• English

    Google Translate Disclaimer

    The Maryland Department of Information Technology (“DoIT”) offers translations of the content through Google Translate. Because Google Translate is an external website, DoIT does not control the quality or accuracy of translated content. All DoIT content is filtered through Google Translate which may result in unexpected and unpredictable degradation of portions of text, images and the general appearance on translated pages. Google Translate may maintain unique privacy and use policies. These policies are not controlled by DoIT and are not associated with DoIT’s privacy and use policies. After selecting a translation option, users will be notified that they are leaving DoIT’s website. Users should consult the original English content on DoIT’s website if there are any questions about the translated content.

    DoIT uses Google Translate to provide language translations of its content. Google Translate is a free, automated service that relies on data and technology to provide its translations. The Google Translate feature is provided for informational purposes only. Translations cannot be guaranteed as exact or without the inclusion of incorrect or inappropriate language. Google Translate is a third-party service and site users will be leaving DoIT to utilize translated content. As such, DoIT does not guarantee and does not accept responsibility for, the accuracy, reliability, or performance of this service nor the limitations provided by this service, such as the inability to translate specific files like PDFs and graphics (e.g. .jpgs, .gifs, etc.).

    DoIT provides Google Translate as an online tool for its users, but DoIT does not directly endorse the website or imply that it is the only solution available to users. All site visitors may choose to use alternate tools for their translation needs. Any individuals or parties that use DoIT content in translated form, whether by Google Translate or by any other translation services, do so at their own risk. DoIT is not liable for any loss or damages arising out of, or issues related to, the use of or reliance on translated content. DoIT assumes no liability for any site visitor’s activities in connection with use of the Google Translate functionality or content.

    The Google Translate service is a means by which DoIT offers translations of content and is meant solely for the convenience of non-English speaking users of the website. The translated content is provided directly and dynamically by Google; DoIT has no direct control over the translated content as it appears using this tool. Therefore, in all contexts, the English content, as directly provided by DoIT is to be held authoritative.


    Maryland CHAMP

    The Maryland Child Abuse Medical Providers' Network

    Child Maltreatment Medical Consultation - Referral Guidelines

    Sexual Abuse/Assault Physical Abuse Child Neglect
    These guidelines are intended to help CPS and law enforcement decide when to seek medical consultation for suspected child abuse and neglect. They serve only as guidelines and careful judgment is needed in every situation.
    Acute sexual abuse or assault is defined as:
    • Any sexual abuse or assault of a child or adolescent that occurred less than 72 hours (3 days) before, with anal or genital skin contact
    • Assault or abuse in a pubertal female (has started menstrual cycle) within 120 hours (5 days) - if genital body fluid exchange may have occurred
    Non-acute sexual abuse or assault is defined as:
    • Abuse or assault that occurred outside the above time frames
    Recommended Approach
    • All acute child sexual abuse/assault cases need to be transported to an appropriate sexual abuse/assault evaluation center with experience in evaluating sexually abused/assaulted children for an urgent medical evaluation and possible forensic evidence collection. Notify and coordinate with local law enforcement for transport to appropriate facility.
    • Any non-acute sexual abuse or assault that presents with any of the following conditions should also be seen urgently in an evaluation center.

