CSA is defined as "any sexual activity with a child when consent is not or cannot be given." CSA is a crime under the laws of all States. Also, every State mandates that professionals who work with children, including physicians and nurses, report suspected CSA to child protection agencies. Barriers to reporting CSA include inadequate knowledge and training related to CSA, lack of confidence in the evidence collected, fear of harming the child and/or family, lack of confidence in the ability of the social service agency to deal with the investigation, concerns about interacting with the legal system, loyalty to the family, and the belief that an accusation might lead to undesirable consequences. The American Academy of Pediatrics (AAP) and the American Professional Society on Abuse of Children recommend that screening for abuse (physical or sexual) be incorporated in every well-child visit. Guidelines for deciding whether to report suspicions of CSA are provided by the AAP. Currently, there is no evidence-based CSA screening tool. Further research is required for the development and validation of CSA screening techniques. Relevant studies have consistently found that health-care providers are generally deficient in knowledge and training regarding screening for CSA and when findings warrant a report to child protective services. In the absence of an evidence-based screening tool, health-care providers should at least cultivate an alertness to the potential for CSA and stay current on psychological, behavioral, and physical signs of abuse. 1 table and 21 references