Emergencies

baby faceIn cases of suspected child abuse or neglect, knowing when to seek emergency medical treatment in an emergency room (ER) setting is important. This section provides information on how and when to seek emergency or urgent care for child sexual abuse, child neglect or child physical abuse.

Child Sexual Abuse: When To Visit The Emergency Room

To protect the child from unnecessary upset and traumatization, evaluation in an emergency room for child sexual abuse should be reserved only for true emergencies that require immediate medical attention or collection of forensic evidence. This includes:

Child Sexual Abuse Disclosed within 72 Hours of Assault (Emergency)

When a child has disclosed sexual contact, or they have been observed engaging in sexual contact that has occurred within the previous 72 hours, take the child to the Newark Beth Israel Medical Center Emergency Room for an acute medical evaluation and for forensic evidence collection.

What happens next?

  1. In the Emergency Room, your child will be examined and cared for by board certified emergency medicine pediatricians in consultation with the child abuse specialists from the Metro RDTC. In addition to a head-to-toe physical exam to assess acute injuries and any other medical findings, lab tests and treatment may be necessary.
  2. Evidence collection may be necessary. For children over age 13, evidence collection may be done by a Sexual Assault Nurse Specialist (SANE nurse) who will respond to the ER to be part of the team. For younger children, specially trained pediatric ER personnel will handle evidence collection in consultation with Metro RDTC medical experts. The ER physician will notify the Division of Child Protection and Permanency (DCP&P) and law enforcement.
  3. Release from ER / Forensic Interviews. After medical evaluation and evidence collection, the child will be discharged from the ER, if appropriate. After discharge, children over the age of 12 may be asked to make a statement to the local police department in the township where the assault occurred. For young children, a forensic interview will be set up at the Child Advocacy Center in Newark. The members of Metro RDTC will observe the forensic interview and participate in a team discussion regarding the forensic interview.
  4. Follow-up at the Metro RDTC. The DCP&P office will refer a child to the Metro RDTC office located at the Wynona’s House Child Advocacy Center for a mental health evaluation and for medical follow-up. The follow-up medical care is usually necessary within 2 to 4 weeks, or sooner, if acute injuries were present in the ER. At the Metro RDTC, the child receives care in a private medical suite where specialists in child abuse provide appropriate care, support, and treatment for the child and family. The Metro RDTC team arranges further additional care, as needed. Recommendations are made at the time of the visit to DCP&P.

Please note that the Metro RDTC and Child Advocacy Center do not allow perpetrators or non-supportive caregivers on the premises. Children must be accompanied to appointments by a child protection worker, a supportive parent/caregiver, or resource parent.

Child Sexual Abuse: Pain, Bleeding, or Discharge (Emergency)

If a child has vaginal or rectal bleeding, penile injuries, or vaginal or penile discharge and if you suspect this was from sexual contact, then your child needs an urgent/emergent medical evaluation.

There are two options for accessing such care:

  1. If a child is medically stable, the Metro RDTC Child Advocacy Center is the preferred venue for an urgent care visit. At the Metro RDTC, a child will receive care in a private medical suite where medical specialists in child abuse will provide appropriate care, as well as support and treatment for the child and family. You must first report the case to the Division of Child Protection and Permanency (1-877-NJ-ABUSE), who will then contact the RDTC to arrange an urgent referral. Please note that the Metro RDTC and Child Advocacy Center do not allow perpetrators or non-supportive caregivers to be present. Children must come with a child protection worker or a supportive parent or caregiver, or some adult who has the authority to consent for the child’s medical evaluation.
  2. If a child is acutely injured, or if an RDTC urgent visit for a medically stable child cannot be arranged, children should be seen in the Children’s Hospital at Newark Beth Israel Emergency Room. Metro RDTC child abuse specialists will provide consultation to the ER team. Most pediatric offices are not comfortable or trained to handle such cases and should refer the child to the Newark Beth Israel Pediatric Emergency Room for appropriate care.

Child Sexual Abuse: Non-Emergency Situations

RDTC entrance doorIn many situations, a caregiver learns that child sexual abuse has been longstanding but not occurring in the week prior to the child’s disclosure, or may have stopped a long time ago, before the child discloses it. While proper services for both the child and family are needed as soon as possible, this type of disclosure is rarely a medical emergency.

If your child has made a disclosure about longstanding abuse which had not occurred within the week prior to the child’s disclosure, or past abuse that now has stopped, medical services should be provided in the Metro RDTC or, perhaps, at your child’s pediatrician’s office, NOT in the emergency room.

The Metro RDTC provides a safe, comforting and private environment for the family and child in this situation.

If a child makes this type of disclosure, please call the Division of Child Protection and Permanency (DCP&P) at 1-877-NJ-ABUSE (1-877-652-2873), and they will start an investigation which may lead to a referral to the Metro RDTC. A referral from the DCP&P is needed to access services of the Metro RDTC.

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