9 Although unintentional fractures are much more common than fractures caused by child abuse, the physician needs to remain aware of the possibility of inflicted injury. 6, – 8 In infants and toddlers, physical abuse is the cause of 12% to 20% of fractures. Differential Diagnosis of Fracturesįractures are a common childhood injury and account for between 8% and 12% of all pediatric injuries. To identify child abuse as the cause of fractures, the physician must take into consideration the history, the age of the child, the location and type of fracture, the mechanism that causes the particular type of fracture, and the presence of other injuries while also considering other possible causes. 2 However, incorrectly diagnosing physical abuse in a child with noninflicted fractures has serious consequences for the child and family.
3 In addition, fractures may be missed because radiography is performed before changes are obvious or the radiographic images are misread or misinterpreted.
3 In children younger than 3 years, as many as 20% of fractures caused by abuse may be misdiagnosed initially as noninflicted or as attributable to other causes. 5 As a result, when fractures are initially evaluated, a diagnosis of child abuse may be missed. 2, – 4 Physical abuse may not be considered in the physician’s differential diagnosis of childhood injury because the caregiver may have intentionally altered the history to conceal the abuse. 1 Failure to identify an injury caused by child abuse and to intervene appropriately may place a child at risk for further abuse, with potentially permanent consequences for the child. 10.1542/peds.2013-3793įractures are the second most common injury caused by child physical abuse bruises are the most common injury. Esposito Evaluating Children With Fractures for Child Physical Abuse. Mehollin-Ray, Maria-Gisela Mercado-Deane, Sarah Sarvis Milla, Irene N. Lukefahr, Robert D Sege, Christopher I. Hennrikus, and the AMERICAN ACADEMY OF PEDIATRICS COMMITTEE ON CHILD ABUSE AND NEGLECT, SECTION ON RADIOLOGY, SECTION ON ENDOCRINOLOGY, SECTION ON ORTHOPAEDICS, the SOCIETY FOR PEDIATRIC RADIOLOGY, Cindy W.
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