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Mr McCann spoke of his nervousness and sense of privilege at meeting the Pope, which he and his wife believe will have a "huge bearing" on Madeleine's safe return.

"In ordinary circumstances it would be a highlight for any Catholic to come and meet the Pope. For us, it is saddened by the realisation that our daughter is still missing," said Mr McCann, a consultant cardiologist.

"It was more personal than I could have imagined. The recognition was immediate looking at Madeleine’s photograph. His thoughts and words were more more tender than we could have hoped, and will sustain us during this most difficult time.”

Mrs McCann, a locum GP, has been reticent about talking to the media, leaving her husband to take the lead in the interviews which have helped maintain the publicity about their daughter.

“At the end of the day this is for Madeleine,” she said. “I do not like talking about this publicly but you have got to put your own feelings aside."

Mrs McCann said it was difficult when their two-year-old twins Sean and Amelie ask about their big sister. The twins are being cared for by relatives in Portugal, the first time the couple have both left them overnight.

“They talk about her and say ’look, there is Madeleine’s bag’ or say ’there is a picture of Madeleine’. Amelie said ’back soon’ again today, and she will be.

“But really, it would be harder if they were a couple of years older, they don’t really have a concept of time at the moment.”

One of the most difficult things is trying to decide whether to tell the twins about why their sister is not at home.

Mr and Mrs McCann, from Rothely, Leicestershire, will this week be seeking advice from a British child psychologist on what to tell Sean and Amelie.

Mrs McCann, who was wearing a rosary, said: “It is a difficult one, we do not want them to be upset about what has happened but we don’t want them to forget her.”

Her husband said: “The fact is that she could just walk back through the door. But as the days go on it becomes worse, it just becomes more difficult. We just have to decide what is best.”

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