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There is a marked variation in the coverage of the subject of child abuse in paediatric textbooks. The standard and arguably definitive North American paediatric textbook (Nelson), contains only a short 12 page chapter (out of a total of 2618 pages) briefly reviewing the subject.1 Another North American paediatric textbook of biblical dimensions (2808 pages), Oski's Pediatrics, has a marginally longer (14 page) chapter on child maltreatment.2 In contrast, the standard and definitive UK paediatric textbook, Forfar & Arneil's Textbook of Pediatrics (1985 pages), has a substantial 27 page chapter covering the various types of abuse and neglect.3 To supplement these sources, there is an assortment of textbooks devoted solely to one or more facets of child abuse.
Do we need another book on the subject of child protection? The answer is that this is a highly original and much-needed book which fills some important gaps. It is not, however, a textbook on child abuse. There are no illustrations depicting injuries. For example, if you want to look up ‘shaken baby syndrome’, this is not the source to use. This is a handbook aimed at helping doctors in the process of child protection case management. There are chapters on important practical issues such as working with other professionals, consent and confidentiality, what to do if you are concerned that a child may be abused, documentation and recording, writing medical reports and police witness statements, court proceedings and giving evidence, and training and support for doctors. There are 18 appendices with examples of proformas, checklists, protocols, consent forms, flow charts and illustrations of how to structure medical reports. There is a chapter of practical advice on the photography of injuries.
The book includes a section on the recognition of maltreatment, and this helpfully sets out to provide evidence to support the advice given. Thus, for example, the book states (on the subject of bruising) that non-abusive bruising has a direct correlation to the developmental stage of the child, that boys and girls have equal rates of non-abusive bruising, and that certain areas of the body are rarely bruised at any age. All these statements are backed up by references to published evidence, where it exists, and the list of references to this section includes a recommended reading list. In addition there is a helpful list of useful websites.
All paediatricians need to be able to recognize the symptoms of abuse and neglect, and the RCPCH has embarked on a comprehensive programme of child protection training, of which this is an invaluable, clearly written and practical component. For those who question the relevance or utility of Royal Colleges, there could be no better example of leadership and provision of improved training than the recent efforts of the RCPCH in the field of child protection, and the team of authors and editors who contributed to this excellent resource are to be congratulated. That the RCPCH has made the publication freely available to all is particularly commendable.
London: Royal College of Paediatrics and Child Health (RCPCH), 2006 Available for free download from www.rcpch.ac.uk/Health-Services/Child-Protection/Child-Protection-Publications