Part 2A: Roles and responsibilities for child protection 52 National Guidance for Child Protection in Scotland 2021 Version 1.0 September 2021 Paediatricians 2.92 Paediatricians have a duty to identify child abuse, neglect and risk to wellbeing. They must therefore maintain their skills in this area and make sure they are familiar with the procedures to be followed where abuse or neglect is suspected. Clinical services must ensure that all paediatricians are trained to assess children for signs of abuse and neglect and are supported to make decisions on the timing of any further assessment or forensic assessment. 2.93 Paediatricians may be asked to write a report for the court as to their findings and conclusions. Paediatricians will be involved in difficult diagnostic situations, where they must differentiate abnormalities resulting from abuse from those with a medical cause. Along with forensic medical examiners, paediatricians with further training should be involved in specialist examinations of children and young people suspected of being abused and neglected, or who have reported abuse or neglect. A medical examination should be carried out by clinicians with appropriate expertise including in the management of complex conditions or additional needs. Examinations for suspected child sexual abuse require expertise in these examinations in addition to general child protection examinations. Child Protection Medical Examinations 2.94 Further detail may be found in Part 3 of this Guidance. 2.95 The main types of medical examination that may be undertaken within the child protection process are described in more detail in Part 3 of this Guidance. In brief they are: a) Joint Paediatric Forensic Examination (JPFE). Examination by a paediatrician and a forensic physician. This is the usual type of examination for sexual assault and is often undertaken for physical abuse, particularly infants with injuries or older children with complex injuries. b) Single doctor examinations with corroboration by a forensically trained nurse. These are sexual assault examinations undertaken for children and young people aged 13-16. Consideration should always be given as to whether a JPFE should occur. c) Specialist Child Protection Paediatric/Single Doctor/Comprehensive Medical Assessment. This type of examination is often undertaken when there is concern about neglect and unmet health needs but may also be used for physical abuse and historical sexual abuse. Comprehensive medical assessment for chronic neglect can be arranged and planned within localities when all relevant information has been collated. However, there may be extreme cases of neglect that require urgent discussion with the Child Protection Paediatrician. 2.96 All medical examinations/assessments should be holistic, comprehensive assessments of the child/young person’s health and developmental needs. 2.97 In some parts of Scotland, where victims of rape or sexual assault are aged 16 and over, they are able to self-refer for a forensic medical examination without first making a report to police. Once commenced the Forensic Medical Services (Victims of Sexual Offences) (Scotland) Act 2021 will extend consistent access to self-referral services across Scotland for those aged 16 and over. A clinical pathway for children and young people and a forthcoming self-referral protocol will provide further guidance.