Diagnosing child abuse

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a1398 (Published 02 October 2008) Cite this as: BMJ 2008;337:a1398
  1. Naomi F Sugar, clinical professor
  1. 1University of Washington, Department of Pediatrics, Harborview Medical Center, Seattle, Washington 98104, USA
  1. nsugar{at}u.washington.edu

    The evidence base is advancing through new areas of research

    No field of medicine is more challenged and scrutinised by non-medical professionals than paediatrics in the context of child abuse. The diagnosis of child abuse has social implications, it is the subject of criminal and civil actions, and it threatens the integrity of families. The diagnosis of child abuse is often made on the basis of the presence of injuries and the absence of a compatible history given by caregivers.

    Law and science are based on different core assumptions of how truth is established. The law frames questions in adversarial terms and uses argument, logic, and construction of a narrative to prove the point. Science, in contrast, depends on observation, testing, and use of accumulated evidence from many sources.1 Scientific knowledge is established by aggregation and confirmation of studies, and the value of evidence depends on the methodology of the study.

    The systematic review of fractures in child abuse by Kemp and colleagues (doi:10.1136/bmj.a1518) is a rigorous attempt to draw meaningful conclusions from a diverse and heterogeneous literature.2 This …

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