All paediatricians and health professionals working with young children need to be aware of the potential for child abuse to be a cause of physical injuries, such as fractures. Clinical experience, Serious Case Reviews and research show us that maltreatment should be kept in mind, in order for investigations to be carried out where appropriate and to prevent further harm. Whilst accidental fractures are common, fractures may also be the sentinel injury that alerts professionals to the possibility of child abuse, presenting clinically or detected as an occult injury on imaging for other reasons or when investigating a case of suspected maltreatment. The health professional evaluating a child with any fracture should be aware of features that raise the suspicion of abuse as a cause and be familiar with current recommendations for further investigations. This article outlines the current research concerning abusive fractures in children. It offers guidance on how to optimize radiological investigations and avoid common pitfalls in clinical practice.