Since the 1970’s reports of child maltreatment in the United States have increased substantially. This increase in reporting is likely due to a number of factors, including changes in the definition of maltreatment over time, better recognition by clinicians and other mandated reporters, and increases in the true prevalence of the problem. While approximately 9 percent of maltreatment reports come from medical settings and the most seriously injured cases are evaluated in hospitals, little information is available about changes over time in the characteristics of children evaluated in these settings. To examine these changes, the researchers compared the medical records of children listed in the child abuse registry of Yale-New Haven Hospital in 1968-1969 and 1990-1991. The first time period was chosen to represent the early hospital-based approach to maltreatment, and the second period to represent a more current approach. The researchers reviewed the medical records of 101 children from 1968-1969 and 107 children from 1990-1991. Cases of sexual abuse were excluded. Analysis of the records found that referrals for nonsexual abuse increased from 80 children per year in the early group to 181.5 per year in the late group. The late group was characterized by a larger number of newborn referrals, 1 percent vs. 52 percent. When non-newborns were compared, the two groups were similar with respect to gender and race, but the late group had fewer patients with insurance, 31 percent vs. 12 percent. The late group also had more female-headed households, 32 percent vs. 67 percent, and more parents with a history of substance abuse, 4 percent vs. 49 percent. Excluding newborns, which were all classified as “at-risk,” the types of problems were classified as abuse (41 percent early vs. 29 percent late), neglect (41 percent vs. 35 percent), and “at risk” (16 percent vs. 35 percent). The study also found that the types of injuries were similar for both time periods: superficial injuries (20 percent vs. 16 percent), burns (9 percent vs. 8 percent), and fractures (6 percent vs. 4 percent); however, fewer maltreated children suffered physical injuries in the late group (71 percent vs. 49 percent). Results of the study show that a substantial change occurred in referrals to the hospital’s child abuse committee for abuse or neglect. Most referrals have become socially high-risk newborns and children or children with minimal injuries. The researchers believe that this shift is likely due to broader definitions of maltreatment and earlier recognition of troubled families by clinicians and health care providers. The early recognition of troubled families highlights the need for effective programs to prevent the subsequent occurrence of maltreatment. References and tables