222 Chapter 27
well as an enquiry about the possible abusive practices, set within the
context of overall parenting and family life. The child should be seen
alone, and psychometric tests given if performance is failing significantly at
school. Social services should be asked whether they know the family, and
whether any of the children are on the Child Protection Register. If abuse
seems likely, a child protection conference is likely to be held, to which a
range of involved professionals will be invited. Nowadays, the parents are
usually invited to attend some or all of the conference. Recommendations
are made, which can include placing the child’s name on the register and
other protective steps.
Investigation of suspected sexual abuse can be carried out as a screening
exercise if the level of concern is moderate, or as a full investigative
process if suspicion is higher. There are extensive guidelines on how this
should be done, and it is imperative to seek advice from a senior colleague
with experience in this area. If the child is not overtly disturbed, social
workers will often be the agreed party to conduct interviews, but if the
child is showing evidence of marked disturbance, or there are special
circumstances, such as intellectual disability or very young children, then a
child and adolescent mental health professional may need to be involved.
Screening interviews must be carried out alone with the child, since if
a family member committed the abuse, the child is unlikely to reveal this
in their presence for fear of the consequences. For example, there may
have been explicit physical threats, emotional blackmail, or a fear by the
child that if they tell, the family will break up and they will lose a parent.
After a general discussion of how things are at home and outside, what
the rules and discipline are and who the child likes and does not like, it
may be helpful to enquire about sleeping and bathing arrangements and
how they look after their body. Questions may concern secrets, matters the
child has not been able to tell anyone about, whom they would confide in
if they had any worries, and whether anybody had done anything to them
or touched them in a way they did not like. Asking such specific questions
has been shown to increase the rate of disclosure of sexual abuse.
Full investigative interviews are a specialised skill, and are often carried
out in conjunction with the police. They are usually videotaped as in the
UK and a number of other countries they are admissible as evidence in
court, instead of the child having to be a witness and be cross-examined.
Anatomically correct dolls may be used, and often help prompt the child’s
memory. Some young children describe what happened to them and show
this in vivid detail with the dolls in a way that is hard to disbelieve.
Nevertheless, caution and judgement have to be applied to avoid over-
interpreting the child’s behaviour and being over-zealous in diagnosing
abuse where there is doubt.
Physical examination of the anus and external genitalia is useful, but
should only be carried out by paediatricians, gynaecologists or police
surgeons trained for the purpose. Whilst tearing and bruising are strongly
suggestive of abuse, weaker signs may be of uncertain significance,
especially as norms are only just being established. Tests for the presence