Child abuse: we have problems.

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Child abuse exists. This is the paramount problem. According to the U.S. Department of Health and Human Services there were 678,932 cases of child abuse and neglect in the United States in 2013 [1]. Eighteen percent of these children suffered from physical abuse [1]. Many of these children also suffered neglect or sexual abuse. There were 9.1 victims per 1,000 children in 2013 [1]. For infants (<1 year old) the number was 23.1 victims per 1,000 children [1]. The estimated number of deaths from child abuse in the United States in 2013 was 1,520 [1]. In addition to the children who die, many more are left with permanent neurological damage from abusive neurotrauma [2, 3]. The cost of lifetime care for these victims is enormous [4, 5]. In addition to the children who die or are left physically or mentally handicapped, innumerable others suffer psychological injury [6]. Many inhabitants of our prisons were vict ims of abuse as a child [7, 8] . Unfortunately, people who are abused as a child have an increased likelihood of becoming abusers themselves as adults [9]. Child abusers tear families apart — not hospital child protection teams, child abuse pediatricians and governmental child protective services. It’s the abusers. This is a problem. When child abuse occurs within a family unit, there is no easy solution. Regardless of compassionate efforts by professionals to properly care for and protect the child and the family, the abuser’s damage is done and cannot be ignored or quickly repaired. The tales told are heartbreaking. It is very understandable why families are devastated. The proper social and judicial response to many cases of child abuse is debatable. Are the consequences appropriate? Is the child (and other children at risk) adequately protected? Is the outcome in the best interest of the child and the family? Are appropriate measures taken to heal and rehabilitate the family environment? Are criminal charges and sentences appropriate? As a society, these questions need to be continually addressed. As uncomfortable as these questions are, however, there is no justification for denying the very existence of child abuse. Denialism of child abuse is a huge problem that threatens the responsible care of children and families, and it is getting worse. Child abuse denialism is not new. It goes back to the time of Ambroise Tardieu’s work in France in the 1860s [10–12], John Caffey’s seminal paper in 1946 [13, 14] and C. Henry Kempe’s landmark paper in 1962 [15, 16]. Nonetheless, in current times denialism swells. Child abuse denialism has as its base a very small number of physicians who perpetuate false science while ignoring the bulk of the scientific literature and the experience of the overwhelming majority. The child abuse denialists come from various disciplines — radiology, pathology, pediatrics, endocrinology, neurosurgery, emergency medicine, orthopedic surgery, even psychiatry. The names are familiar, they reference one another in the literature and they show up in court, often together and all too frequently. The tactics of denialists are well established: (1) manufacture doubt, (2) identify alleged conspiracies, (3) create impossible expectations of research, (4) use false experts, (5) misrepresent logical fallacies, (6) selectively cite the literature [17–19]. The denialists create the appearance of scientific and medical controversy when, in almost all cases, there is none. Rather than providing clarification, the denialists’ tactics are to confuse judges and jurors, to bias the news media and to mislead the public. * Peter J. Strouse Rad-Ped-Radiol-Journal@med.umich.edu