[Experienced violence and enacted violence: The place of somatic expression]

Being a victim of violence and neglect during childhood can expose minors to significant health repercussions on the physical, psychological, psycho-affective and neuro-developmental levels.. Self- and hetero-aggressive violences in all age groups are now considered to be possible consequences of these severe adverse experiences. The place of the body is essential in this context. The body, often considered as the only tangible and opposable marker of violence, has a singular and integral place in the psyche and overall health. It is an important vector in order for professionals to have access to the child. The examination of the body allows the expression of violence and its formulation from a very young age, especially during clinical examinations in situations of possible danger. It also "speaks" in situations of malaise, growth disorder, self or heteroaggressive acts. During the adolescence, it can also be attacked by scarification, dietary restrictions, mutilations, early and risky sexual activity, prostitution.. By taking jointly both the body and the psyche, children and adolescents find a unity, are no longer fragmented. It is this unity that will allow the continuation of more specific care and more specifically child psychiatric support. This joint concern of paediatricians, general practitioners, child psychiatrists and psychologists will also ensure, particularly during adolescence, the continuation of health monitoring. It is essential to think about these collaborations from the first meeting with children and adolescents who are victims or perpetrators of violence. Encountering child and adolescent victims of violence confronts practitioners with a reality that is difficult to see and to conceive. Although the continuum between suffered violence and perpetrated violence seems to be better known today, these different situations remain difficult to understand and to manage. We believe that the violence that is perpetrated can be a screen for the causes of the violence and for the response to the needs of minors, particularly in terms of health. For practitioners, going to meet children and adolescents who are perpetrators of violence entails to be able to take a "step aside" from the classical representations of aggression or aggressiveness, whether they are directed towards third parties or towards the minor himself. Access to the somatic examination and medical history of these children or adolescents must be fully integrated from the first meeting. Associating health in all its aspects (somatic, psychic and social) then allows for specific care to be provided, regardless of their nature and place. This initial integrated practice allows us to take care of children and adolescents and highlights the notion of otherness that is undermined in situations of violence or neglect, particularly when they occur in the family environment. This initial joint somatic and psychological care in a single unit enables re-establishment of a dialogue with the minors and their parents. The shared competencies and the links that unite these different professionals together constitutes already therapeutic care. By reintroducing a dialogue about the children and adolescents and their overall health, the response to their needs can be perceived as a common and reachable objective that inscribes the minor in the temporality and extracts him or her from the immediacy of a punctually repressed act.