Creative Responses to Child Sexual Abuse: Challenges and Dilemmas

By Sue Richardson; Heather Bacon | Go to book overview

CHAPTER 6
Flamingos or sparrows?
Paediatricians and the recognition
of child sexual abuse

Jane Wynne

Child sexual abuse is common but many paediatricians avoid seeing sparrows (the obvious diagnosis) in favour of pursuing flamingos (exotic, non-provable rarities) and children remain unprotected. This chapter is based on my experience as a paediatrician in a large northern city. It discusses some of the difficulties that paediatricians may encounter in dealing with probable sexual abuse, such as working with uncertainty, risk and working with professionals from other disciplines.

The report of the Inquiry into Child Abuse in Cleveland (Butler-Sloss 1988) should have been the starting point for paediatricians to take up the challenge of child sexual abuse. The report dealt with all aspects of this issue, including approaches to management. The medical assessor to the Inquiry, Professor David Hull (later President of the British Paediatric Association, forerunner to the Royal College of Paediatrics and Child Health), acknowledged that child abuse was ‘difficult for all concerned’ (Hull, personal communication, 1987). At the same time, he recognised that it was part of mainstream paediatrics and that consultant paediatricians should be able to manage all but the most complex situations. However, many paediatricians have denied their responsibility towards abused children in general and sexually abused children in particular, usually on the grounds that they are not trained for it or that it is too time consuming. Most have avoided the protean challenges that flow from the recognition of child sexual abuse; and resources have not been adequately established for the initial recognition of abuse and the

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