The etiology and significance of fractures in infants and young children: a critical multidisciplinary review


This paper addresses significant misconceptions regarding the etiology of fractures in infants and young children in cases of suspected child abuse. This consensus statement, supported by the Child Abuse Committee and endorsed by the Board of Directors of the Society for Pediatric Radiology, synthesizes the relevant scientific data distinguishing clinical, radiologic and laboratory findings of metabolic disease from findings in abusive injury. This paper discusses medically established epidemiology and etiologies of childhood fractures in infants and young children. The authors also review the body of evidence on the role of vitamin D in bone health and the relationship between vitamin D and fractures. Finally, the authors discuss how courts should properly assess, use, and limit medical evidence and medical opinion testimony in criminal and civil child abuse cases to accomplish optimal care and protection of the children in these cases.

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Correspondence to Sabah Servaes.

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Conflicts of interest

Dr. Christian and Dr. Palusci provide medico-legal expert work in child abuse cases. All other authors have no disclosures.

Additional information

This review was endorsed by the Society for Pediatric Radiology Board of Directors on Nov. 29, 2015.

Sabah Servaes, Stephen D. Brown, Arabinda K. Choudhary, Laura L. Hayes, and Joëlle A. Moreno are members of the Child Abuse Committee of the Society for Pediatric Radiology.

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Servaes, S., Brown, S.D., Choudhary, A.K. et al. The etiology and significance of fractures in infants and young children: a critical multidisciplinary review. Pediatr Radiol 46, 591–600 (2016).

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  • Child abuse
  • Children
  • Fractures
  • Infants
  • Metabolic bone disease
  • Non-accidental trauma
  • Radiography
  • Rickets
  • Vitamin D