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