This chapter describes the criminal justice framework in relation to familial sex offences, and then examines available statistics on familial rape and abuse of children. It investigates the case of Mr X, named by the media as 'the British Fritzl', including the findings from a serious case review into how the abuse could continue for so long within the family, and finally two approaches to preventing or responding to familial rape and abuse are outlined. Familial rape and abuse of adults within the family is thought to be less common, but when it does happen it is no less damaging. The chapter outlines two possible responses, one that is directly at children and other that is controversial but could offer some sense of justice for adult survivors of child sexual abuse. It shows that knowledge is lacking about the prevalence of familial rape and abuse and there is a lack of up-to-date knowledge generally on child sexual abuse.