Diagnosing and responding to serious child abuse

Confronting deceit and denial is vital if children are to be protected

Publishing recently in Pediatrics,Southall et al described their experience of using covert video recordings to diagnose life threatening abuse.1 Of 39 children (median age 9 months) referred to two UK hospitals for investigation of suspicion of induced illness, including 36 with apparent life threatening events, the authors filmed evidence of abuse in 33. This included suffocation in 30, poisoning in two, and the breaking of an arm. The transcripts of the recordings make distressing, yet essential, reading. Risk of abuse extended to other children within these families: 12 out of 41 siblings had died suddenly and unexpectedly (suffocation was subsequently admitted for 8, and reinvestigation of another revealed salt poisoning), and abuse was documented in a further 15.

Southall et al have revealed the grim world which has been intermittently explored over the past 100 or so years.2 4 Now, however, the filmed evidence concretely exposes what was previously available only to professional imagination. These children were not damaged during bouts of anger but harmed coolly and callously by parents who appeared concerned …