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Coming back to the new edition of this book is like coming back to an old friend. Like many paediatricians, I have used the first edition as a valuable reference in child protection cases. The expertise and experience of all three authors are well recognised internationally and there is no doubt that this edition will continue to be a valuable aid to all clinicians working with children.
All aspects of abuse are covered and there are helpful summaries in each chapter. It is an easy book to read but also I find it easy to get information on individual issues in child protection. There is an interesting historical introduction: although I would have liked rather more before modern times.
The problem I find with this book is that it is not really evidence based in a modern sense. Papers are quoted with no real attempt to assess their quality. This is partially because there are so few quantitative studies in child protection but I think readers would have liked to have more descriptions on the quality of the methodology of the papers that are quoted. I would have liked the references tabulated in each area of abuse. There are also concerns regarding the section on epidemiology of abuse. The histogram that is used as an illustration does not give incidence rates nor is it population based.
I particularly studied areas in the book that I know cause diagnostic difficulty and where there is controversy. One of these is subdural haemorrhage. I was disappointed that the section was quite short: only four pages. I was also disappointed at the number of references, only 14, in what is the most common cause of serious physical harm in physical child abuse.
I find that neglect and emotional abuse are areas where it is difficult to put facts together for a clear diagnosis. The section on neglect has a helpful list of points to look for in the potentially neglected child and also ways of assessing the whole family. I found the section on emotional abuse less helpful.
Child protection is a very difficult area for clinicians and many shy away from committing themselves to clear diagnoses. This new edition will help give more confidence in dealing with these difficult cases. It is a pity that at nearly £70 it will not be accessible to young doctors outside libraries. Perhaps fewer photographs and being in paperback would make it less expensive and more accessible.
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