The purpose of the present study was to identify demographic variables and medical causes of death associated with child deaths, secondary to abuse, at one pediatric hospital. Abuse and neglect reporting forms, social service records, and autopsy reports were reviewed. A total of 72 known deaths occurred between 1965 and 1984. The majority of children were under two years of age, and the most common cause of death was head trauma. Less than one half of the children who died presented to the emergency department with visible signs of injury. Male abusers outnumbered females; boyfriends of the victims' mothers were the most frequent perpetrators. Emergency department personnel should have a high index of suspicion about abuse in cases of inadequately explained conditions in children. All cases of children who die unexpectedly, or from inadequately explained conditions, should be referred to the coroner, and autopsies should be performed.