In cases of child abuse and neglect, the overall incidence of physical alterations documentable by diagnostic imaging is relatively small. However, imaging studies are often critical for infants and young children with evidence of physical injury, and they also may be the first indication of abuse in a child who is seen initially for an apparent natural illness. As most conventional imaging studies performed in this setting are noninvasive and entail minimal radiation risks, recommendations regarding imaging should focus on examinations that provide the highest diagnostic yield at acceptable costs and should consider their potential use as courtroom evidence of child abuse.