BACKGROUND Abuse and/or neglect of children can lead not only to serious health damage but in extreme cases to death. A lethal outcome in the abused child is an incomplete group of seriously damaged children; it, however, makes possible not only numerical comparison but also assessment of trends. The objective of the present work was an analysis of deaths of children who died in conjunction with the use of force in the family. RESULTS The author analyzed a group of 75 children, 47 boys (63%) and 28 girls (37%) aged less than five years: it covers the period of 25 years (1964-1988) and administrative area of the capital of Prague and former Central Bohemian region with a total number of 2 million population. Newborn babies killed by the mother during delivery or immediately after delivery (63 subjects) were not included in the group. According to analysis by age the following number of deaths was recorded in different groups: 0-1 year 45 deaths (60%), 1-2 years 13, 2-3 years 11, 3-4 years similarly as 4-5 years 3 deaths each. The ratio of boys:girls was 47:28. The most frequent cause of death were head injuries (31-41%), followed by suffocation 15x, injury of abdominal organs 6x, intoxications (4x, incl. 3x carbon monoxide), multiple injuries 4x, injuries of thoracic organis 3x, starvation 2x, hypothermia 2x, thermal damage 1x. The findings on necropsy are not useful only for assessing the cause of death, the mechanism of damage and the time when the damage was inflicted but the spectrum of types of damage can help clinical and social workers in the prevention of the battered child syndrome. CONCLUSIONS Child abuse and neglect in families can lead not only to serious health damage but it can be also fatal. In an area with a population of 2 millions in the course of 1964-1988 75 deaths of children aged less than five years were recorded (ratio: 2.5:1 million per year). Mechanical injuries predominate (89%) in particular head injuries (41%).