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Child Abuse

Spiral Fracture of the Humerus at Daycare



Our son who has been walking for about 3 weeks now, attends daycare. When my husband picked him up from daycare, the provider said that she picked him up, and put him in his highchair. He was crying hysterically for half an hour to 45 minutes before he was picked up by my husband. The next morning, we noticed he was not moving his arm. We went to the emrgency room and found that it was a spiral fracture on his humerus. The Doctor said this is caused by a violent forceful tug. We were wondering if this was something that had to have been done with excessive force or if perhaps when he walked by and if he started to fall was grabbed by his upper arm and it twisted. The emergency room called CPS and a police detective. They are already investigating this as a child abuse case. We feel that noone at his daycare would have purposely hurt our child. Please help. Thank you!


Fractures in infants that occur without a clear explanation regarding the cause should always be investigated by CPS.  The child care center should expect and welcome such an investigation.

It would also be appropriate to have your son examined for other broken bones and unrecognized injuries by obtaining a skeletal survey (x-rays of each on your son's bones) and, if the fracture just occurred, blood work for liver function tests.  Many experts also recommend a CT scan of his head to look for occult head injury.

Spiral humeral fractures need not be abusive and can result from accidental handling or falls.  The incidence of child abuse as the cause of unexplained fractures, however, is very high.  A thorough investigation should be completed to ensure that your son, and other children within the same environment, are not in harms way. 

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Response by:

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