HISTORY: Taking the History from the Child/Adolescent
If the Parent/Caregiver Must Be Present
If at all possible, obtain a direct history from the child/adolescent without an accompanying parent/caregiver. This may not be possible in the following instances:
A very young child (less than four years old) who does not separate well from adults
An older child who refuses to be separated from adults
A child who does not speak English and an interpreter cannot be provided in the medical setting
A parent/caregiver who refuses to allow an interview unless he/she is present
When a parent/caregiver is present during the interview, document the reason for his/her presence. The adult should be seated behind the child so that the child cannot see facial expressions or other nonverbal cues. The adult must understand that the child may not be able to answer all the questions or may answer questions differently from his/her expectations. Instruct the adult that any expressions of shock, disbelief, or disapproval and/or any verbal or physical signals could upset the child and impede the interview. Also instruct the adult not to ask or respond to questions.
Questioning the Child/Adolescent
Resume building rapport with the child/adolescent by asking non-threatening questions about a neutral subject. Use the answers to assess the child/adolescent's cognitive, developmental, and social levels and language ability. Then move on to ask non-leading, non-suggestive questions. Avoid complex questions that may be confusing. When asking yes/no questions, follow-up to ensure the child/adolescent understood the question and you understood the response. Be sure to use terminology the child/adolescent understands. For a confidence continuum related to the types of interview questions, see A Sample Continuum of Medical History Questions and Confidence in the Responses, Appendix B.
Questions that May Trigger Disclosure of Abuse
Do you know why you are here?
Does anything on your body hurt?
Do you know about good touch and bad touch?
Has anyone ever touched you in a way that made you feel uncomfortable?
Do you have any secrets?
Although it is important to maintain confidentiality, special situations may arise when talking to adolescents or older children regarding their abuse. It may be helpful to explain that some confidential issues may need to be shared. For example, such a statement could be: "If you tell me something that is a threat to you or your health, I have a duty to tell someone. I will include you in the process and make sure you are involved in the process."
Keys to Good Rapport with the Child/Adolescent
Have the child sit at eye level
Begin the conversation with neutral subjects
Draw on information previously obtained about the child
Prepare the child for the exam through education regarding the procedure,
that is, it will be a head-to-toe exam, like a routine check up
Ending the History Taking
Before proceeding with the physical examination explain that the purpose of the head-to-toe examination is to ensure his/her well-being. In addition, describe the steps of the
exam and how the colposcope works. This will help the child/adolescent prepare for the
physical examination. For further information on preparing the child/adolescent, see PHYSICAL EXAMINATION: Preparing the Child/Adolescent for the Examination.
If No History Is Given
Attempt to obtain as much information about the suspected abuse from the parent/caregiver, other appropriate adults, and from previous interviews when the child is unwilling or too young to talk, when a report of abuse has already been investigated and substantiated, or when the child has been interviewed more than once in a complex case. Then determine how best to proceed with respect to clinical evaluation and treatment.