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This is the first of two linked papers. It examines the main changes in approach to child sexual abuse that have occurred since the events in Cleveland 20 years ago. Comparison between estimated prevalence rates and registrations for sexual abuse suggests that we are aware of only the tip of the iceberg. It is argued that in many cases uncertainty may have to be accepted, and that protection may be better achieved through a protective parent than through the child protection system. Clinical examples of cases presenting to a specialist child and adolescent mental health service are given. It is argued that, although society is now more willing to recognise the existence of child sexual abuse and professionals are better at dealing with families, outcomes for this group of children are not much improved. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]