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Maryland Department of Health
Maternal and Child Health Bureau (MCHB)
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Ma
ryland CHAMP
The Maryland Child Abuse Medical Providers' Network
Maryland CHAMP has developed the following practice recommendations and resources to assist in the evaluation of and response to suspected child maltreatment. Please use this information in consultation with a child abuse medical expert.
Peer review recommendations
In order to assure the highest quality of care for Maryland children, CHAMP recommends that ALL clinicians who evaluate children for suspected maltreatment participate in peer review.
Click here to access CHAMP's Peer Review Recommendations
.
Web-based peer review
When evaluating children for physical or sexual abuse, it is highly recommended to use TeleCAM to enable peer review and to document the physical findings. TeleCAM is a secure and HIPAA-compliant Web-based application that allows Maryland health care professionals to upload case information (including photographs) and receive rapid feedback from Maryland CHAMP faculty. Anyone with Internet access is able to use TeleCAM.
Maryland health care professionals, who evaluate children for suspected maltreatment and who would like to participate in this valuable peer review system, please contact CHAMP Program Manager,
Sara Lewis
, to learn more and/or sign up for a TeleCAM account.
If you are unable to use TeleCAM, CHAMP recommends at least using the following forms in conducting medical examinations for evaluating possible child abuse:
Physical Abuse Evaluation Form
Sexual Abuse Evaluation Form
For information and guidelines for evaluating different aspects of maltreatment, please access the
CHAMP Physician's Handbook (2008)
.
Individual sections of the CHAMP Physician's Handbook can be accessed below.
CHAMP Handbook Chapter 1: Introduction to Child Abuse Assessments
CHAMP Handbook Chapter 2: Evaluating Sexual Abuse
CHAMP Handbook Chapter 3: Evaluating Sexual Assault
CHAMP Handbook Chapter 4: Evaluating Cutaneous Trauma
CHAMP Handbook Chapter 5: Photographing Injuries
CHAMP Handbook Chapter 6: Evaluating Burn Trauma
CHAMP Handbook Chapter 7: Evaluating Skeletal Trauma
CHAMP Handbook Chapter 8: Evaluating Head and Other Internal Injuries
CHAMP Handbook: Elements of Child Abuse History
CHAMP Handbook: Protocol for Forensically Sensitive History from a Child
CHAMP Handbook: Guidelines for Age-Appropriate Interview Questions
CHAMP Handbook: Elements of a Child Abuse Physical Examination
CHAMP Handbook: Patterned Bruises
CHAMP Handbook: Ancillary Studies in Physical Abuse
CHAMP Handbook: Indications for Sexually Transmitted Infection Testing
CHAMP Handbook: Films in a Skeletal Survey
CHAMP Handbook: Fractures Suspicious for Abuse Given Context
CHAMP Handbook: Distinguishing Spill or Splash Burns from Immersion Burns
CHAMP Handbook: Important differential diagnoses of child physical abuse
CHAMP Handbook: Child Abuse Diagnostic Assessment
AMERICAN ACADEMY OF PEDIATRICS
Policy Statements
The American Academy of Pediatrics (AAP) Committee on Child Abuse and Neglect periodically issues policy statements on important areas of practice.
Please access all American Academy of Pediatrics Policy Statements pertaining to child abuse and neglect
.
Abusive Head Trauma in Infants and Children
(5/09, reaffirmed 3/13)
Caregiver-Fabricated Illness in a Child: A Manifestation of Child Maltreatment
(9/13)
Child Abuse, Confidentiality, and the Health Insurance Portability and Accountability Act
(1/10)
Distinguishing Sudden Infant Death Syndrome from Child Abuse Fatalities
(7/06, Reaffirmed 1/10, 3/13)
Evaluating Children with Fractures for Child Abuse
(1/14)
Evaluating for Bleeding Disorders in Suspected Child Abuse
(4/13)
Evaluating for Suspected Child Abuse: Conditions that Predispose to Bleeding
Technical Report (4/13)
Evaluation of Children in the Primary Care Setting when Sexual Abuse is Suspected
(8/13)
Evaluating Infants and Young Children with Multiple Fractures
(9/06, under revision)
The Evaluation of Children in the Primary Care Setting When Sexual Abuse Is Suspected
(7/13)
Evaluation of Sexual Behaviors in Children
(9/09, reaffirmed 3/13)
Evaluation of Suspected Child Physical Abuse
(6/07, reaffirmed 5/12, under revision)
Failure to Thrive as a Manifestation of Child Abuse
(11/05, Reaffirmed 5/09)
Intimate Partner Violence
(5/10)
Maltreatment of Children with Disabilities
(5/07)
Oral and Dental Aspects of Child Abuse and Neglect
(12/05, Reaffirmed 5/09)
Psychological Maltreatment
(7/12)
Recognizing and Responding to Medical Neglect
(7/12)
The Evaluation of Sexual Behaviors of Children
(9/09)
The Pediatrician's Role in the Prevention of Child Maltreatment
(9/10)
Understanding the Behavioral and Emotional Consequences of Child Abuse
(9/08)
When is Lack of Supervision Neglect?
(9/06)
American Academy of Pediatrics Clinical Report:
Postexposure Prophylaxis in Children and Adolescents for Nonoccupational Exposure to Human Immunodeficiency Virus
The AAP Clinical Report,
Post Exposure Prophylaxis in Children and Adolescents for Nonoccupational Exposure to Human Immunodeficiency Virus (2003)
,
reviews accidental exposure to HIV in children and adolescents and provides recommendations for PEPs in those circumstances. This report includes an algorithm (found below) to assist in the assessment. Any decision to start PEPs should made with the child, family and “a clinician experienced in HIV exposure and management.”
The decision to start HIV nPEP should not be delayed while awaiting HIV testing of the alleged perpetrator unless results can be returned within 1 hour. When testing alleged perpetrators, consent must be obtained as per usual.
When 28 days of PEP have been completed, the medication is normally stopped. Follow up blood tests must be done to assess HIV status.
Fig 1.
Possible exposure to HIV in children and adolescents: algorithm for decision-making for use of PEP.
Pediatrics June 1, 2003 vol. 111 no. 6 1475-1489
AMERICAN ACADEMY OF RADIOLOGY
The American Academy of Radiology's guideline on performing skeletal surveys on children.
Journal of the American College of Radiology; Volume 8, Issue 2, February 2011, Pages 87-94
ACR Appropriateness Criteria® on Suspected Physical Abuse—Child Review Article
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