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How good is the evidence available in child protection?
  1. Jonathan R Sibert,
  2. Sabine A Maguire,
  3. Alison Mary Kemp
  1. Department of Child Health, Cardiff University, Heath Park, Cardiff, UK
  1. Correspondence to:
    Alison M Kemp
    Department of Child Health, Cardiff University, Heath Park, Cardiff CF14 4XN; kempam{at}cardiff.ac.uk

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There is little doubt that the attitude of most paediatricians to child protection has changed since the travails of Roy Meadow and David Southall. However, those involved in giving evidence in court may have noticed increasing difficulties before then.

Twenty years ago, child abuse was seen and managed in the general paediatric ward, often used as a “place of safety” while complex clinical and social issues were dealt with. Paediatricians and the Children Act 1989 recognised that hospitalisation was inappropriate for most child protection cases, and as paediatrics became a field of subspecialties, child protection became the domain of community paediatricians. This has to some extent led to a deskilling of general paediatricians who have lost confidence in the field, further compounded by recent high-profile legal cases.

The legal system evolved so that, in any but the most straightforward child protection cases, the examining paediatrician gave little more than basic professional evidence. An independent expert was appointed to assess the case, make a report and give “expert opinion” in court. The court appearance was often intimidating, and many paediatricians felt exposed and humiliated by the aggressiveness of the defending barrister. The national media, throughout this period, had become heavily polarised against the profession. Fewer and fewer paediatricians were inclined to give evidence in court or felt capable of the assessments needed to protect children.

This meant that an increasingly small number of people were available to be experts in complex child protection cases. These doctors were faced with increasing demands on their time for legal work and became increasing targets for criticism, particularly in the …

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