• child sexual abuse
• mental health

Listening to a child is a paramount activity, yet, the ‘silence is defeaning’.1 The importance of hearing the voice of the child or young person who is traumatised, and the importance of justice to survivors, cannot be overstated. This applies particularly to survivors of child sexual abuse (CSA) where report of maltreatment might well influence the legal process. The article by Marchant et al 2 notes that imprecations to health professionals to listen and hear the child’s voice are not accompanied by explanations on how to do this ‘practically, well or safely’. They provide guidance on how to do this, through expertise gained through Triangle Services for Children, an independent organisation enabling children and young people to communicate, especially in legal proceedings. The authors use the ‘Opening Doors’ framework that ‘draws on what is known about children’s memory and children’s testimony’. One author (Ruth Marchant) died in December 2018. She was an experienced forensic interviewer who brought considerable expertise and humility to bear, particularly with very young children.3

There is potential difficulty in how a paediatrician might enable a child to tell their story and how that might impact on the child’s need for justice that is duly recognised by the authors of this timely and important paper. This commentary provides both paediatric (GD) and legal (RP) insight into this tension. This will inevitably reflect the situation within England and will reflect the situation in other jurisdictions.

The authors of Opening Doors have ‘reframed’ the term ‘disclosure’ for reasons that, within the ‘Opening Doors’ framework, and with its specific meaning in the legal system, seem valid. This article will adopt ‘report of maltreatment’ which is used in HM Government guidance instead of ‘disclosure’.

CSA is associated with adverse effects on physical and mental health that, without effective intervention, …