1. Andrew P. Sirotnak, MD* 2. Tamara Grigsby, MD† 3. Richard D. Krugman, MD§ 1. *Associate Professor of Pediatrics, University of Colorado School of Medicine; Director, Kempe Child Protection Team, The Children’s Hospital and Kempe Children’s Center 2. †Armed Forces Center for Child Protection, National Naval Medical Center, Bethesda, MD 3. §Dean, and Professor of Pediatrics, University of Colorado School of Medicine, Denver, CO After completing this article, readers should be able to: 1. Recognize the 10 commonly identified history elements and risk factors in the presentation of child abuse. 2. Identify the soft-tissue and skeletal injuries that are indicative of physical abuse. 3. Understand the complexity of the presentation of abusive head trauma and the key diagnostic findings. 4. Review the mandated child abuse reporting requirements for medical professionals. 5. Discuss the physician’s role as child advocate in both the identification and the prevention of child abuse. Since the last Pediatrics in Review update of physical abuse of children in 1994, information in the field has exploded. Data regarding diagnosis and treatment of physical abuse, neglect, and sexual abuse of children is more readily available to health care clinicians than ever before through peer review articles, written texts, picture atlases, internet resources, and American Academy of Pediatrics (AAP) educational materials. It is, however, even more difficult for the busy practitioner to evaluate suspected child abuse. According to the federal publication Child Maltreatment 2002 , the rate of childhood victimization was 12.3 per 1,000 in 2002 compared with a rate of 12.4 per 1,000 in 2001. Of nearly 3 million referrals to child protection agencies in 2002, 67.1% were assigned to workers for investigation. Of these assigned investigations, fewer than one third (26.8%) were “substantiated” or “founded” as child maltreatment, reflecting an estimated 896,000 victims. During 2002, 58.5% of victims suffered neglect, 18.6% were physically abused, 9.9% were sexually abused, and 6.5% were emotionally or psychologically maltreated. Children who suffered more than one form of abuse were more likely to be recurrent victims. Children who had been victimized in a prior year also were more likely to experience a recurrence of founded abuse. Children from birth to age 3 years had the highest rates of childhood victimization, and more …