Physical child abuse is a significant social and medical problem within the United Kingdom, and elsewhere. This study considers the role of emergency medical services in the detection of non-accidental childhood injury by examining paediatric attendances at a central London Accident and Emergency department over a two year period. There were 183 recorded episodes of non-accidental injury out of 17,582 paediatric attendances to the A&E department over two years. At bivariate level, non-accidental injury was associated with the age of the patient, and the primary clinical diagnosis groups of wounds, poisoning and burns (p < .01). Attendances by children over the age of 10 years, along with attendances for the treatment of wounds or burns, were statistically significant multivariate predictors of non-accidental injury being recorded in A&E (p < .001). This study shows that about 1 in 100 paediatric attendances at A&E are recorded as non-accidental injury. Young children are less likely to be recorded as non-accidentally injured, compared to adolescents. Health professionals need to be vigilant to the possibility of non-accidental injury for all children using emergency health services.