Book Review

Infants and Children

Child Abuse: Medical Diagnosis and Management

N Engl J Med 1994; 331:409-410August 11, 1994

Article

Child Abuse: Medical Diagnosis and Management
By Robert M. Reece. 466 pp., illustrated. Philadelphia, Lea and Febiger, 1994. $69.50. ISBN: 0-8121-1498-1

Child Abuse: Medical Diagnosis and Management sets a new standard for scholarly, unbiased, and well-balanced writing about child abuse. The editor and 25 contributors provide state-of-the-art reviews on child sexual abuse, head trauma, ocular signs of abuse, skeletal findings, failure to thrive, poisoning, and dental neglect -- to name a few of the topics.

Detecting and confirming child abuse is a difficult task. Challenging obstacles are met in the search, but with effort and the application of new and sophisticated diagnostic techniques, these obstacles can be overcome. This book offers guidelines for evaluation and solid scientific data to document established forms of child abuse.

In the past five decades, there has been an uneven but dramatic expansion in the understanding of both the medical manifestations of abuse and its forensic management. Most works to date have focused on the social sciences, child welfare, and the psychological aspects of mistreatment. By contrast, this book is written for physicians and follows the medical model. The concept of the differential diagnosis is steadfastly applied, and careful consideration is given to demonstrating diagnostic reasoning, balancing data, and explaining the nuances of radiographic and laboratory findings.

The signs of child abuse are often subtle and silent. Developmental, medical, traumatic, and genetic disorders can mimic child abuse. For example, the diagnosis of the sudden infant death syndrome (SIDS) remains a controversial and much-debated issue. After going through the theories of causation, Reece presents criteria for distinguishing SIDS from fatal child abuse and other medical conditions. Occasionally, more details and basic science are offered than is necessary, but this shortcoming causes minimal distraction.

Physicians in all specialties need this book on their reference shelf. Pediatricians and family physicians could benefit from reading the entire book. Radiologists, surgeons, ophthalmologists, dermatologists, dentists, pathologists, and psychiatrists will find at least one chapter that is required reading.

I recommend this book highly to physicians involved in evaluating and treating children. This excellent book should guide medicine toward a more valid and reliable approach to child abuse.

A. Kenneth Fuller, M.D.
Southwestern State Hospital, Thomasville, GA 31799