Child abuse is an all too prevalent disorder showing no signs of subsiding. When injuries from abuse or neglect are severe enough to threaten life or organ system function, the victims are admitted to the PICU for management. In this article, we elucidated aspects of caring for abused children that are unique to this entity. A case was presented that illustrates the complexity of the juxtaposition of social and legal and medical issues that invariably occurs in these situations. A general approach to diagnosis and management of these cases was discussed and several more specific conditions were examined in greater detail. This is an effort to clarify findings specific to abused children and to integrate these with accepted pediatric intensive care practices. Above all, however, we the authors hope to have reinforced the reader's understanding of his or her role as an advocate for these unfortunate children. In guiding them through the labyrinth of medical, social service, and legal systems, we as physicians must not forget their helplessness.