concern, to allow opportunity for:  

• the child to speak in a more relaxed environment before experiencing what may be an intrusive examination
• any disclosure made by the child to be shared with the medical practitioner and potentially corroborated by evidence obtained in the medical examination or assessment
• information to be provided to help prepare the child for the examination or assessment and to find out whether the child requires any support to assist them in the process.

Consider arranging a medical examination of the child in the following circumstances:

• the child is reluctant to show an injury
• the injury is in the genital area
• the child’s condition or injury does not appear consistent with the explanation given by the parent
• the child’s age or physical and intellectual development does not appear consistent with the parent’s explanation of the injury or condition
• a medical practitioner’s expertise is required to provide additional information, such as
  • an assessment of the impact of long-term neglect on the child
  • a developmental assessment of the child
  • a diagnosis of a suspected disability.

Arrange an urgent medical examination

Arrange an immediate medical examination of any child who:

• appears ill, is in a poor physical condition or is dehydrated
• has an altered state of consciousness
• has obvious serious physical injuries
• is manifesting significant abnormalities of behaviour or ideation
• has allegedly been sexually abused
• is an infant who
  • displays a lack of response to stimuli, alterations in breathing or temperature, poor feeding, irritability or lethargy
  • is alleged to have suffered significant trauma or shaking—especially a child under 2 years of age
  • has bruises.

In most circumstances, it is preferable that a paediatrician with child protection experience carries out the medical examination.

Always seek parental consent to have the child medically examined. If the parents will not consent, the Child Protection Act 1999, section 97 allows a medical practitioner to carry out an examination or treatment without consent of the parents if:

• a child at immediate risk has been taken into custody (Child Protection Act 1999, section 18)
• a TAO, CAO or TCO authorises the examination or treatment.

In this situation, the medical practitioner must:

• not override the rights of the child in relation to the examination or treatment
• only carry out treatment that is reasonable in the circumstances
• provide a report about the examination or treatment to Child Safety, or to the QPS.

Inform the child

Consider the best way to inform the child and seek their views about the need for a medical examination. This may involve helping a parent to explain the need for the medical examination to the child or arranging other support the child may need to proceed with the examination.

A child should not be forced to have a medical examination. The decision to proceed will be made by the examining doctor, depending on the:

•  child’s age and Gillick competence
•  need for immediate treatment.

Determine the appropriate time for the examination

For urgent matters, arrange an immediate medical examination. In all other circumstances, to ensure timely medical examination and treatment, arrange the medical examination as soon as possible after sighting or interviewing the child.

A medical examination after an alleged sexual assault must occur within 72 hours for the collection of evidence.

Ensure sufficient planning with medical professionals (and the QPS if relevant) to co-ordinate interviews and medical examinations. If the QPS is not involved, ensure the interview of the child and the medical examination occur in the most appropriate order in the circumstances.

Arrange for a parent to attend the examination

Make sure that a parent, or someone nominated by the parent, or nominated by the child depending on the child's age and ability to understand the examination, always accompanies the child to the medical examination. This is important, to ensure relevant medical history of the child and family is provided and the child has appropriate support. The person to accompany the child to the examination for this purpose cannot be:

• a CSO, even if nominated by the parent
• a parent or other person suspected of causing serious injury to a child.

If a child has been taken into custody under the Child Protection Act 1999, section 18, or is subject to a TAO, CAO or TCO that authorises a medical examination or grants custody of the child to the chief executive, do not prevent a parent from attending the child’s medical examination—unless it is decided that their attendance would jeopardise a criminal investigation or expose the child to harm or the child does not want them to attend.  

If powers under the Child Protection Act 1999 are used to authorise the medical examination or treatment, still make every effort to encourage and assist the parents to attend the medical examination—unless this would jeopardise a criminal investigation or expose the child to harm.

A CSO may transport and accompany the child and parent or nominated person to the appointment; however, they cannot transport the child unaccompanied by the parent or their nominated person unless the child is subject to a TAO, CAO or TCO.

Record the outcome of the examination

Record the details and results of the child’s examination in ICMS. If a written report is also provided by the medical practitioner or specialist, place a hard copy on the child’s paper file, and attach the report to the investigation and assessment event in ICMS.

The results of medical examinations that occur during the investigation and assessment are to be included in the comprehensive health assessment. This will ensure the comprehensive health assessment is adequately informed and avoids the duplication of medical examinations or treatment. (Refer to Procedure 5 Develop a child health passport.)