Purposeful sampling was used to choose five States that represent a range of programs, from well-established to fledgling and nonexistent, as well as a range in functions, from funding of diagnostic services to training. Individuals who were knowledgeable about programs for medical diagnosis of child abuse and neglect were identified for each selected State. Through a series of phone interviews, recorded presentations at two workshops, and written materials, information was obtained on systems for medical diagnosis in each State. The term "medical diagnosis" refers to medical assessment of suspected child abuse or neglect to arrive at a diagnosis. Systems for medical diagnosis refer to programs that are established to foster the process of medical diagnosis. For the two States without statewide programs, regional programs and efforts to create statewide programs are described. Of the five States reviewed, Florida and North Carolina have the oldest and most well-established programs in the country; Oklahoma has statewide training, but no direct services; whereas, Louisiana and Kansas have no statewide services or training for the diagnosis of child abuse. Some of the most salient issues identified in each State, either in the formation or maintenance of a State program for diagnostic services, were related to funding, type and organization of services, and training. Regarding funding, the article recommends joining forces with those organizations with complementary goals and asking for their support when needed, using the media to gain support for child protection services, developing programs that garner the interest of various funding sources, and negotiating standard reimbursement rates for standard services. Regarding services, plan for services for each potentially maltreated child based on selected factors; and establish regional diagnostic evaluation offices. Training recommendations include setting up a central training center, using this center to establish quality assurance mechanisms, ensuring adequate reimbursement for court time as expert witnesses, and using a standardized form to help ensure quality services. 23 references