Forensic Medical Exams

Sometimes a doctor needs to examine foster kids to gather evidence to be used in court when allegations of abuse or neglect are made.  This is called a forensic  medical exam.  Here’s what one is like.

Child Protective Services will request that a particular doctor examine a particular child.  Where we live, the county uses a special unit at a children’s hospital.  The foster parent takes the child to that clinic.

The waiting room is small, but has lots of toys to keep kids busy.  While the foster parent fills out paperwork, someone comes to explain to the child what the exam will be like.  I forget what the exact title for that person, but it’s a child specialist whose job is to keep a child calm during a medical exam.  She does this by first showing the child different medical instruments and showing him/her what they are for.  Then she talks about the exam, using easy-to-understand terms.  “You will wear a hospital gown that opens in the back.  It’s like putting on a jacket backwards.”  “The doctor will look at your skin from head to toe.”

During the exam, the doctor begins at the head and works his way down, documenting any injuries, such as bruises, cuts, burns, scars, etc.  He will set a ruler next to the injury and take a photo to document the size and severity of the injury.  He will also use the stage of healing to determine how frequently injuries are occurring.  If physical abuse is particularly severe, the doctor may take x-rays to see if there is evidence of previous broken bones.  If sexual assault is suspected, the exam may include swabbing genitals for evidence of semen or hairs.  If severe neglect is suspected, weight and blood work showing nutritional deficiencies may be ordered.

During the exam, the foster parent can be present if the child feels comfortable with them in the room.  The child specialist will be charged with distracting the child during the exam.  At our clinic, she uses an iPad with games on it.  And if a child becomes anxious during a particular part of the exam, she will redirect their attention to the game or ask them a question or otherwise distract them.

At the end of the appointment, the child gets to pick out a toy to take home.

The forensics doctor usually only gives the foster parent a cursory read out – something really general like diagnosis suspected child, bruises and burns.  You can get a fuller report from the social worker, who may say something like the number of injuries, what may have caused them (e.g. cigarettes).

The medical report will be used by the county to substantiate their claims of abuse or neglect.  This helps the judge determine whether the county was justified in removing the child from his/her home.  The medical report may also be used to prosecute a criminal case, if the county decides to file charges against parents for the maltreatment of their child.

We really like our local forensics pediatrician.  You would be surprised, but kids actually kinda have fun.  They get to play video games and get a nice toy (think remote control car, teddy bear, etc.).  The exam doesn’t include any vaccinations, so no shots – a bonus in most kids’ minds.

Bottom line:  It may seem scary to take a child to a forensics pediatrician to have their injuries documented, but really it’s not bad at all.  I recommend foster parents go along and keep calm, lending their strength to these young children in need.

You (yes you!) CAN Parent an Abused Child

How do you parent a physically abused child?  Cute-as-a-button, 8-year-old Watchful has had a tough week, and I thought I’d share how we dealt with abuse-related behavior that came up to give you a sense of just how “doable” foster parenting can be.

Scenario:  Fear of Playing Outside

Last Saturday, we told all four kids it was time to play outside since it was a beautiful, sunny day.  Silent One, Sassy, and Joyful all ran out and began pulling out sidewalk chalk, bikes, and a kick ball.  Watchful lingered behind, begging to stay inside.  Since we could tell he was stressed, we opened up the garage door and said Watchful could play in the garage (hubby’s man cave occupies half of the space, so there’s room to play).  We stayed nearby.  At first, Watchful did ok, but then he hid and began to cry.  Time to take him inside.  He was too upset to talk, so we waited until later when he was calm.  When he could talk, he explained that he felt like he was going to pass out and die when we asked him to play outside.  Ah ha – diagnosis panic attack.  We discussed things he could do next time he had a panic attack.

Parenting Techniques:

Here are the parenting techniques broken out into individual pieces so you can see what steps to take for any similar situation.

1)  Expose to healthy activities.  When we asked Watchful to play outside, we were encouraging physical exercise and social interaction.

2)  Modify “normal” activities as needed.  When Watchful had a hard time being outside, we modified outdoor play to mean in the garage, which is close to the desired behavior, but scaled back to make it easier on him (i.e. “baby steps” in the right direction).

3)  Be present during hard times.  We stayed in the garage with Watchful, because his emotions were heightened.  Feeling big emotions can mean a bumpy road ahead, so sticking around can help calm a child.  Being present also positions parents to be there when needed.

4)  Remove from trigger.  Abused children can have triggers that remind them of past scary events.  To find triggers, look for heightened emotional states (crying, hiding, lying, hitting, etc.) which are a kid’s signal that something big is going on inside them.  What happened right before the behavior?  That’s the likely trigger.  Remove the trigger to help the child calm down.  We could see that even being in the garage was too much for Watchful, so we took him inside.

5)  Talk when they can hear.  Kids in the middle of big emotions cannot process information well.  Help them calm down before trying to figure out what’s really going on.  One of the best ways to calm a child is to be calm yourself.  Your peaceful attitude is contagious and reassures them that everything is going to be ok.  You may need to wait minutes or hours.  We waited seven hours until Watchful was fully back in control of himself.

6)  Diagnose.   When a kiddo is calm, ask them to describe how they felt.  I asked Watchful was his heart pounding, did his tummy hurt, etc. to get a sense of what was happening with his body.  I asked about what he was thinking or doing right before these symptoms happened.  From his physical description of “feeling like he was going to pass out and die” when he walked outside, I could tell this was a panic attack.

7)  Label.  Traumatized kids may not be able to identify their feelings well.  Sometimes it’s because of their developmental stage or because the feeling is so overwhelming.  Other times, it’s because their abusers told them not to feel scared/angry/sad.  Or  because what the kids feel is too painful.  Or because kids had to “numb” their feelings in order to hide the abuse.   When asked what he thought happened, Watchful self-diagnosed his problem as “being bored.”  By careful questioning, I was able to let him know that what he was describing sounded more like scared than bored.  This labeling of the feeling is important, so a child understands himself better and can better communicate to caring adults about what’s going on inside them.  Now, Watchful will be more likely to understand that when his heart pounds and he feels like he’s going to pass out and die, that what he is feeling is scared.

8)  Validating.  Since abused kids sometimes are not sure if it’s ok to feel the way they do, it’s important to validate their emotions.   I told Watchful that being scared can be overwhelming, but it is ok to sometimes feel that way.

9)  Give coping skills.  The last thing I did was give Watchful ideas for what he can do the next time he feels that way.  He can go to a trusted adult like a foster parent or a teacher.  He can put on a hoodie and block out everything going on by pulling the hood over his face.  He can distract himself with a favorite toy.  This way he feels like he has some control over the feelings, rather than the feelings controlling him.

Writing this post took me longer than the actual parenting interaction.  It took two minutes to realize Watchful was being triggered, a few minutes to get him inside and playing a video game to calm down, and once he was ready to talk, about 10 minutes of talking.

See?  You can TOTALLY do this!