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Child Abuse

Skull Fractures

07/31/2006

Question:

can a 8 month old baby,whos seen a doctor since 4 days old have 2 nondepressed skull fractures? can a boy in the 75%cause these fractures? can same boy climb in crib and land on baby and cause a fracture in leg? when dad picked up baby he pulled and twisted leg to see what was wrong .could dad have hurt leg when he picked up baby?children have seen regular doctors and wic people and they say they have seen no signs of abuse. friends and family have seen no signs of abuse. couple is young and on state assistance.they are not married,Ineed some help answering these questions.

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.

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Response by:

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