The pediatrician gives an opinion based on the history, the examination of soft tissue injuries, a general examination of the child, and investigations such as biochemical tests and x-rays. Fractures result from trauma; spontaneous fractures occur only in moderate to severe bony disease that is recognizable radiologically. Fractures in childhood follow weightbearing and ambulation. Fractures also cause pain; caregivers are aware of the trauma and pain and seek help. It is unlikely for metabolic bone disease and physical abuse to be confused in clinical practice. The bone disease osteogenesis imperfecta is a rare disorder; further research is needed to evaluate its clinical aspects. Clinicians recognize physical child abuse on the basis of the history, examination, and medical tests in the context of a social services and police investigation. Tables and 20 references