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Child Abuse

Baby with Skull Fratures

07/31/2006

Question:

We have an 8 month old baby with 2 old skull fractures nothing bad more like eggs. She has been seen by doctors since 4 days old, shes gone to doctor for all shots and extra appointments.The doctors never find fractures or any thing else wrong. Her 2 year old broyher climbs in crib. lands on baby ,the baby cries The dad comes in sees legs look funny ,pulls on leg to see whats wrong. He hears a poping noise andt akes baby to e.r., they claim abuse. Can a 2 year old fall in and hurt a baby? Can a baby boy in the 75% growth rate hit a baby and cause a skull fracture that no one sees but a bruse. These kids have been to the doctors for everything from a cold,cough to thrush and no one has seen any type of abuse. The baby when taken to the E.R. was found with 2 old skull fractures no blood or anything. They were nondepressed skull fractures which her regular doctor never detected. The ER visit was for leg fracture from brother falling and dad pulling. can these things happen even at a 100 to 1 odds?

Answer:

Unfortunately it is difficult for us to answer the question specifically related to your situation without examining the child and seeing the medical record.

What we can say is that skull fractures can be asymptomatic and without a large amount of swelling can be difficult to diagnosis just by looking at the head. Often a history of some type of injury is given (ie a fall) is very helpful and alert us to a possible injury. Typically to diagnosis skull fractures, we need to perform X-rays.

With regard to a fracture in the leg, without knowing the type of fracture and seeing the X-rays of the fracture, it is very difficult to determine a mechanism for the injury. For some types of leg fractures, an accidental injury (twisting or a fall) can cause a fracture. It is very rare to cause a fracture in any child during routine care of a child (ie manipulating the leg to see if there is an injury). Some types of fractures are very concerning for abuse, including some types of leg fractures.

Some fractures may be difficult to diagnosis just by looking at the child.

A 2-year-old can hurt an 8-month-old with a toy. The type of injury that would result would most likely be a bruise or swelling. It would be less common to see more serious injuries such as fractures or serious head injuries.

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Response by:

Robert Shapiro, MD
Professor of Clinical Pediatrics
College of Medicine
University of Cincinnati