In infants and toddlers, physical abuse is the cause of 12 percent to 20 percent of fractures.
In a revised clinical report, “Evaluating Children With Fractures for Child Physical Abuse,” in the February 2014 Pediatrics (published online Jan. 27), the American Academy of Pediatrics (AAP) describes recent advances in the understanding of which fractures are suggestive of abuse, how fractures occur, and medical diseases that may make some young children’s bones more likely to fracture.
The report updates a previous report published in 2006. According to the report, rib fractures in infants and toddlers have a high probability of being caused by abuse, as do classic metaphyseal lesions, a type of long bone fracture. Multiple fractures, fractures of different stages of healing, and complex skull fractures have a moderate probability of being caused by abuse. However, any fracture can be caused by abuse, and it’s important for physicians to understand the mechanisms of fractures to determine whether a fracture is caused by abuse or something else. Pre-existing medical conditions and bone disease may make a child’s bones more vulnerable to fracture. It is important for pediatricians to take a complete medical history, family history and social history to determine how an injury occurred. Siblings of children who have been physically abused should also be evaluated for maltreatment.
When evaluating a child with a fracture, the AAP recommends physicians take a careful history of any injury and then determine whether the mechanism described and the severity and timing are consistent with the injury.