Step one involves acknowledging the possibility of abuse. This means that health practitioners must be willing to consider child abuse for any of their patients when the history and medical circumstances suggest it. Adherence to a proven system for recognizing medical evidence of child abuse is a recommended standard of practice for health-care providers. Step two is to recognize a patient history that does not match findings. A history suggestive of possible child maltreatment includes no explanation for significant trauma, inconsistency, changes with the retelling of how trauma happened, parental blame of the child or someone else for the injury, and suggestion of neglect and/or lack of supervision. Step three is to recognize medical evidence of possible abuse. This chapter's description of such medical evidence focuses on cutaneous injuries, skeletal injuries, syndromes of abuse, and medical evidence of sexual abuse, as well as other findings suggestive of possible child maltreatment. Step four involves evaluating the child for possible abuse. Such an evaluation encompasses the child's medical history, the caretaker's explanation for any injuries, a physical examination, and an ancillary evaluation. Screening should also address developmental, behavioral, emotional, and dental problems. Attention should be given to areas of injury for pattern or shape, evidence of healing or delayed care-seeking, and possible alternative explanations for injuries. The chapter focuses on the head, eyes, and mouth; the musculoskeletal system; genitals and anus; and laboratory testing. Step five focuses on reporting suspicions of abuse and referral. This section advises that medical suspicion rather than proof of abuse is the basis for a report. The appropriate agencies will conduct a comprehensive investigation of the family situation that is beyond the scope of the medical practitioner's practice. 17 references