Fractures in nonambulatory children that are not consistent with history or for which no history of injury is given are concerning for abuse
By Elana Gotkine HealthDay Reporter
TUESDAY, Jan. 21, 2025 (HealthDay News) — In an American Academy of Pediatrics clinical report published online Jan. 21 in Pediatrics, guidance is presented for the diagnosis of pediatric fractures and assessment of suspected child abuse.
Suzanne Haney, M.D., from the University of Nebraska Medical Center in Omaha, and colleagues reviewed recent advances in the understanding of fracture specificity, fracture mechanisms, and other medical conditions that predispose infants and children to fracture and developed guidelines for evidence-based diagnosis and appropriate evaluations when assessing fractures in children.
The authors note that fractures in a nonambulatory child, fractures that are not consistent with the history provided or for which no history of injury is given, and fractures that have a high or moderate specificity for abuse are more concerning for abuse. For children in whom abuse is suspected, a close examination of all areas of skin to look for other injuries is important. Medical history and family history are important to assess for prior injuries, fracture, or medical conditions predisposing children to fracture. Follow-up imaging is recommended and laboratory evaluation is important. Suspected abusive fractures should be reported to authorities based on reasonable concern/suspicion for abuse and subject to state statutes. Bias exists in the diagnosis and reporting of child abuse; providers should be aware of this bias and try to limit its effects.
“Optimal assessment of the child with fractures and suspected child abuse requires careful review of the clinical history, a thorough physical examination, rigorous imaging evaluation, and correlation with bone health laboratory studies,” the authors write.
One author disclosed ties to BioMarin, Pfizer, Catalyst, and Alexion.
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