Bench Bar Conference 2025
Medical Findings in Child Abuse, Sexual Abuse, Trafficking, and Neglect
Training Resources
Medical Glossary – Pediatric Abuse, Neglect, Trafficking, and Forensic Evaluations
Acute Findings
Recent physical signs of injury—such as redness, swelling, or lacerations—observed during a forensic medical exam.
Why It Matters: Supports child disclosure timelines and helps inform immediate safety or legal intervention.
Anogenital Exam
A specialized medical examination of the genital and anal areas performed by trained pediatric professionals.
Why It Matters: Provides medically sound documentation of findings in a developmentally appropriate, trauma-informed manner.
Anogenital Laxity
Looseness of anal or genital tissues; may be normal or trauma-related.
Why It Matters: Requires careful interpretation by pediatric experts to avoid misjudgment or misdiagnosis in legal proceedings.
Chronic Findings
Evidence of older or healed trauma, such as scarring or healed fractures.
Why It Matters: May indicate ongoing or repeated abuse or neglect over time—important for identifying patterns.
Colposcopy
Use of a magnifying instrument to examine and photograph genital/anal tissues in detail.
Why It Matters: Enhances accurate documentation and allows peer review; helps courts understand subtle, non-visible findings.
Diagnostic Findings
Medical signs that definitively indicate abuse (e.g., STIs in young children, unexplained injuries).
Why It Matters: Strong clinical indicators that may serve as key evidence in both civil and criminal cases.
Failure to Thrive (FTT)
A condition where a child does not gain weight or grow as expected.
Why It Matters: Can be a sign of chronic neglect, medical neglect, or a caregiver's inability to meet basic needs.
Forensic Evidence Collection
Gathering of biological and physical evidence during an exam (e.g., swabs, clothing, photographs).
Why It Matters: Preserves potential evidence while maintaining the child’s dignity and emotional safety.
Forensic Medical Exam (FME)
A medical evaluation that assesses for abuse and collects evidence, performed with trauma-informed care.
Why It Matters: Offers a critical intersection of medical care and legal documentation, ensuring the child is both protected and heard.
Fracture Dating
Estimation of the age of bone fractures via imaging.
Why It Matters: Helps identify whether injuries occurred at different times—often a red flag for abuse or neglect.
Hymenal Variants
Normal anatomical differences in the hymen based on age and development.
Why It Matters: Prevents misinterpretation of normal anatomy as evidence of abuse; requires pediatric expertise.
Human Trafficking Medical Red Flags
Clinical signs like malnutrition, multiple STIs, and restricted communication.
Why It Matters: Helps identify trafficking even when the child does not or cannot disclose; supports MDT investigation.
Multidisciplinary Team (MDT)
A team including medical, legal, CPS, law enforcement, forensic interviewers, and mental health professionals.
Why It Matters: Ensures child-centered, collaborative decision-making; no one works in isolation when interpreting findings.
Non-Specific Findings
Findings (e.g., redness, irritation) that may be caused by various factors, not just abuse.
Why It Matters: Avoids over-pathologizing normal or non-abuse-related findings; supports accurate, fair assessments.
Peer Review (Medical Case Review)
Ongoing review of cases by child abuse medical experts for accuracy and consistency.
Why It Matters: Promotes accountability, prevents bias, and strengthens the credibility of expert testimony.
Penetrating Injury
Trauma involving entry into the body (e.g., vaginal, anal, or oral penetration).
Why It Matters: May be consistent with sexual abuse depending on injury type, age, and child’s history—needs skilled, contextual interpretation.
SANE (Sexual Assault Nurse Examiner)
A nurse with advanced training in forensic exams for sexual abuse survivors.
Why It Matters: Conducts developmentally appropriate, evidence-based exams and plays a critical role on the MDT.
Sentinel Injury
Small but suspicious injuries (e.g., unexplained bruises in non-mobile infants).
Why It Matters: Often an early warning sign of physical abuse; early detection can prevent further harm.
Sexually Transmitted Infection (STI)
Infections like gonorrhea, syphilis, or chlamydia in children.
Why It Matters: Presence of an STI in a prepubescent child is considered diagnostic of sexual abuse.
Tanner Staging
Assessment of a child’s physical sexual development.
Why It Matters: Assists in determining whether physical findings or reported behaviors are developmentally possible or appropriate.
Trauma-Informed Care
An approach that prioritizes safety, emotional well-being, and choice in all services.
Why It Matters: Reduces re-traumatization, supports healing, and builds trust in both the medical and legal process.
Medical Evaluation Information for Parents Brochure
References
Azzopardi, C., Arruda, A., Miguna, A., & Bruder, R. (2024). Child sex trafficking: A model of survivor inclusion and survivor-informed practice. Child Protection and Practice, 3, 100074. https://doi.org/10.1016/j.chipro.2024.100074
Cole, J. (2018). Service providers’ perspectives on sex trafficking of male minors: Comparing background and trafficking situations of male and female victims: C & A. Child & Adolescent Social Work Journal, 35(4), 423–433. https://doi.org/10.1007/s10560-018-0530-z
Denne, E., Suzanne St. George, & Stolzenberg, S. N. (2023). Developmental considerations in how defense attorneys employ child sexual abuse and rape myths when questioning alleged victims of child sexual abuse. J Interpers Violence, 38(23-24), 11914–11934. https://doi.org/10.1177/08862605231189512
Department of Family and Protective Services. (2022). Forensic assessment center network evaluation. https://dfps.texas.gov/About_DFPS/Reports_and_Presentations/CPS/documents/2022/2022-09-01_SB1578_FACN_Report_AppendixB.pdf
Faugno, D., Speck, P., Spencer, M., Giardino, A. (2016). Sexual assault quick reference 2nd edition. STM Learning, Inc.
Finkel, M. A., & Giardino, A. P. (2019). Medical evaluation of child sexual abuse : A practical guide. American Academy of Pediatrics.
Hodgins, E., Mutis, J., Mason, R., Du Mont, J., Hodgins, E., Mutis, J., Mason, R., & Du Mont, J. (2023). Sex trafficking of women and girls in canada: A scoping review of the scholarly literature. Trauma, Violence & Abuse., 24(4), 2363–2378. https://doi.org/10.1177/15248380221094316