Pulmonary interstitial emphysema

We do think that it is important for every child to have experience of warm physical contact, and we hope that young children of both sexes will continue to be cuddled by parents of both sexes. This contact is the ingredient for healthy development in any child. It has, however, nothing to do with 'sexualisation' of relationships and we entirely agree with Clarke et al on the abusive nature of sexualist parent-child interaction. Simple concepts of power do not quite fit when dealing with clinical issues of sexual abuse of children in the family. We have found it much more helpful to talk about the notion of parental responsibility and structural dependence of the child. Whatever happens between parents and children, parents are responsible for protecting their children and are in any circumstance held responsible for their actions towards the child. This also clarifies the issue that however seductive the child may in fact be, she or he can never in any way be responsible or to blame for the abuse. Child sexual abuse within the family has been brought up mainly by professionals of both sexes and is only now being taken up again by feminists, usually being put on very much the same level as rape. In child sexual abuse there are certainly some cases similar to rape. The presentation and dynamic, however, of long term child sexual abuse within the family has otherwise very different characteristics from those of rape in terms of structural dependence, intergeneration of boundaries, parental care, and issues of trust, as well as violence. The context of dependency on a parent accounts for the fact that actual physical violence is comparatively rare in long term child sexual abuse within the family. This does not, however, mean that we do not find powerful threats of violence and that the abusive interaction may not be as damaging, or even more damaging, than rape is. It makes, however, for a very different form of abusive dynamic and interaction that require different forms of intervention. Finally, we certainly do not have a 'cosy view' of sexual abuse and we regard this statement, among others in the last paragraph, as emotive and unhelpful. Nor do we in any way deny the facts of violence or the threat of violence. On the contrary, these issues were very much behind our taking the suffering of sexually abused children seriously, and starting the present programme. Feedback from the girls and boys involved, and from the parents, has satisfied us that our approach is to some degree helpful. We agree, however, that this approach may have to be modified as our own experience increases and that of others is added. In addition, as we indicated in our paper, careful evaluation will have to be undertaken in future.