The 1970s saw the rise of shaken baby syndrome diagnoses. In many countries this has led to children placed in custody and parents prosecuted. Child protection services were rapidly established in Anglo-American countries from the 1970s. Often professionals were mandated to report to government authorities on suspicion of child maltreatment, with the definition expanded to include physical, emotional, and sexual abuse and neglect. In the desire to keep children safe, child abuse paediatricians may be reluctant to accept possible non-abuse causes for medical findings. Instead of adversarial child protection systems focused on removal of children to keep them safe from dangerous parents, Nordic and some Continental European countries have a family-support orientation. This views abuse as a problem of family conflict or dysfunction arising from social and psychological difficulties, which will respond to support and help. Out-of-home care is last resort. The way that child abuse is framed influences outcomes for children and their families to a much greater extent than whether or not there is mandatory reporting.