Book Review

Child Abuse and Neglect: A clinician's handbook

N Engl J Med 1995; 332:543February 23, 1995

Article

Child Abuse and Neglect: A clinician's handbook
By Christopher J. Hobbs, Helga G.I. Hanks, and Jane M. Wynne. 325 pp., illustrated. New York, Churchill Livingstone, 1993. $79.95. ISBN: 0-443-04146-6

At a time when there are 3 million reports of suspected abuse or neglect of children each year in the United States, when homicide is the leading cause of injury-related deaths among infants, when the Advisory Board on Child Abuse and Neglect has claimed that child abuse presents a national emergency, there is clearly a need not only for the protection of children but also for professionals in a variety of disciplines, particularly physicians, to develop expertise in this area. Physicians must recognize their new role, not reporting but diagnosing child abuse, and they must respond to the challenge posed by the diagnostic problems facing them.

There is still a great need for scientific study and debate, for teaching and sharing of information, and for consensus. The study of child abuse and neglect has developed rapidly over the past 15 years. The national conference on child abuse in San Diego, California, and the one in Huntsville, Alabama, are in their 9th and 11th years, respectively. There have been seven new textbooks on child abuse since 1990, two of which contain extensive photographic atlases.

It is in this climate that Child Abuse and Neglect has been written. Much like other textbooks, it seems comprehensive, focusing on all aspects of child abuse in 18 chapters. It is “a clinician's handbook,” according to the authors, but not a physician's handbook and not a compact reference book or manual. It is written in a style that is easy to read and can keep the attention of a reader from any of the disciplines related to child abuse. It expresses the opinions of the three authors, who have a wealth of experience and deserve to write about it. Two of the authors have discussed controversial topics at the conference in San Diego and lived through the judicial inquiry into child abuse in Cleveland, England. Many of the chapters, however, are not as thorough or referenced as extensively as those in some of the more formal textbooks. This is not a source book one would use in preparation for an appearance in court to defend the diagnosis of abusive trauma. It is more suitable for clinicians who want a thorough general discussion of the topic.

This handbook is full of helpful tables and diagrams, providing teaching tools and quick references for review. There are more than 100 photographs documenting patterns of injury due to abusive trauma, fractures, and genital and anal findings characteristic of sexual abuse. Eighty pages are devoted to the discussion of sexual abuse of children and to signs associated with genital and anal abuse. Of all the physical findings related to long-term sexual abuse, the most controversial is the reflex anal dilatation first described by C.J. Hobbs and J.M. Wynne (“Buggery in Childhood: A Common Syndrome of Child Abuse.” Lancet 1986;2:792-796). The authors remain committed to this phenomenon as a sign of habitual anal penetration and devote two full pages to the controversy surrounding it.

The study of child abuse is becoming a mature specialty. We in the field need to work together, learn from our past mistakes, and explore further scientific endeavors. This book provides a foundation for future work and exemplifies the compassion, experience, and wisdom that are needed for work in the study and treatment of child abuse.

Carolyn Levitt, M.D.
Children's Hospital Center, St. Paul, MN 55102