A major problem has developed in England that may have profound effects on the practice of pediatrics, particularly in relation to identification of child abuse. Two pediatricians, Dr Marietta Higgs and Dr Geoffrey Wyatt, working in Cleveland, England, identified a series of children as potential victims of child abuse. In so doing, they relied heavily on a sign described by Hobbs and Wynne1 in Lancet in 1986, reflex anal dilatation. This sign is elicited by stroking the skin near the anus and observing dilatation instead of puckering. The claim is made that such dilatation reflects anal penetration, hence sexual abuse of the child in question. The two pediatricians claim that the sign was only part of their assessment, and that other signs and historical data were also used in their diagnosis. The public claimed otherwise.
The problem became a public issue when the number of patients identified as being