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A shift in attitudes

Imagine you are in clinic. You call your next patient, a toddler, who comes in with his dad.

As the boy totters uncertainly through the door, he turns his face to look across your room. His cheek bears two thick, deep, red and yellow stripes. The wounds extend from ear to nose, and are old enough to have become obviously infected.

You ask the father what happened and he casually replies that the boy had misbehaved a few days earlier. To discipline him, the father struck him twice across the face with a riding crop. Would you see it as potentially difficult to condemn this action, ‘if the family circumstances are stable and loving, albeit somewhat violent’?

This quote comes from a book on the subject of child abuse published in 1985. The case – and its accompanying photograph – are exactly as laid out here.

The past is indeed a foreign country. It’s not my intention to pass Whiggish judgment on the author, who was writing at a time when society’s norms were so different, but rather I marvel at how much our culture has changed.

Last week, I involved a paediatric consultant in a young patient’s case, even though I was fairly certain there had been no abuse. But my patient had returned from nursery with an unexplained injury to his natal cleft and none of us wants to miss another Baby P.

The sickening child abuse cases that have made the press since 1985 have contributed to a broad rejection of corporal punishment – although this had already been gathering pace.

Now, any suspicion of abuse is taken seriously. We are increasingly being asked to report even the most vague feelings that abuse is happening. Failure to act in the above case would, quite probably, lead to uncomfortable discussions with the GMC. This week’s newspapers carry the encouraging news that murder rates are in decline. As murders are so often a family affair, the general shift against tolerating domestic violence is thought to underpin this drop.

Less than 30 years ago, the act of flaying a toddler’s face open presented the family doctor with a difficult dilemma of whether to intervene. In 30 years’ time, which cases from today’s textbooks will be read with the same incredulity?

Dr Nick Ramscar is a GP in Twickenham