<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.12.02.04" title_num="10" subtitle_num="12" chapter_num="02" heading="Alleged Child Sexual Abuse Victim Care.">
  <paragraph num="A.">
    <text>The professional involved in the care of the victim of alleged child sexual abuse shall make every effort to minimize additional physical or emotional trauma to the child.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The following protocol is recommended for the initial assessment:</text>
    <paragraph num="(1)">
      <text>A history of the child shall be obtained from the parent, guardian, or custodian separately from the child, if possible, and shall:</text>
      <paragraph num="(a)">
        <text>Minimize repetitive questioning of the child;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Recognize that the child is often threatened and afraid to tell; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Include a review of behavior relevant to sexual abuse;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A physician or forensic nurse examiner shall perform a thorough pediatric physical examination on the child in the presence of a supportive adult not suspected of being party to the abuse and a physician or forensic nurse examiner shall:</text>
      <paragraph num="(a)">
        <text>Use gentleness, time, sedation, or general anesthesia if absolutely necessary;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Note evidence of physical abuse and injuries;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Avoid internal anogenital examinations except when internal injuries are suspected;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Perform a gender specific examination on the male child to include:</text>
        <paragraph num="(i)">
          <text>Examining thighs, penis, scrotum, testes, and anus for evidence of injury and infection, and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Noting Tanner stage;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(e)">
        <text>Perform a gender specific examination on the female child to include:</text>
        <paragraph num="(i)">
          <text>Examining thighs, labia majora and minora, clitoris, urethra, hymen and vaginal wall (especially posteriorly) for evidence of injury and infection and noting horizontal hymenal opening diameter;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Maintaining a frog-leg position during the examination; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Noting Tanner stage;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(f)">
        <text>Perform a routine pelvic examination on the postpubertal female child only if the victim has had a previous pelvic examination;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Depending on the specifics of the individual case and exercising best professional judgment, a physician or forensic nurse examiner may perform a rape examination if the child is seen within 120 hours of alleged sexual abuse, and the examination shall:</text>
      <paragraph num="(a)">
        <text>Include only applicable parts of the rape kit; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Maintain the chain of custody of evidence;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>The physician or forensic nurse examiner shall obtain laboratory tests when the tests are indicated from information obtained through the child's history or physical examination;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>A psychological assessment shall include:</text>
      <paragraph num="(a)">
        <text>A review of what happened to the child from the child's perspective;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The use of play, dolls, or drawings as a way for the younger child to communicate what happened to the child;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>An assessment of the effect of the alleged sexual abuse on the child; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A developmentally age-appropriate description of the psychological findings and any indications for follow-up care;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>An interview with a parent, guardian, or custodian shall include a:</text>
      <paragraph num="(a)">
        <text>Review from the parent's, guardian's, or custodian's understanding of the alleged child abuse;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Description of any behavioral manifestations that may be observed in the child such as fears, clinging, sleep disturbances, bed-wetting, somatic complaints, or school problems; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Discussion of anticipated medical or investigative follow-up, or both, pursuant to Family Law Article, Title 5, Subtitle 7, Annotated Code of Maryland;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>Professionals qualified to gather information and evidence as part of the initial assessment include:</text>
      <paragraph num="(a)">
        <text>A physician;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Qualified hospital health care personnel;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A mental health professional; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>An interdisciplinary team expert in the field of child abuse.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>