Management of child sexual abuse: the impact of Cleveland.

Abstract

As practitioners involved in the Cleveland child abuse crisis of 1987, we ask what has happened to clinical practice in the detection and management of child sexual abuse during the last 30 years. We argue that key issues from that time, together with subsequent advances in the research base, should give rise to a fresh debate about how paediatricians can best help sexually abused children today.\n\n‘ Although the events leading up to the Butler-Sloss Inquiry into Child Abuse in Cleveland in 1987 and the resulting Inquiry Report itself are rightly seen as part of a watershed time with respect to the acknowledgement of child sexual abuse in the United Kingdom, any feeling of complacency that by 1987 we then knew all about sexual abuse was clearly misplaced. It is only in more recent times that many victims have felt sufficiently confident to speak about what has befallen them, sometimes many years ago ’. The Rt Hon Lord Justice McFarlane.1\n\nIt is possible that many of today’s younger paediatricians have never heard of the Cleveland child abuse crisis in 1987, one of the most significant events for children’s health in the UK in the second half of the 20th century. Cleveland was a pivotal point, which has influenced attitudes, policies, politics and medical practice over the subsequent decades. We argue here that the way child sexual abuse is managed today still reflects the general misunderstanding of that crisis and that the lessons that should have been learnt are still of relevance.\n\nThe Cleveland crisis had its origins in a seminal paper by Leeds paediatricians Drs Hobbs and Wynne,2 which identified anal abuse as a relatively common form of child abuse. In 1987, two Cleveland paediatricians, Drs Higgs and Wyatt, made a medical diagnosis of sexual abuse in 127 …