At a loss for words (communicating with children after child abuse)

This is a guest post by Bruna Dessena, with edits by Justin Morgenstern. Bruna is an ALS paramedic from South Africa, with 26 years of clinical experience. She has worked for 17 years preparing children for court as a volunteer at the Teddy Bear clinic in Johannesburg. She has also published a book that acts as a guide to interacting with children after abuse.


You are seeing a 3 year old child with a femur fracture. You perform a rapid primary and secondary survey, confirming that there are no other life threatening injuries. The vital signs are stable. You provide rapid analgesia, starting with an intranasal dose of fentanyl as you set up for an IV. As you finish ticking off the clinical boxes in your head, a question pops into your mind: how exactly did this injury happen? Was this truly an accidental injury? And what should I say to this child? Continue reading “At a loss for words (communicating with children after child abuse)”