Sir.—Dr Schmitt1 is to be commended for his concise and thoughtful analysis of a common pediatric problem, the child who cries and refuses to be examined. However, I believe one of his points requires correction.
He correctly identifies prior child abuse as a potential cause of this problem, but states that such children "will be obvious." In fact, he says: "The parent will quickly respond with the correct diagnosis if the child is... an abused child." This may well be true if the child is in foster care, or if (as may have been true for Dr Schmitt's three cases) the identified abuser is no longer involved with the child. It will be far from obvious, however, if abuse is a component of the child's present home situation, especially if it is the abusing parent who accompanies the child to the doctor.
The "Methods" section indicates that, in