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Child Abuse Case 23


An 8-year-old girl is brought to your office with a complaint of behavioral problems. The mother states that her daughter has begun to have nightmares and complains that she does not want to go school in the morning. She has also been using sexual language, including words for body parts that her family does not use. As the physician, you decide that you want to talk to the girl alone to see if she has anything that she needs to tell you that might suggest sexual abuse. She tells you in private that someone at school has been touching her in the genital area.


You should be careful to:

  1. Control the natural response of shock.
  2. Promise to protect the child from further harm.
  3. Ask why she let the person touch her.
  4. Ask leading questions so that you can clearly ascertain the perpetrator.

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The answer is A.

It is natural to be upset when a child discloses abuse. However, children may not feel comfortable disclosing more about the incident if they perceive that the disclosure has affected you negatively. It is always important to maintain a calm demeanor, encourage the child to tell more and support the child for telling you.

Promising to protect the child from further harm is a natural reaction that must also be suppressed. Even with the best intentions and efforts to utilize the systems and agencies that work to protect children, you cannot promise the system will work. Abused children have already been betrayed by a trusted adult. You can avoid further emotional harm by not promising protection.

Asking a child victim why an incident of abuse has occurred implies that the victim could have controlled or prevented the abuse. It places blame on the victim when, in fact, the adult is the responsible party.

Once a disclosure has occurred, the identification of the perpetrator is important so that a call can be made to Child Protective Services or law enforcement. However, leading questions are not appropriate. Leading questions are those with a forced choice or where the answer is implied. Instead, questions should be asked in a format using initially broad concepts, such as, "What happened when you were at school?" The questions can then be tapered to more specific areas as the child discloses more information. For example, if the child indicates by name that a teacher was the perpetrator, the questions can include the teacher’s name.

For more information on what do when a child discloses abuse, see History: Responding to the Disclosure of Abuse www.childabusemd.com/history/history-disclosure.shtml .


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