CASE HISTORIES WERE REVIEWED FOR ALL CHILDREN REFERRED TO THE COMMITTEE FOR CHILDREN AT RISK OF THE ROYAL ALEXANDRA HOSPITAL FOR CHILDREN, SYDNEY, AUSTRALIA, FROM NOVEMBER 1973 TO NOVEMBER 1976. THE CHILDREN WERE USUALLY ADMITTED FOR UNEXPLAINED BRUISES (31 PERCENT), FRACTURES (20 PERCENT), SYMPTOMS OF NEGLECT (18 PERCENT), SUBDURAL HEMATOMATA (11 PERCENT), OR A MOTHER WHO SEEMED UNABLE TO COPE (11 PERCENT). MULTIPROBLEM FAMILIES FROM THE LOWER SOCIOECONOMIC GROUPS PREDOMINATED, REFLECTING THE POPULATION SERVED BY THE HOSPITAL. IN ALMOST ALL CASES THERE WAS A CHRONIC, ONGOING CONDITION LEADING TO THE CRISIS WHICH CAUSED RECOGNITION. OF THE CHILDREN, 28 PREVIOUSLY HAD BEEN ADMITTED TO HOSPITALS WHERE THE ABUSE OR NEGLECT HAD GONE UNRECOGNIZED, 5 DIED UPON FIRST ADMISSION TO THE HOSPITAL, 3 DIED ON A SUBSEQUENT ADMISSION, 2 WERE SPASTIC QUADRAPLEGICS, 1 DEVELOPED HYDROCEPHALUS, AND 1 WAS MODERATELY RETARDED. THE MOTHERS WERE CLUSTERED IN THE YOUNGER AGE GROUPS, WITH 54 PERCENT UNDER AGE 25. JUST OVER 50 PERCENT WERE LEGALLY MARRIED AND 24 PERCENT HAD COMMON-LAW MARRIAGES. MOST OF THE PARENTS HAD BEEN ABUSED AS CHILDREN AND MOST WERE ISOLATED FROM FAMILIES OR COMMUNITY SUPPORT SYSTEMS. THE FIRST CHILD WAS THE MOST COMMONLY ABUSED AND FIRST-BORN MALES WERE AT THE GREATEST RISK OF ABUSE AND NEGLECT. A HIGH PROPORTION OF MOTHERS DESCRIBED PROBLEMS DURING PREGNANCY OR BIRTH AND NEARLY HALF DESCRIBED THEIR CHILDREN AS 'DIFFICULT' OR 'NASTY'. THE DISCUSSION LISTS THE EARLY SIGNS OF CHILD ABUSE AND URGES HOSPITAL PERSONNEL TO BE ALERT. THE STUDY CONTAINS TABLES, REFERENCES, AND CASE HISTORIES OF THE CHILDREN WHO DIED. (GLR)