C.M.R. 16, 219, ch. 71, PRE-PUBERTAL CHILDREN INSTRUCTIONS
If questions arise during the collection of evidence from prepubertal children, please contact the Spurwink Child Abuse Program at 1-800-260-6160.
When a forensic examination is performed, it is vital that the medical examination and evidence collection procedures be integrated at all times in order to minimize trauma to the child.
If the alleged perpetrator is a pre-pubertal child, the Office of Child and Family Services should be notified at 1-800-452-1999 (Voice) 711 (TTY). The State of Maine's child abuse hotline is staffed 24 hours a day.
If the assault or last sexual contact occurred within 72 hours prior to the hospital visit, or if the time frame cannot be determined, physical evidence from adolescents (13 years or older) can be collected utilizing the uniform standardized forensic examination kit, according to the instructions given for adults. However, physical evidence from pre-pubertal children should be collected using the following instructions:
* If it is determined that the last sexual contact took place more than 72 hours prior to the hospital visit, it is extremely unlikely that trace evidence will still be present on the child's body. This is most common in situations involving long-term abuse. Therefore, a careful evaluation of each case must be made to decide which, if any, evidence collection procedures should be implemented.
* Regardless of when the last sexual contact might have occurred, valuable evidence can still be obtained through a medical / forensic examination of the child and history from the caregiver and / or child. However, it is important that a child not be asked questions by multiple providers / people. A Sexual Assault Forensic Examiner is the most appropriate provider to care for the child, in consultation with the ED physician and the Spurwink Child Abuse Program medical staff.
* Do not force any steps of the examination and / or evidence collection process.
* The collection of specimens for drug testing is not generally necessary for pre-pubertal children unless they provide a history consistent with drug ingestion, including drowsiness, altered consciousness, memory loss, impaired motor skills, or other symptoms consistent with drug ingestion. If the child presents with these symptoms, head trauma should be considered.
PLEASE NOTE:
[TICK] Unless otherwise noted, do not moisten swabs prior to sample collection. If moistening is required, use only sterile / distilled water.
[TICK] All swabs should be air dried prior to packaging, with the exception of the Known DNA Collection swab, which may be packaged immediately using the plastic aerated cap provided.
[TICK] Unless otherwise noted, place the evidence collection specimens back into the envelope or bag from which they came.
[TICK] All envelopes and bags containing evidence should be sealed. Attach a tracking label to the outside of each envelope or bag and fill out all information requested.
CLOTHING COLLECTION:
[TICK] Clothing may be removed and collected at any point during the examination process. When the patient is ready to disrobe, use the paper sheet from the Foreign Material Collection bag to collect any foreign material by placing the sheet on the floor over a clean facility bed sheet and instructing the patient to stand on it while removing each item of clothing.
[TICK] Collect each clothing item as it is removed and place it in the appropriate clothing bag. Do not shake out the clothing or cut through any existing holes, rips, or stains in the clothing. Air dry any wet or damp clothing if secure facilities are available; otherwise, notify law enforcement personnel that the clothing is wet or damp.
[TICK] Refold the Foreign Material Collection sheet in such a manner as to retain any material present and place it in the Foreign Material Collection bag.
[TICK] If the patient changed his or her clothing after the assault, notify law enforcement personnel so the clothing worn at the time of the assault may be collected.
Step 1. ORAL SWABS
NOTE: Oral swabs should only be collected if the case history indicates oral contact. Oral swabs may be difficult to obtain from very young children.
Carefully swab the buccal area and gum line using the two swabs simultaneously. Be sure to collect the swabs from the upper and lower buccal areas and the gum line, rotating the swabs during collection.
Place the swabs in the swab box and check "Oral".
Step 2. KNOWN DNA COLLECTION
NOTE: Have the patient rinse his / her mouth with water prior to completing this step.
Open the swab protector and slide the protector back to expose the swab head.
Using the swab, vigorously swab the inside of both cheeks for 5 to 10 seconds.
Pull the swab head back into the protector and re-close the protector around the swab head.
Step 3. FINGERNAIL CLIPPINGS / SWABS
NOTE: Do not collect fingernail clippings from young children unless the examination is performed under anesthesia. The fingernails may be swabbed instead.
Remove the folded paper from the envelope and place, unfolded, on a flat surface.
Hold the patient's hands over the paper and gently clip the entire nail, allowing the clippings to fall on the paper.
Refold the paper so as to retain the fingernail clippings.
For young children, use one of the swabs to swab under the fingernails of the right hand and the other swab to swab under the fingernails of the left hand. Allow the swabs to air dry, then place the swabs in the swab box and check "Fingernails".
Step 4. KNOWN HEAD HAIR SAMPLE
NOTE: It is recommended that head hair standards not be taken from pre-pubertal children at the time of the initial examination.
