Article Text

other Versions

Download PDFPDF
Opening doors: suggested practice for medical professionals for when a child might be close to telling about abuse
  1. Ruth Marchant1,
  2. Jamie Carter2,
  3. Charlie Fairhurst3
  1. 1Triangle Services for Children, Brighton, East Sussex, UK
  2. 2Community Paediatric Department, Seaside View CDC, Brighton General Hospital, Sussex Community NHS Foundation Trust, Brighton, UK
  3. 3Department of Paediatric Neurosciences, Evelina Children's hospital, London, UK
  1. Correspondence to Dr Jamie Carter, Community Paediatric Dept, Seaside View CDC, Brighton General Hospital, Sussex Community NHS Foundation Trust, Brighton BN2 3EW, UK; Jamie.carter{at}

Statistics from


The way medical professionals and others working with children respond when children begin to show or tell about possible abuse can determine whether they continue telling and therefore whether they can be kept safe. Medical professionals can clarify, confuse or contaminate children’s accounts, and medical professionals’ responses to children can prove crucial in later legal proceedings. This paper challenges the seemingly negative, prohibitive guidance provided to many professionals across health and education about responding to early concerns and instead offers a framework of positive, practical guidance for ‘opening doors’, based on the approach developed by the team at Triangle over many years. The content of this article and its approach is also applicable to nursing and allied health staff, teachers and professionals working with children within the safeguarding arena. The term ‘disclosure’ is challenged and reframed. A worked real-life example follows a 6 year old through a sequence of moments where a doctor has opportunities to open or close doors based on clinical experience.


Children are often not heard by health and other professionals when they try to reveal abuse. Triangle is a UK-based, independent organisation that enables children and young people to communicate, particularly in legal proceedings. It offers training, advocacy, investigative interviews, therapy and expert opinion. The ‘opening doors’, approach has evolved with Triangle’s training of forensic interviewers over two decades. The approach itself involves careful, open-minded responding, offering an accessible and safe way to explore possible concerns with children, gently at their own pace.1–3 The aim is to get just enough information to work out what action is required, without leading children or contaminating their accounts. This approach is safe in terms of safeguarding both children and potential evidence. Medical professionals play a crucial role in protecting children from abuse and neglect. We know many children attempt …

View Full Text


  • Twitter @RuthMarchant, @N/A

  • Contributors CF and JC contributed to this original article authored by RM before she sadly died last year. We provided medical advice and guidance to the original version and JC updated the final version being submitted. Triangle are aware of this submission and support it and the acknowledgment of RM’s role.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles