THE PROGRAM REEVALUATED 25 CHILDREN 3 YEARS AFTER EPISODES OF ABUSE AND FOUND THAT A THIRD OF THE CHILDREN HAD SUFFERED REPEATED ABUSE OR GROSS NEGLECT. IT APPEARS THAT THE SEVERE, PERMANENT DAMAGE ASSOCIATED WITH ABUSE USUALLY DOES NOT RESULT FROM THE INITIAL INCIDENT. DETECTION OF ABUSE AT AN EARLY STAGE OFFERS AN OPPORTUNITY FOR INTERVENTION WITH THE GOAL OF PREVENTING SUBSEQUENT TRAUMA AND IRREVERSIBLE INJURY. THE PROGRAM'S STUDY OF THE DISTRIBUTION OF INJURIES IN TWO GROUPS OF CHILDREN ADMITTED TO THE HOSPITAL EMERGENCY DEPARTMENT INDICATED THAT LACERATIONS AND INGESTIONS, THE MOST COMMON TYPES OF INJURIES, ARE LEAST INDICATIVE OF ABUSE. THESE FINDINGS SUGGEST THAT AN EARLY DETECTION PROGRAM SHOULD FOCUS ON CHILDREN WITH OTHER INJURIES (HEAD INJURIES, BURNS, FRACTURES AND DISLOCATIONS, ABRASIONS AND BRUISES). CHILD ABUSE SITUATIONS REQUIRE A MULTIDISCIPLINARY APPROACH. THE PHYSICIAN SHOULD NOT ATTEMPT TO HANDLE A CHILD ABUSE CASE ALONE, BUT SHOULD HAVE ACCESS TO CONSULTANTS AND TO A COMMUNITY REGISTRY OF CHILDHOOD ACCIDENTS. (SUCH REGISTRIES SHOULD LIST ALL ACCIDENTS, NOT ONLY THOSE IN WHICH ABUSE OR NEGLECT IS SUSPECTED.) ALTHOUGH PHYSICIANS IN PRIVATE PRACTICE DO COME INTO CONTACT WITH ABUSED CHILDREN, IT APPEARS REASONABLE TO CONCENTRATE EARLY DETECTION EFFORTS ON CHILDREN SEEN IN HOSPITAL EMERGENCY DEPARTMENTS FOR INJURIES. FAMILIES FROM ALL SOCIOECONOMIC LEVELS USE THESE FACILITIES, AND THERE IS A TENDENCY FOR FAMILIES WHO NORMALLY USE PRIVATE PHYSICIANS TO BRING THEIR CHILDREN TO EMERGENCY DEPARTMENTS WHEN ABUSE IS INVOLVED. IN THE AREA OF CHILD ABUSE, THE FUNCTION OF THE HOSPITAL EMERGENCY DEPARTMENT SHOULD MOVE BEYOND SOLUTION OF THE IMMEDIATE MEDICAL PROBLEM TO ENCOMPASS PREVENTIVE SERVICES AND RECOGNITION OF THE SOCIAL AND PSYCHOLOGICAL NEEDS OF ABUSED CHILDREN AND ABUSING PARENTS. AN IMPORTANT FACTOR IN PROVIDING SUCH SERVICES IS THE ASSIGNMENT OF SPECIFIC RESPONSIBILITIES TO MEDICAL PERSONNEL AND THE MAINTENANCE OF COMMUNICATION AMONG PHYSICIANS OF VARIOUS SPECIALTIES, NURSES, AND SOCIAL WORKERS. EMERGENCY ROOM PHYSICIANS UNDER SOME CIRCUMSTANCES ARE ADVISED TO CONFRONT PARENTS WITH THE ISSUE OF ABUSE, AND ARE REMINDED THAT CONCLUSIVE EVIDENCE IS NOT A PREREQUISITE FOR REPORTING SUSPECTED ABUSE. A LIST OF REFERENCES IS INCLUDED. (LKM)