Step 5. DEBRIS COLLECTION
NOTE: This step is provided for the collection of debris such as foreign hairs, fibers, etc. from the patient's body. Do not package debris from different areas of the patient's body in the same envelope; if necessary, use a separate clean facility envelope and make a druggist fold.
Remove the folded paper from the envelope and place, unfolded, on a flat surface.
Collect any debris present on the patient (including the thighs and external genitalia) and place in the center of the paper. Fold the paper so as to retain the debris.
Identify the location from which the samples were removed on the anatomical drawings on the envelope.
Step 6. DRIED SECRETIONS / MISCELLANEOUS SWABS
NOTE: This step is provided for the collection of suspected blood, semen, or saliva which may be present on the patient's body. Carefully examine areas of kissing, sucking, or biting for saliva, and other body areas for ejaculate or other dried secretions. An alternate light source is helpful for locating secretions. Do not package swabs from different areas of the patient's body in the same swab box; use separate swab boxes or clean envelopes from facility stock. Additional swabs are provided in this step for the collection of evidence not covered elsewhere in this kit (e.g. nasal swabs, strangulation swabs).
Lightly moisten two of the provided swabs with sterile / distilled water and thoroughly swab the dried secretion with both swabs.
Allow swabs to air dry, then place the swabs in one of the swab boxes provided.
Mark on the swab box if the swabs are suspected semen, saliva, blood, or other. If other, please describe.
Identify the location from which the samples were removed on the anatomical drawings on the envelope.
If additional swabs are necessary, lightly moisten the other swabs with a minimal amount of sterile / distilled water and thoroughly swab the area making sure to rotate the swabs during the collection procedure. Place the swabs in the other swab box and check "Other". Identify the sample on the line provided and write the area of the patient's body from which the sample was obtained.
Step 7. PUBIC COMBING
NOTE: Instead of collecting pubic hair combings from pre-pubertal children, carefully examine the thighs and external genitalia for any loose hairs or fibers. If any are found, collect according to the instructions given in Step 5 of these instructions.
Step 8. KNOWN PUBIC HAIR SAMPLE
NOTE: It is recommended that pubic hair standards (if present) not be taken from pre-pubertal children at the time of the initial examination.
Step 9. GENITAL / PENILE SWABS
Lightly moisten the swabs provided with 1-2 drops of sterile / distilled water.
Holding the swabs together, gently swab the external genitalia from the mons to the perineum, including along the folds between the labia majora and the labia minora in the female patient. Be sure to rotate the swabs during the collection procedure. With the male patient, swab the entire penis and scrotum. Retract the foreskin if uncircumcised.
Allow the swabs to air dry, then place the swabs in the swab box and check "Genital / Penile".
Step 10. ANAL SWABS
If necessary, lightly moisten the swabs with a minimal amount of sterile / distilled water for the comfort of the patient.
Carefully swab the anus using the two swabs simultaneously.
Allow the swabs to air dry, then place the swabs in the swab box and check "Anal".
Step 11. VAGINAL SWABS
NOTE: NEVER use a speculum of any size on a pre-pubertal child.
For pre-pubertal females, some young adolescent females, and for the female patient who is too traumatized or anxious to have a vaginal examination, evidence specimens can be obtained by gently swabbing the perineum, inner thighs, and external genitalia (including the sulcus, fossa navicularis, and posterior fourchette) using two swabs slightly moistened with sterile / distilled water.
Unless there is evidence of penetrating trauma in the pre-pubertal female, it is not necessary to collect vaginal swabs. If there has been penetrating trauma, vaginal swabs can be obtained during the repair of the trauma while the child is anesthetized. Attempts to collect vaginal swabs on the pre-pubertal female can result in hymenal and / or vaginal trauma that may mimic abuse.
Carefully swab the vaginal vault using the two swabs simultaneously.
Allow the swabs to air dry, then place the swabs in the swab box and check "Vaginal / Cervical."
Step 12. MISCELLANEOUS EVIDENCE
NOTE: This step is provided for the collection of miscellaneous evidence not covered elsewhere in this kit. Do not package multiple miscellaneous items together in the same bag. Use a separate facility paper bag or one of the clothing bags if available.
Collect the item and allow it to air dry if necessary. When dry, place in the paper bag.
Steps 13 and 14. URINE and BLOOD SPECIMENS
NOTE: Generally these specimens will not need to be collected; however, if the patient presents with drowsiness, memory loss, impaired motor skills, etc. or there is a suspicion of a drug used to facilitate rape, follow the instructions provided in the adult instructions.
C.M.R. 16, 219, ch. 71, PRE-PUBERTAL CHILDREN INSTRUCTIONS