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A new clinical report by the American Academy of Pediatrics offers guidance for diagnosing fractures in children and assessing potential child abuse. The report, published online in the journal Pediatrics, was authored by Suzanne Haney, M.D., from the University of Nebraska Medical Center in Omaha, and colleagues.
The authors reviewed recent advances in understanding fracture specificity, fracture mechanisms, and other medical conditions that make infants and children more prone to fractures. They developed guidelines for evidence-based diagnosis and appropriate evaluations when assessing fractures in children.
Signs That May Indicate Child Abuse
The report highlights several signs that may indicate child abuse, including:
- Fractures in a child who is not yet walking
- Fractures that are inconsistent with the reported history of injury or for which no explanation is provided
- Fractures with a high or moderate likelihood of being caused by abuse
For children suspected of being abused, the authors recommend a comprehensive examination of all skin surfaces to check for other injuries.
Importance of Medical and Family History
The report emphasizes the importance of obtaining a detailed medical and family history to identify any prior injuries, fractures, or medical conditions that could predispose a child to fractures. Follow-up imaging and laboratory tests are also recommended.
Reporting Suspected Abuse
The report states that suspected child abuse should be reported to the authorities based on reasonable suspicion and following state guidelines. The authors acknowledge the existence of bias in diagnosing and reporting child abuse and urge healthcare providers to be aware of this bias and strive to minimize its impact.
Careful Evaluation is Key
“An optimal assessment of a child with fractures and suspected child abuse requires careful review of the medical history, a thorough physical examination, rigorous imaging evaluation, and correlation with bone health laboratory studies,” the authors write.
One of the report’s authors disclosed financial ties to several pharmaceutical companies.
Source:
- Suzanne Haney et al, Evaluating Young Children With Fractures for Child Abuse: Clinical Report, Pediatrics (2025). DOI: 10.1542/peds.2024-070074
