Radiological findings in 563 abused infants and children who were studied retrospectively emphasize the limitations of diagnostic imaging, specifically radiographic examination of the skeleton. Skeletal trauma was detected in less than one-third of all patients and was uncommon beyond two years of age. Fractures were rarely present without clinical evidence of physical abuse. Radiographic features considered specific for child abuse (epiphyseal-metaphyseal, rib fractures) or highly suggestive (occult, multiple/repetitive fractures) were distinctly infrequent and limited to infancy. A more efficacious approach to radiological evaluation based on clinical presentation is offered.