Child sexual abuse in Leeds before and after Cleveland

We report a retrospective cohort study in which clinical and outcome features of 237 cases of child sexual abuse diagnosed by Leeds paediatricians after Cleveland in 1989 were compared with previously published characteristics of 337 children diagnosed by the same paediatricians before Cleveland in 1985 and 1986. Clinical and diagnostic features also were analysed in two subgroups of the 1989 cohort, those for whom there was no case conference and those in whom further abuse was detected at follow‐up examination. The number of cases diagnosed annually remained high, and source of referrals and age and sex distribution were similar. Most suspected perpetrators were from within the home in both cohorts. Some clinical features of the 1989 cohort suggested more physically severe abuse. In 1989 fewer children were registered as sexually abused, or were taken into care, and fewer suspected perpetrators were convicted. From the 1989 cohort those children for whom there was no case conference tended to be older, to disclose and were abused less severely by someone outside their home as compared to those for whom a case conference was held. The children in whom further abuse was detected tended to be younger, to not disclose. to be more severely abused by a perpetrator within the home and to be taken into care as compared to those in whom further abuse was not detected. One or more case conferences were held for nearly all of the children in whom further abuse was detected. For most of the 1989 children no evidence was found indicating receipt of mental health services from other than the key social worker. Implications of these findings are discussed in terms of professional and public knowledge and attitudes regarding children's and parental rights and family preservation.