Key Points:

Four of the five people accused of abusing a Rotorua three-year-old have appeared in a packed Rotorua courtroom charged with assault.

The hearing took place in Rotorua District Court's biggest courtroom, which was completely full with standing room only in the public gallery, where about 60 people gathered.

Some 20 members of the media, three uniformed police officers, four detectives and five or six probation officers and court staff were also present.

Last week, 3-year-old Nia Glassie was flown to the children's hospital in Auckland with serious head and abdominal injuries, allegedly caused by months of abuse, which included being put in a tumble dryer.

She remains in a serious condition in Starship Hospital.

Five people, including her step-father and uncle, have been arrested over the alleged abuse.

Michael Curtis, 21, William Curtis, 48, Michael Pearson, 19, and 17-year-old Oriwa Kemp appeared in court today.

Kemp cried throughout the hearing, while Michael Curtis appeared with a black eye.

The group were remanded in custody until August 8, when bail applications will be heard.

Judge James Weir warned the public not to disrupt the procedings in any way. He said there was a "significant degree of public interest" in the case.

"It's most important that this judicial process proceeds fairly without any interruption from anyone," he said.

Any disruption would see mean those responsible would be "immediately removed from court and possibly charged with contempt".

Wiremu Te Aroha Te Whanau Curtis, 17, has also been charged with assault and was earlier bailed to an Auckland address.

The Prime Minister earlier voiced her concern over the issue of child abuse.

A second Rotorua child - a 12-week-old baby - is in the Starship with suspicious head injuries.

The latest baby, a boy, was admitted on Saturday. He was in a stable condition last night.

The cases have prompted a Starship intensive care specialist to describe New Zealand's level of child abuse as a national scandal.

Prime Minister Helen Clark condemned the abuse on TVNZ's Breakfast programme today, and called for people to act when they knew of abuse.

"I cannot believe that a child subjected to that level of horror, sadism, torture -- that nobody knew," she said.

"I can't believe that and people have got to start turning in those who frankly are maiming and killing our children."

Speaking on Newstalk ZB, The PM agreed the Maori abuse figures were concerning but said the problem was one for the whole of New Zealand.

"They (statistics) are not good and that is a cause for Maori to reflect on and I believe act on.

"Us lecturing people won't get the results we need, which is far fewer small children subjected to this sadism, torture and horror that small children in our country have been subjected to."

Helen Clark was asked on Breakfast if sentences needed to be tougher and was given the example of a four and a half year term handed down for the manslaughter of a three year old boy.

In May, a jury found Maine Ngati, 32, and Teusila Fa'asisila, 27, not guilty of murder but guilty of manslaughter of Ngati's son in February last year.

The couple were also found guilty of wilful ill-treatment and a separate charge of manslaughter for failing to provide medical care which could have saved the boy's life.

The PM said: "In light of the horrific nature of those crimes it (the sentence) doesn't seem high at all."

Nia's condition improved yesterday and her father flew from Sydney to be at her bedside.

She had been living with her mother and other whanau members in a house in suburban Koutu.

Dr Liz Segedin, who cares for the small and vulnerable victims, last night said up to one child a month was admitted to the Starship with brain injuries caused by abuse.

"We know it's high; we know it's a national scandal - or should be," she said. "It's extremely distressing when we hear absolute nonsense stories [about what happened to the child] that we know are not true.

"It's hard for the staff but your job in the intensive care unit is to get on and do what we can and look after the children and families as best we can, as we do with any other child."

The extent of the injuries to the Rotorua boy are not known.

An Auckland District Health Board spokeswoman said: "They're non-accidental injuries."

Senior Sergeant Greg Sowter said the Auckland crime squad had been asked to make initial inquiries with the baby's family at the Starship.

"Rotorua is going to be following up on the investigation," he said.

The baby was flown on a Life Flight plane to Auckland, arriving at 5am, and taken by ambulance to the hospital.

A Starship spokesman said last night that Nia was in a serious but stable condition, but refused to say if that meant she was out of a drug-induced coma.

But a visitor to the hospital told the Herald that Nia had smiled and waved at her several times as she walked past her room.

She described Nia as a "nice girl" who had her mother at her bedside.

Nia's paternal grandfather, Glassie Glassie of Tokoroa, said his son, Glassie Glassie jnr, had flown from Sydney on Saturday to be with his daughter. He said the family were going through a hard time and were "not good".

Rotorua MP Steve Chadwick said any violence against children was totally unacceptable, but she cautioned against linking the two cases to the city.

"We haven't had this for a long time in Rotorua," Ms Chadwick said.

"I think when we get two together we can overreact and start to jump to conclusions, rather than looking at them both as cases on their own."

Rotorua Mayor Kevin Winters said child abuse was not a problem just in Rotorua.

"It's not a good way to start the week, it's awful. I'm really saddened that we've been put on the media radar for such horrific child abuse. Yeah, we've had two incidents [in a week] but it's a nationwide problem."

Dr Patrick Kelly, a paediatrician and clinical director of the Starship team that deals with suspected child abuse, has highlighted the high costs of the problem.

"You look at the cost to families - the disruption and heartache - and then on top of that the prosecution costs and the recriminations afterwards."

Children's Commissioner Cindy Kiro was last night also highly critical of New Zealand's levels of child abuse.

"They are shockingly high and completely unacceptable," Dr Kiro said.

"We have known for some time that this has been the case and there is a desire to do something about it, which is great. It requires decent investment in programmes.

- additional reporting: Beck Vass