Child abuse and neglect among American Indians is a political as well as a clinical problem, as the victims belong to one cultural group and health professionls who detect maltreatment generally belong to another. Reluctance to diagnose and report child abuse, although universal, is probably more significant in Indian communities for several reasons: unclear reporting practices, possible unfavorable community reaction to reporting of maltreatment, and absence of effective protection and treatment programs, resulting in negative consequences such as separation of children from families. Although each case of child maltreatment must be assessed individually, some general patterns are: non-Indian health and social workers' misunderstanding of traditional childrearing practices; poverty; cultural change with erosion of social supports; situational stress with ineffective social supports; unparented parents (those raised in boarding schools and foster homes, with poor parental role models); alcoholism; divorce; unusual perceptions of children (psychotic or influenced by mythology); handicapped children; and sexual abuse. Health professionals should work cooperatively with other agencies, communities, and parents to deal with child maltreatment through prevention at three levels: primary (provide education to prevent unwanted pregnancy, enhance parental adjustment to pregnancy/parenthood, facilitate parent/child attachment), secondary (early detection of maltreated children), and tertiary (intervention to minimize handicapping effects of child abuse). (MH)