The pediatrician's role in child abuse interviewing

The history of sexual abuse that a child gives to the pediatrician may be the single most important factor in determining if a child has been abused. Most children have completely normal anogenital examinations; very rarely is definitive forensic evidence obtained or a sexually transmitted disease discovered. Physicians, in general, are given unique authority and privilege in reporting such hearsay evidence. The pediatrician often is the first professional with whom a child has contact when an allegation of abuse is made. Child protective issues then become paramount. It is important, therefore, for the physician to have the basic skills and knowledge of the developmentally appropriate approach to interviewing a child. How that interview is preserved and documented is also critically important and will be scrutinized in any legal proceedings. The physician's interview should not replace a skilled forensic interview but be considered a supplement, whose purpose is foremost the health, well-being, and protection of the child.