At what age should a child be removed from the room when discussing a sensitive topic such as domestic violence?

This is a sensitive question, because the best thing for the children is not really possible in our setting. I don't really know the answer, but I won't let that stop me.

We certainly know that any baby perceives and reacts to the mother's emotional state. The child's own knowledge that he is doing so comes late, in the era of logical thought (after 7 if ever.)

Up to about 3 (younger if the child is precocious): If a mother is not a victim of abuse, the discussion may be neutral or even positive for the child to hear. If she is a victim, it's fair to presume that she's upset quite often, and perceiving some maternal unhappiness during an interview in clinic would not seem to be much additional strain for the child.

Between 3 and 6 or more, I would be worried that a child hearing specifics would be bothered not by the information, which he already has, but by the way he would interpret the discussion, and construct age-specific worries about injury or death, being punished, losing a parent, etc. The verbal, factual information is likely to be understood with the primitive logic of that age and the fears and fantasies are likely to be vivid and hard for them to defend against. (Mental defense mechanisms are only then being formed, and the chief defense against perceived danger, the mother, is herself not safe.)

If we had the playroom and child life staff and activities that any self-respecting pediatric clinic should have, it would be possible for the over-3 year old to spend time there during the clinic visit as part of the natural course of events. Of course, if the mother is very stressed the child may have exaggerated separation anxiety and not be able to use the playroom.

Removing a child because the mother is upset, or sending him out so you can discuss a secret is a terrible idea. It leads to worse fears and fantasies than the reality, and it leaves the parent alone and unsupported trying to reassure the child when they go home.

If there is a lot to discuss the mother should have a separate appointment and come alone.

Above 7 or 8 I would hesitate to send children out of the room, as they know very well what is going on and deserve the respect of being included, although that's a much harder job for the clinician. If it's really messy or the mother wants to talk alone, she should come back alone.

Harriet McGurk