Forty-five children admitted to the department of pediatric surgery at Strasbourg (France) from 1980 through 1989 were reported as being possible victims of abuse. The conditions of the hospital admission and nature of the injuries found are analyzed. On the basis of the data in the reports established by social workers and judicial authorities and in psychiatric expert evaluations, the social and familial characteristics of child abuse are defined. Although based on the demonstration of many elements pointing in the same direction, the diagnosis of child abuse remains fraught with difficulty.