INTRODUCTION: Child abuse, a pressing medical and social issue in Hong Kong, requires high vigilance for prompt identification and early management. The Mandatory Reporting of Child Abuse Ordinance has recently been gazetted, establishing a mandatory obligation for suspected injury reporting to protect children's rights. This study aimed to describe the incidence and patterns of child abuse in Hong Kong to draw attention to this key issue. METHODS: A retrospective review of all reported child abuse cases admitted to Prince of Wales Hospital over a 10-year period (2014-2023) was performed. RESULTS: In total, 503 cases of child abuse were retrieved from the hospital's electronic system, revealing an increasing trend over the years. Of these cases, 341 cases (67.8%) were attributed to physical abuse. Most cases involved trivial soft tissue injuries, apart from two limb fracture cases, which represented 0.4% of all reported child abuse cases (n=503) and 0.6% of all reported physical child abuse cases (n=341). Abusive head trauma (n=3) constituted 0.6% of all reported physical child abuse cases and 0.9% of all reported child abuse cases. Two cases of severe abusive head trauma required paediatric intensive care, and one case warranting neurosurgical intervention subsequently exhibited gross motor delay. CONCLUSION: Most child abuse cases in Hong Kong present with minor clinical manifestations. Imaging evidence of skeletal or neurological injury is present in a small proportion of patients. Abusive head injury is uncommon but carries far-reaching consequences; early recognition is essential to protect affected children from further harm. Paediatric radiologists play a pivotal role in making the diagnosis.