Education And Debate

Social services can act on anonymous information about abuse

BMJ 1998; 316 doi: (Published 03 January 1998) Cite this as: BMJ 1998;316:56
  1. Jane Wynne, consultant paediatriciana (jladley{at}
  1. a Community Child Health, Leeds LS2 9NJ

    The link between physical and sexual abuse was not well recognised 15 years ago. It is now known that about one sixth of physically abused children have also been sexually abused.1 When this child was admitted to hospital for investigation, had she been referred because of her parents' or general practitioner's concern? The admission gave staff an opportunity to observe her behaviour and her attachment to her parents. Why hadn't her parents noticed she was upset? Did she talk to the nurses? Did she have any genital symptoms such as soreness or dysuria? Did anyone ask the child why she had so many bruises? Probably not in 1980, but all these questions spring to mind in 1997.

    In 1997 there is a greater awareness of the various ways in which sexual abuse may present, and children are more likely to be spoken to and treated as people rather than “objects of concern.”2 3 4 Paediatricians are also more likely to be direct with parents. But even today most sexual abuse goes unrecognised. Even in proved cases of sexual abuse in children similar to the one described above, neither the general practitioner nor school (or school nurse) is likely to have voiced concern, and these families are not known to the National Society for the Prevention of Cruelty to Children or to social services.

    Why were there no more bruises? Paedophiles are likely to continue to abuse, but perhaps the parents knew more than they had volunteered? Had the parents challenged the babysitter? Would this distressed young woman be able to talk to her parents now? If they were aware or suspicious of sexual abuse all those years ago, they might be able to help their daughter understand her abuse even at this late stage, unless they were in some way involved.

    What should the paediatrician do with this new information? In particular, what is his or her responsibility towards the “babysitter's” children?

    The General Medical Council gave the following advice in 1993: “Where a doctor believes that a patient may be the victim of abuse or neglect the patient's interests are paramount and will usually require a doctor to disclose information to an appropriate, responsible person or officer of a statutory agency.”5 In this case the former babysitter's daughter is not the paediatrician's patient. But he has been given very worrying information. If the young woman were given support, would she be able to talk to a social worker? Did she seek out her hospital notes so that someone in authority would take on this responsibility?

    The police cannot investigate unless the young woman is able to make a complaint, but the social services department can act on information given anonymously. The paediatrician could contact a senior social worker, giving details of the alleged abuser but not the victim. The social worker could do the usual checks, could talk to the police, and might of course already know the man and his family. Further action would then be the responsibility of the social services department.

    Whatever happens, the young women clearly needs help and with skilled therapy may learn to live with the knowledge of her childhood abuse more comfortably. If the allegations are unfounded, preliminary investigations will be negative and the former babysitter's family will be undisturbed. Or might this be a repetition of the original mismanagement?


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