Too few children see a medical examiner despite suspicion of violence
Only a minority of children involved in reports of violence get a medical examination. A new report from the Department of Forensic Medicine suggests that, as a result, children who may have suffered violence are overlooked. “To us, it is obvious that all children involved in reports of violence should as a minimum be offered a forensic examination,” says the researcher responsible for the report.
In Denmark, when an adult is exposed to violence, e.g. an assault, the person is typically examined to identify potential injuries. The examination is a part of the police investigation and used as evidence in court.
But the same does not apply to children who are exposed to violence. Only 3.8 percent are examined by a doctor in case of suspicion of violence by a family member, and only 2.3 percent are examined by a medical examiner.
This is because most of them are not offered an examination – unlike adults, who are offered a medical examination when they report the crime.
A new report from the Department of Forensic Medicine shows that a lot more children than the 3.8 per cent who currently get a medical examination have bruises that suggest that they have been exposed to violence. The report is the result of a two-year research project.
I have mostly seen scars caused by objects you are likely to have at home such as mobile chargers, kitchen utensils and belts
The project is a collaboration between the Department of Forensic Medicine at the University of Copenhagen, the refuge Børnehus Hovedstaden and the Copenhagen Police. In connection with the project, 200 children whom the police suspected of having been exposed to violence at home underwent a forensic examination.
“In more than 25 per cent of the children, the medical examiner found bruises or other signs of violence on the child’s body,” says Professor Jytte Banner from the Section of Forensic Pathology at the University of Copenhagen’s Department of Forensic Medicine.
“The result of the report speaks for itself. We should systematically offer all children involved in reports of violence a forensic examination,” says Jytte Banner.
There are currently no guidelines for when the police must request a forensic examination in cases of suspicion of violence against a child.
“It is worrying that children do not enjoy the same degree of follow-up and thus the same legal rights as adults,” says Consultant Doctor Anne Birgitte Dyhre Bugge from the Section of Forensic Pathology at the University of Copenhagen’s Department of Forensic Medicine, who has contributed to the project.
Specialised in examining bruises and scars
“Medical examiners have specialised in examining signs of violence, both new and old ones,” says Consultant Doctor Anne Birgitte Dyhre Bugge.
She therefore argues that it is important to make sure that children who may have been exposed to violence are examined by a medical examiner and not a regular doctor.
“Doctors who have not specialised in forensic medicine focus on elements that require treatment, and because of the doctor-patient relationship they do not enjoy that degree of objectivity that is so central in criminal cases,” says Anne Birgitte Dyhre Bugge.
As a rule, you cannot tell the difference between a bruise caused by a fall and one caused by violence. Instead, you have to compare the bruises on the body to the child’s story, their age and level of activity as well as the location of the bruise, Anne Birgitte Dyhre Bugge explains.
In more than one fourth of the children examined, the medical examiner found signs of violence, typically in the form of bruises.
“E.g., the child would have reported being pulled by the ears, and we would find bruises along the edge of the ear, corroborating the child’s story. You rarely get bruises on the ears from playing,” says Anne Birgitte Dyhre Bugge.
The medical examiners also found a number of scars on the children examined for the project.
“A blow with an object causing the skin to break can leave a scar. I have mostly seen scars caused by objects you are likely to have at home such as mobile phone chargers, kitchen utensils and belts,” says Anne Birgitte Dyhre Bugge.
Offhand, a forensic examination may seem like an intrusive and potentially uncomfortable experience, especially for a vulnerable child who may have been exposed to violence. But when asked in connection with the project, most of the children found the examination to be a “really good” or “good” experience.
“We seek to make the examination as comfortable as possible, i.a. by taking the time to explain what we do and carefully observing the child’s reactions during the examination,” says Anne Birgitte Dyhre Bugge.
From caries to suicidal thoughts
In addition to the forensic examination, the 200 children were also subjected to a health screening, where a nurse talked to them about diet, sleep, pain and well-being, and a dentist examined their teeth.
“In more than 25 per cent of the children, we found health issues that required notifying the municipality,” says Jytte Banner and adds:
“Health issues may be poor sleep, stomach aches or mental issues that require a specialist examination. From the less serious ones such as caries to the extremely serious ones such as suicidal thoughts.”
According to Anne Birgitte Dyhre Bugge, it can be extremely difficult for a child to talk about what goes on at home.
“Some children do not say anything. Therefore, it is important to examine them and thus give them a voice,” she says.
Jytte Banner also focusses on the greater perspective of identifying the children who are exposed to violence at an early age.
“It is a fact that children who are exposed to violence during childhood do not do as well as other children. They have problems at school and with the educational system as well as physical and mental issues. So from a socio-economic perspective, there is a lot to gain from handling this early on,” she says and adds:
“To us, it is obvious that all children involved in reports of violence should as a minimum be offered a forensic examination.”
Read the whole report "Systematisk retsmedicinsk screening af børn ved mistanke om vold - En erfaringsopsamling fra et 2-årigt interventionsprojekt 2020-2022" here.
Facts: The forensic examination procedure
The forensic examinations were conducted in the screening room at Børnehus Hovedstaden. First, the child and his or her adult contact person – a teacher or pedagogue close to the child – were informed of the procedure and any injuries were photographed. Both before and during the screening, the examiner focussed on making sure the child was as comfortable as possible. The child could at any time object to parts of or the entire examination. During the first part of the examination, the child was asked a series of questions concerning his or her health and well-being.
The project forensic examination resembled the type of examination adults and children outside the project undergo. It was a full body examination that involved stepwise undressing to make sure the child was never completely naked. Injuries on the body were recorded and photographed – both fresh injuries such as bruises and grazes and scars that might be a result of violence over a period of time or playing – as well as signs of illness and neglect.
Finally, the child was examined by a dentist who checked whether the child’s teeth development matched his or her age and looked for caries, dental injuries or changes to the oral cavity.
Sources: Børnehus Hovedstaden
Contact
Professor Jytte Banner
Jytte.Banner@sund.ku.dk
+45 23 81 14 64
Consultant Doctor Anne Birgitte Dyhre Bugge
anne.bugge@sund.ku.dk
+45 35 32 81 52
Press Officer Liva Polack
liva.polack@sund.ku.dk
+45 23 68 03 89