THE PAPER EXPLAINS THE PROGRESSION FROM ADMISSION OF THE ABUSED CHILD TO A HOSPITAL, REFERRAL OF HEAD INJURIES TO THIS NEUROSURGEON'S DEPARTMENT, AND DIAGNOSIS OF THE CHILD'S INJURIES. IT IS DURING DIAGNOSIS, AND THE STEPS PRECEDING IT, THAT THE CLUES TO THE EXISTENCE OF CHILD ABUSE ARISE. IN ADDITION TO CLUES FROM CLOSE STUDY OF THE INJURY, THE PARENTS' EXPLANATIONS WILL OFTEN BE INCOMPATIBLE WITH EACH OTHER. THE MOST IMPORTANT EFFECT OF THIS PHYSICAL ABUSE IS LIKELY TO BE INJURY TO THE BRAIN. IT IS THEORIZED THAT, WHERE SUCH HEAD INJURY TO THE CHILD HAS BEEN SUSTAINED, THE PARENTS' EMOTIONS ARE LIKELY TO BE VERY INTENSE AND DISTURBING. AT THIS TIME, IT MAY NOT BE PROFITABLE TO GO INTO THE DETAILS OF THE CIRCUMSTANCES WITH THE PARENTS; IT IS MORE USEFUL FOR THE MEDICAL, NURSING, AND SOCIAL STAFFS TO CONCENTRATE ON KEEPING THE PARENTS CLOSELY IN TOUCH WITH THE CHILD'S CONDITION, ITS SIGNIFICANCE, AND TREATMENT. GRADUALLY, THE PARENTS' CONFIDENCE AND TRUST WILL EMERGE. THE NEUROSURGEON'S ROLE IS TO ALLEVIATE SUCH COMPLICATIONS AS BLOOD CLOTS AND 'WATER ON THE BRIAN.' THE NEUROSURGEON ALSO DIAGNOSES FRACTURES OR OTHER BONE INJURIES AND RETINAL HEMORRHAGES, RESULTING FROM PRESSURE WITHIN THE HEAD OR ON THE THORACIC CAVITY, WHICH CAN LEAD TO TEMPORARY OR PARTIAL BLINDNESS. THE GENERAL RECOMMENDATIONS OFFERED ARE: (1) PROMPT RECOGNITION OF ABUSE; (2) PREPARATION OF A PAMPHLET EXPOUNDING THE MEDICAL, NURSING, SOCIAL, AND LEGAL ASPECTS INVOLVED; (3) MAINTENANCE OF A CENTRAL REGISTER RECORDING THE ADMISSION OF CHILDREN WITH CERTAIN FORMS OF DISORDER, WHICH WOULD IMPROVE COMMUNICATION, BE CONFIDENTIAL, AND CONTAIN NO JUDGMENT ABOUT ORIGIN OF REAL OR SUSPECTED ABUSE; AND (4) INVOLVEMENT OF POLICE AUTHORITIES AS SOON AS THERE ARE REASONABLE GROUNDS FOR SUSPECTING ABUSE. HOWEVER, POLICE SHOULD BE ENCOURAGED TO HAVE CONFIDENCE IN THE MEDICAL STAFF'S APPROACH. THE LEGAL DUTY TO INVESTIGATE A CRIMINAL OFFENSE SHOULD NOT INTERFERE WITH LAW ENFORCEMENT'S PURPOSE IN THE CONTEXT OF CHILD ABUSE, WHICH IS PREVENTION AND CURE. (RBS)