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Despite the grandiose title and the veneer of scholarliness, the main thrust of Dr Le Fanu's back-to-basics theory (June 2005 JRSM1) may be accurately summarized as: 'if they look respectable, they're innocent'. The evidence he selectively quotes in his favour has been adequately rebutted.2–4
Le Fanu fails to highlight that the danger of wrongful diagnosis is to the child or the siblings. Misdiagnosis will lead to the inappropriate management of the child's condition, whether by missing child abuse or by over-looking an alternative underlying disease. The responsibility of professionals involved in child protection is to act in the best interests of the child, which can be at odds with the interests of their more vocal parents. Le Fanu barely rates the child a mention in his article, couching his argument entirely in terms of the impact on parents' feelings of raising suspicions of child abuse.
When a child presents with certain clinical features found in child abuse, a responsible clinician would garner further evidence for or against this diagnosis by directed history taking and investigations. Presumptive management, such as limiting parental access, may be indicated before the diagnosis is clear (much as we treat speculatively for sepsis before obtaining confirmation). It would be surprising if this process did not lead to grievance on the parents' part, particularly if handled in an insensitive manner. To avoid initiating child protection procedures for the sake of the parents' feelings, as Le Fanu appears to be suggesting, is tantamount to negligence and ill-serves the child.