Child abuse is widespread, and abused children who return to the abusive home without sufficient precautions has a 50 percent chance of experiencing continued abuse and a 10 percent chance of being killed. More than half of the perpetrators are parents; others include relatives, babysitters, child care workers, and lovers. Physicians should approach the abused child diagnostically in the same way they do other children. They should take a good history, carefully document explanations for the child's injuries, and give the child a thorough medical inspection. Concealed areas where physical findings can relate to child abuse include the head, the eyes, the mouth, the neck, the abdomen, and the skin. Physicians examining a child for potential sexual abuse must gain the confidence of the child and not be threatening and determine the existence of physical findings of abuse. The diagnosis of emotional deprivation tends to be a diagnosis of exclusion for young children, although the history and physical evaluation are also important. Physicians should also be aware of the possibility of Munchausen syndrome by proxy, in which a parent induces illness in the child. Photographs and 23 references