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Author: Michelle Mitchell, MD, PGY-1
Duke University Medical Center
Posterior rib fractures in infants. Burns on the buttocks and legs. Mechanism of injury that is not consistent with developmental age. Most physicians will recognize these potential red flags of child abuse. However, many emergency medicine physicians have received little training on how to interview children who present with injuries concerning for child abuse. As physicians, we are not expected to definitively determine if child abuse has occurred. Instead, we often report suspected cases and leave the investigation to the authorities. It is thus important to obtain and document a thorough history in the medical record as it may be used in future court proceedings.
It is imperative that physicians have general knowledge about forensic child interviewing, as the method of interviewing may greatly impact the information that a child provides. Most models of child forensic interviewing have three stages.
- Rapport building
- Age-appropriate introductions are made along with an orientation to the interview process. The physician should stress that openness and honesty are the expectation. A potentially appropriate phrase would be as follows, “I was not there and I don’t know what happened. When I ask you a question, I don’t know the answer to the question.”  Some children will say what they think the adult wants to hear; this phrasing lets the child know that there are no correct or incorrect answers, only truthful responses.
- The physician should also encourage the child to narrate. Research has shown that a child who is encouraged to provide detailed answers in the rapport-building phase of the interview is more likely to provide unsolicited details later. The physician could ask the child to discuss his or her interests, or describe a specific event in the past that is not related to the potential abuse incident. For example, a physician can ask what the child did on his last birthday, instructing the child to describe the day from the “beginning to end and not to leave anything out.” The physician can solicit more details by paraphrasing or using statements such as “tell me more.”
- Substantive Phase
- Physicians then transition into gathering more sensitive information by asking, “What are you here to talk to me about today?” The interviewer should allow the child to describe the entire story without interrupting.
- After the child finishes his or her story in its entirety, the physician can ask for additional information using open-ended questions. “Why” questions are a method to ask clarifying questions (e.g. “What was his name?”) without using suggestive language (e.g. “His name was Tom, right?”). When using clarifying questions, try to mirror the child’s own words. For example, “You said that you played the ‘cat and mouse game’ with Tom. Tell me more about that.”
- Closure Phase
- This final phase provides the physician an opportunity to wrap-up the interview in a way that is respectful to the child. The interview might have been very difficult for the child, so it is important to thank them for their effort, instead of the content provided. The closure phrase also allows the child an opportunity to ask or tell the interviewer any information that might not have been covered during the interview. If required, this is also when safety plans and educational material can be provided.
When interviewing children who are potential victims of abuse, it is important to keep these principles in mind. Although physicians are not expected to be experts at forensic interviewing, utilizing these phases will allow the physician to obtain accurate and complete information, which may assist in getting a child out of a dangerous situation.
1. Newlin C, Steele LC, Chamberlin A, Anderson J, Kenniston J, Russell A, Stewart H, Vaughan-Eden V. “Child forensic interviewing: Best practices”, pp. 1-20, 2015.
2. Brubacher S, Roberts K, Powell M. Effects of practicing episodic versus scripted recall on children’s subsequent narratives of a repeated event. Psychology, Public Policy & Law. 2001; 17(2):286–314.
3. Hymel KP and Jenny C. Child sexual abuse. Pediatr Rev. 1996; 17:236.