Twelve cases involved physical abuse and two involved neglect. The median age was 6.5 months (range 24 days to 3 years). Six families (43 percent) had prior protective-service involvement; however, four of the referrals involved a sibling. Only two of the 12 physical-abuse victims had a history of a prior suspicious injury. Clinical and postmortem findings are presented in this article. The cause of death in all physically abused patients was blunt-impact head injury; one also had contributing intra- abdominal injuries. Ten cases were ruled homicides; 12 have come to legal closure that resulted in nine felony convictions. These findings emphasize the role of blunt-impact brain injury in fatal child-abuse cases. Two findings have significant implications for prevention: the paucity of injuries recognized prior to the fatal incident; and among families known to child-protection agencies, the focus was not on the abuse of the child who was subsequently fatally injured. 3 tables and 28 references