Catalogue of child abuse

This is the second edition in five years of this rather expensive atlas by two reputable British paediatricians who specialise in the investigation and management of child maltreatment. It is a distressing catalogue of the injuries deliberately inflicted by caregivers on children and young people.

The book covers the full spectrum of child abuse as well as providing over 300 pages of photographs (with up to five photographs per page). It provides good guidance on conducting physical examinations, colposcopy and photography. The authors emphasise that the diagnosis and management of abuse requires an interdisciplinary approach, where different professionals and systems bring together different pieces of the jigsaw. There are sections and subsections that cover each type of abuse and its differential diagnosis, and each section starts with a brief overview of the salient points. The contents of many of these sections are in note form (as if they have been made up from teaching slides which were orally expanded). This can be occasionally confusing — for example, under a section on retinal haemorrhages is a dot point “vaginal birth (30%)”. It is unclear if this refers to the proportion of vaginal births having this abnormality, or whether it refers to the fact that only 30% of retinal haemorrhages occurred in infants born vaginally. References for some of these assertions would also have been helpful. Nevertheless, the format is clear and user-friendly.

I do have a number of criticisms. The book is somewhat unevenly balanced with head and abdominal injuries sharing a chapter, while superficial integumental injuries are divided among four chapters and burns among three. There are occasional typographic errors, and some references are misspelled. Some of the advice given is not consistent with best evidence for practice in teaching hospitals — for example, CT scans are a more sensitive investigation for head injury than plain skull x-rays, and the role of radioisotopic bone scans as the initial approach to screening for skeletal injuries is underemphasised. The authors note the value of digital photography for exchanging images electronically. In Australia, this advice is problematic, as digital images have been ruled out for evidentiary purposes owing to the ease with which they can be manipulated. Despite these reservations, and considering the fact that the authors are going to produce a complementary slide set (presumably on CD-ROM), I believe that access to this reference book would be helpful to many. It is particularly suitable for those training as general and community paediatricians and for those working in hospitals with a large paediatric patient load.

Graham V VimpaniPaediatrician Child, Adolescent and Family Health Services Wallsend, NSW