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Pediatrics Group Offers Advice on Evaluating Fractures for Signs of Abuse — Physician’s First Watch

Medical News |
January 28, 2014

Pediatrics Group Offers Advice on Evaluating Fractures for Signs of Abuse

By Kelly Young

The American Academy of Pediatrics has published a guide to assessing whether childhood fractures are the result of abuse.

The article, published in Pediatrics, notes that a fracture should be suspicious for child abuse in the following circumstances:

  • There is no history of injury, or the history described is not consistent with the injury sustained.

  • The caregiver provides inconsistent or changing histories.

  • The fracture is in a nonambulatory child.

  • The fracture has a high specificity for child abuse; in infants and toddlers, these include classic metaphyseal lesions and rib, scapular, sternal, and spinous process fractures.

  • There are multiple fractures or fractures of different ages.

  • The child has other suspicious injuries.

  • The caregiver delayed seeking medical treatment.

The article also provides a framework for the medical exam, lab work, imaging, sibling evaluation, and diagnosis.

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