Increasing medical burden of child abuse

awareness, the numbers of reported (but not proved) cases of abuse to children living in South Birmingham increased thirtyfold; the incidence of detected and proved cases of abuse increased fourfold. The increase was principally due to bruises, scalds, and neglect. The numbers of serious fractures and brain injuries did not increase. The first case of sexual abuse was reported in 1981 and this was followed by a subsequent rise in the detection rate. The combination of increased reporting, increased incidence of proved abuse, and the necessity for increased supervision of families and intervention has created a serious burden on the child health services that may necessitate a reduction in services to other children. Alternative ways of tackling the problems of child abuse may have to be introduced, but they may have unwelcome consequences. Violence against infants and children has been recorded throughout history. Darwin postulated that one could correlate the beginning of human civilisation with the recording of infanticide. ' The reported incidence of child abuse varies with definition and is thought to be always under