The authors propose that theoretical confusion and clinical inadequacy regarding child abuse is due, in part, from medical and legal ambiguity concerning child abuse and from dilemmas surrounding social policy and the professional response toward families and children. The dilemmas of social policy (family autonomy versus coercive intervention) and professional response (compassion versus control) are explained and discussed. Problems with the medical and legal responses to child abuse are reviewed. Outlined are several areas for potential conflicts between medical and legal perspectives, including the importance of the abuser's mental state and the seriousness of the injury. The selective ascertainment of marginal families for the attention of child protection professionals is discussed in relation to the social construction of medicine and law. Guidelines are offered to minimize the abuse of power of the professional definers. (Author/SBH)