Communication with the Child

Show Interest in the Child, Their Words, and Behavior

Interacting with a child who has experienced abuse requires special professional skills, a delicate approach, and specific training. This is not only due to the difficulty of detecting abuse but also because such cases are often hidden, and their revelation typically provokes intense reactions. These challenges are particularly evident in cases of domestic or sexual abuse.

Pediatricians are often the first to suspect abuse. Their task is to address these concerns accurately and promptly. However, detailed questioning by the physician is not necessary, as this responsibility lies with law enforcement and child protection services.

If abuse within the family is suspected or the physician fears a child may be punished for being truthful, it is recommended to inform appropriate authorities before speaking with the parents. The physician's primary concern should be the child's health, not patient retention.

In cases where abuse is suspected, physicians should not press the child to recall every detail. Forcing a child to repeatedly recount the story can lead to symptoms of post-traumatic stress, further harming the child. The physician’s role involves not only listening to the child’s complaints and story but also, when necessary, ensuring the protection of the child’s rights.

How to Conduct Conversations with Children

Be honest with the child and avoid making promises you may not keep. Children may only share if they believe their story will remain confidential.
Allow the child to speak in their own language and use their vocabulary. Children may also convey information through gestures, which can be significant.
Create a comfortable, safe environment. Physicians should avoid interrogating the child for details or validating parental comments. Begin the conversation by getting to know the child, asking about their interests, family, friends, school, and other aspects of their life.

Question Types

Open Prompts: These encourage more detailed responses and allow the child to narrate freely, using prompts like "Tell me..." or "Explain to me..."

Clarifying Prompts: After open prompts, these help fill in missing information with prompts such as "Tell me more about that," "What happened next?" or "Continue."

Direct Questions: Include questions beginning with "what," "who," "where," "when," "how," and "why."

Closed Questions (Yes/No): These can be risky as children often feel compelled to answer, even if they don’t know the answer, or may agree out of politeness.

Multiple-Choice Questions: Offer response options but should be used cautiously as they can lead to inaccurate answers if a child chooses an option without knowing.

Suggestive/Leading Questions: Should be avoided as they may influence the child’s responses by implying details or events.

Considerations for Interacting with the Child

• Show empathy and attention.
• Use simple, understandable grammar and avoid professional terms.
• Refer to body parts with terms familiar to the child.
• Avoid pronouns and keep questions short and clear.
• Be ready for the child to be hesitant initially. Acknowledge that sharing can be difficult, and let them know you understand.
• Avoid Physical Contact with Child Victims of Sexual Abuse and refrain from showing fear, disgust, or intense emotions, regardless of what the child may share.
• Thank the child for their trust and courage, and explain the next steps, such as "I will talk to your mother to make sure we keep you safe together."