CHILD ABUSE IS DEFINED AS 'PHYSICAL OR PSYCHOLOGICAL TRAUMA INFLICTED OR PERMITTED BY A PARENT OR PARENT SUBSTITUTE.' THE SPECTRUM OF ABUSE IS INDICATED TO COVER MULTIPLE BRUISING, DEPRIVATION, NEGLECT, INFANTICIDE, AND SEVERE PSYCHOLOGICAL ABUSE. PHYSICAL ABUSE IS SAID TO BE MOST EVIDENT IN THE EXISTENCE OF MULTIPLE INJURY/MULTIPLE TRAUMA. IT IS INDICATED THAT STUDIES OF BATTERED CHILDREN HAVE SHOWN THAT 80 PERCENT HAD SIGNS OF REPEATED INJURY. THE NATURE OF NEGLECT AND DEPRIVATION IN CHILD ABUSE IS DESCRIBED, AND IT IS ADVISED THAT THE NEGLECTED CHILD IS USUALLY UNCLEAN, HAS DIAPER RASH, AND FREQUENTLY HAS A NUMBER OF SMALL BRUISES. IF THE PARENT IS OBSERVED TO BE DETACHED AND INATTENTIVE WHILE THE CHILD IS BEING TREATED, THIS IS CONSIDERED TO BE, ALONG WITH OTHER EVIDENCE, AN INDICATION OF A PATTERN OF PARENTAL NEGLECT. SOME EXAMPLES OF PSYCHOLOGICAL ABUSE OF CHILDREN ARE ALSO PROVIDED. IN PROVIDING GUIDELINES FOR DIAGNOSING CHILD ABUSE, EMPHASIS IS UPON DETECTING IT BEFORE ABUSE IS SO SEVERE TO BE OBVIOUS EVEN TO A LAYMAN. HISTORY, PHYSICAL EXAMINATION, X-RAYS, AND PARENTAL ATTITUDES ARE DISCUSSED AS THE MAJOR SOURCES OF EVIDENCE OF ABUSE. WHAT TO LOOK FOR AS EVIDENCE OF ABUSE FROM EACH OF THESE SOURCES AND IN COMBINATION IS SPECIFIED IN DETAIL. IN DISCUSSING THE MANAGEMENT OF CHILD ABUSE IDENTIFICATION, IT IS INDICATED THAT THE FIRST STEP SHOULD BE THE SETTING UP OF AN INSERVICE TRAINING PROGRAM FOR APPROPRIATE HOSPITAL PERSONNEL. A SECOND STEP IS TO HAVE AVAILABLE (PREFERABLY 24 HOURS A DAY) A CONTACT PERSON OR TEAM WHO CAN BE CALLED FOR INFORMATION, SUPPORT, OR SCIENTIFIC ASSISTANCE REGARDING A POSSIBLE CHILD ABUSE DIAGNOSIS. THE RECORDING OF THE FIRST HISTORY IN SOME DETAIL IS INDICATED TO BE PARTICULARLY IMPORTANT. PRECISE STEPS FOR PHYSICIANS TO TAKE TO PREPARE FOR ANY LEGAL PROCEEDINGS THAT MAY ATTEND THEIR INVOLVEMENT IN CHILD ABUSE CASES ARE DESCRIBED. SOME STATISTICS INDICATING THE PREVALENCE OF CHILD ABUSE ARE INCLUDED. (RCB)