Masters wisely highlights the shrinking frequency of routine contact with children, by 'modern' general practitioners.[1] As we discussed in the Royal Statistical Society this week [2] diagnosis of child abuse is often a complex task of decision making in the face of uncertainty. The effectiveness of that process depends on much prior knowledge and the synthesis of multiple observations by an experienced clinician.[2] Limited observation of the child does not mean that a generalist cannot make many children safer. Mental disorder in either parent can put one or all their offspring at risk, especially the perinatal psychiatric disorders [3] that are likely to present in primary care settings. One alarming adult example: 'A mother who believes that her child has changed in some way, looks strange, is not hers or is, for example, evil, is at risk of harming that child'.[3] For all the children sharing a home with adults who have untreated dependence on alcohol, International statistics suggest there is an increased risk of harm. There is some UK evidence, however, that successful identification and engagement of the parent to reduce their drinking greatly improves the safety of their children.[4]

[1] Masters NJ. What is the role of GPs in safeguarding children? BMJ 2012;344:e4123

[2] Royal Statistcal Society discussion meeting "A Bayesian approach to complex clinical diagnoses: a case-study in child abuse", London 20 June 2012.

[3] Henshaw C, Cox J, Barton J (Ed.s). Modern Management of Perinatal Psychiatric Disorders. London: Royal College of Psychiatrists publications, 2009.

[4] Caan W. Alcohol and the family. Contemporary Social Science: Journal of the Academy of Social Sciences 2012; 7: in press.

Competing interests: None declared