    ·     Current signs or symptoms of possible physical abuse associated with sexual abuse
    ·     Serious mental health problem (e.g., suicidal, severely depressed or mentally unstable).  The evaluation should focus on the mental health problem, not the examination for sexual abuse
    ·     Current serious anogenital complaint – (e.g., pain, non-menstrual bleeding. Itching or discharge don’t require urgent care)
    • All non-acute sexual abuse/assault cases should be evaluated in the most experienced, child friendly environment in the community. Typically, this is the local Child Advocacy Center. The timing for the evaluation should be the next available appointment.
    Indications for a medical evaluation of non-acute sexual abuse/assault in children include:
    • An abnormal exam from an outside institution
    • Disclosure of possible perpetrator contact with child’s genital/anal area and/or child contact with perpetrator’s genital/anal area, including any contact by genitals, finger or object
    • A report of genital discharge, or prior bleeding or discomfort/pain following possible abuse, even if that has since resolved.  If the child still has pain or bleeding, refer immediately to the local sexual assault center
    • A report of prior anal bleeding or discomfort following possible abuse that has since resolved.   If the child still has pain or bleeding, refer immediately to the local sexual assault center
    • Parental concern
    • Any concern for injury raised during a skilled interview
    • Another child in household with a sexually transmitted infection
    • Another child in a child care setting with a sexually transmitted infection – if there is suspicion that abuse occurred in that setting
    • A sibling with a report of sexual abuse and possible contact with an alleged perpetrator
    Sexual abuse/assault cases that may not need a medical exam after a forensic interview and consultation with an experienced child abuse specialist include:
    • Old history of fondling, without pain or bleeding
    • A child living in the same household as an alleged victim or perpetrator, if that child has NO history suggestive of abuse, and has provided a credible denial of abuse during a structured forensic interview
    • Abusive acts that clearly do not include physical contact (e.g., taking pornographic photos/videos of child; having child view pornographic photos/video; voyeurism)
    A child’s medical and mental health status is key to determining the need for emergency, urgent or less urgent health care.  In addition, there are forensic considerations, as evidence may be lost (e.g., bruises fade).  The following is a guide to the timing of the forensic medical evaluation.
    • The following conditions should be evaluated immediately at the nearest ED:
    • Any child with a change in mental status (e.g., not acting right)
    • Any child with a loss of consciousness
    • Any signs of head trauma including bruising, swelling, or redness on the face, head or ear in a child under 1 year old with a history suspicious for abuse, or no adequate explanation for the injury
    • Large burns; burns located on the face, genitals, hands, or feet; and/or burns that wrap around any body part
    • Any burn on a child less than 3 years of age
    • Broken bone (fracture) with concerning or no explanation for injury
    • A child with abdominal pain, abdominal bruising, or other reason to suspect abdominal trauma (e.g., child severely beaten)
    • Any child with serious concerns about safety/protection or severe illness
    • A child with a recent ingestion of a toxic or illicit substance
    The following conditions should be medically evaluated urgently (within 12-24 hours), by a child abuse specialist, if possible*:
    • Bruising in an infant who cannot “cruise” (walk holding onto objects)
    • Any suspicious bruising on a child who is less than three years old or developmentally delayed
    • Small, localized burns (cigarette, iron) that newly or recently occurred
    The following conditions should be medically evaluated non-urgently (within 24-48 hours) by a child abuse specialist, if possible*:
    • Suspicious bruising in a child over 3 years old and developmentally normal
    • Pattern bruise marks
    • Healing localized burns (cigarette, iron)
    *If unable to refer to child abuse specialist urgently, photographs should be obtained and reviewed by child abuse specialist.
    In addition, consider evaluation by a child abuse specialist for:
    • Follow-up of any child with an inconclusive hospital evaluation for physical abuse
    • Siblings of a child who has been physically abused, according to the following guidelines:
    • Siblings under the age of 3 must receive a medical evaluation by a child abuse specialist

      Strongly consider requesting skeletal survey
      For infants less than one year, strongly consider head CT
    • Siblings 3-6 years old—strongly consider medical evaluation by either Child Abuse Pediatrician or child’s primary care practitioner
    • Siblings 6-10 years old—consider medical evaluation based on concerns raised by child and/or caregivers, school, etc.
    There are many circumstances when the assessment and management of child neglect can be enhanced with medical consultation by a physician specialist in child abuse and neglect.
    • While the concern with physical health may be a priority, expert consultation can also inform assessments where children’s mental health, dental health and development may be affected.
    • In general, such consultation is not urgent as neglect reflects patterns of inadequate care or children’s needs not being met over time.  Nevertheless, it is helpful if the consultation is sought early during the assessment.
    • In most situations, a physical examination is not needed for the consultation.
    • The consultation will usually hinge on the availability of a comprehensive history and medical records, particularly from the child’s primary care provider.  It may often be helpful if the consultant confers with the primary care provider.
    • The following are circumstances for which expert medical consultation is recommended:

    CPS report for medical neglect (e.g., failure/delay to seek medical care, failure to adhere to recommendations for evaluation or treatment)

    Neglect in children with chronic diseases or conditions

    Neglect in children with disabilities or mental health problems

    Supervisory neglect related to injuries, ingestions, fatalities

    Failure to thrive, growth problems, severe obesity

    Concerns of dental neglect

    Concerns regarding hygiene, sanitation, lack of basic utilities (e.g., heat) that may affect children’s health

    CHAMP Links
    About Us
    What's New?
    Practice Recommendations
    ​Referral Guidelines
    Training for Non-Medical Providers
    Contact us