Thank you for your letters regarding the cover art on our October issue [13]. The BCMJ Editorial Board and the authors of the two-part series on child maltreatment agree that this image is very disturbing. But the issue of child maltreatment is equally unpleasant. The cover image is meant to draw attention to this topic so that as physicians we remain ever vigilant in protecting our youth. The image was based on a humanely staged photo, which was then computer manipulated to create the disturbing facial expression. 
—ED.