THE ROYAL CHILDREN'S HOSPITAL IN MELBOURNE, AUSTRALIA HAS HAD EXTENSIVE EXPERIENCE WITH MALTREATED CHILDREN. THESE CHILDREN WHO ARE FIRST SEEN IN CHILDREN'S HOSPITALS ARE GENERALLY UNDER 3 YEARS OF AGE. THE MOTHER IS USUALLY RESPONSIBLE FOR INFLICTING INJURIES. MALTREATMENT OCCURS IN ALL SOCIOECONOMIC GROUPS. MOST PARENTS WHO INJURE THEIR CHILD ARE NOT BASICALLY CRUEL PEOPLE WHO INTENTIONALLY WANT TO KILL OR HURT THEIR CHILD. SOME MOTHERS WHO MISTREAT THEIR CHILDREN HAVE OTHER CHILDREN MAKING PHYSICAL AND EMOTIONAL DEMANDS ON THEM OR HUSBANDS WHO GIVE THEM NO REAL SUPPORT IN THE RAISING OF CHILDREN. FOUR COMMON FINDINGS OF THE ROYAL CHILDREN'S HOSPITAL ARE THAT: (1) MOST PARENTS WHO ABUSE THEIR CHILDREN HAVE BEEN ABUSED THEMSELVES, PHYSICALLY OR EMOTIONALLY; (2) PARENTS TEND TO REVERT TO CHILD-REARING METHODS THEY HAVE EXPERIENCED, ESPECIALLY UNDER STRESS, EVEN WHEN THEY CONSCIOUSLY REJECT THESE METHODS; (3) PARENTS WHO ABUSE THEIR CHILDREN HAVE VERY LOW FEELINGS OF SELF-WORTH; AND (4) EXPECTATIONS OF CHILDREN ARE OFTEN UNREALISTIC AND INAPPROPRIATE TO THE CHILD'S AGE. ACCORDING TO UNIVERSITY OF COLORADO STUDIES, FACTORS INTERACTING IN ABUSIVE PATTERNS ARE A PARENT WITH A POTENTIAL TO ABUSE, A CHILD WHO IS DIFFERENT OR SPECIAL IN SOME WAY, SOME FORM OF CRISIS, AND A PARENT WHO DOES NOT HAVE SOMEONE TO TURN TO WHEN HE OR SHE FEELS THEY ARE LOSING CONTROL. MEDICAL PERSONNEL IN GENERAL AND HOSPITALS IN PARTICULAR HAVE IMPORTANT RESPONSIBILITIES WITH REGARD TO DIAGNOSIS AND ASSESSMENT. THESE RESPONSIBILITIES ENCOMPASS INITIAL CONTACTS, THE SAFETY OF CHILDREN, AND THE IDENTIFICATION AND USE OF RESOURCES (SOCIAL WORKERS, SUPPORT SERVICES, PARENT AIDES, MATERNITY AND CHILDREN'S HOSPITALS, ANTENATAL CARE, INFANT WELFARE, SERVICES FOR DEPRESSED OR ISOLATED MOTHERS, PARENTS ANONYMOUS, TEACHERS, EMERGENCY CARE, AND HOME HELP). POSSIBLE ALTERNATIVES TO PARENTAL CHILDREARING IN CASES OF ABUSE ARE CONDITIONAL DISCHARGES, THE USE OF A CHILD'S ADVOCATE, THE TERMINATION OF PARENTAL RIGHTS, AND ADOPTION. AT THE TIME OF THIS WRITING, CRITERIA ARE NOT AVAILABLE TO DISTINGUISH THE INADEQUATE PARENTS WHO, WHEN APPROPRIATE HELP AND SERVICES ARE AVAILABLE AT APPROPRIATE TIMES, CAN MEET THEIR CHILDREN'S NEEDS FROM THOSE WHO CAN NOT. THE NEED FOR EVALUATION OF SERVICES IS STRESSED. REFERENCES ARE INCLUDED. (DEP)