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Doody's Review ServiceReviewer: Kenneth Feldman, MD (University of Washington School of Medicine)
Description: The busy clinician is likely to enter unfamiliar and anxiety provoking territory when faced with evaluations of possible child abuse and neglect. The price of either a failure to identify abuse or an incorrect diagnosis of abuse is high for the child and the family. This second edition updates the original 1993 version.
Purpose: The authors wished to write a clinically useful text while providing sufficient references to support pediatric opinion. Due to the significant consequences of over- and under-diagnosis, the authors' goal of getting beyond anecdote to reliably based data is laudable. However, it will be difficult for the clinician to expeditiously locate reliable guidance in this text.
Audience: Although the primary audience for the text is the practicing clinician who only intermittently encounters child abuse, the text wavers between providing extensive treatment of commonly known material to detailed recounting of more specialized research results. The text often wanders into a conversational, anecdotal style, which reveals insightful observations at the expense of being somewhat ponderous. Although the authors are well-known and active researchers in child abuse, they seem more distant from consensus groups, which attempt to make sense of complex and sometimes inconsistent research data.
Features: The authors provide extensive treatment of the medical manifestations of physical and sexual abuse and child neglect. The etiologic background, treatment, and social/legal management of abuse are also extensively covered. Many summary tables are included. These tables and the narrative style of the text may smother the reader in details and leave the clinician uncertain of what is normal and abnormal. For example, although the absolute size of the hymenal opening has largely been discarded in the U.S. as evidence of sexual abuse, the authors present conflicting standards of normal size and elevate abnormal size to a stronger indication of abuse than is generally accepted. Child physical and sexual abuse are highly visual diagnoses. The color and black-and-white illustrations are of generally good quality, but their small size and location in a separate, center section of the book make them more isolated from the text. Some important areas of child abuse, such as inflicted head injury, receive relatively brief treatment as does discussion of our current understanding of the biomechanics of trauma. Others, such as failure to thrive and anal abuse, receive disproportionately more extensive treatment.
Assessment: Although insights and clinical pearls regularly appear, the presentation style makes the information less accessible to the busy clinician. Some of the authors' privately held opinions may also make it a less reliable resource for those who are unfamiliar with the field. Other more easy to read and authoritative texts are available in the field.