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For Release:

1/21/2025

Media Contact:

Lisa Robinson
630-626-6084
lrobinson@aap.org

Careful evaluation is critical to identify if child abuse is suspected or can be ruled out due to other medical conditions.

ITASCA, IL--The American Academy of Pediatrics guides pediatricians on how to evaluate young children with fractures and differentiate between unintentional injuries and the possibility of abuse within a new clinical report.

 “Evaluating Young Children With Fractures for Child Abuse: Clinical Report,” published in the February 2025 Pediatrics (published online Jan. 21), describes fractures as one of the most common injuries from child physical abuse, second only to bruising.

Clinical reports created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics.

“Children can fall and break bones while running, jumping off playground equipment, or crashing while riding bicycles,” said Suzanne Haney, MD, FAAP, lead author of the report and member of the executive committee of the AAP Council on Child Abuse and Neglect. “But there are circumstances that pose a greater concern for abuse.”

 The AAP Council on Child Abuse and Neglect, AAP Section on Orthopaedics, AAP Section on Radiology, AAP Section on Endocrinology, and the Society for Pediatric Radiology collaborated to write the report.

The clinical report describes how to evaluate if a preexisting medical condition such as a metabolic disorder, bone disease or preterm childbirth contributed to the fracture. When assessing a child with fractures and suspected abuse, AAP recommends a careful review of the clinical history, a thorough physical examination, rigorous imaging evaluation, and correlation with bone health laboratory studies. A multidisciplinary evaluation should include a child abuse pediatrician, orthopaedic surgeon, radiologist, endocrinologist, and/or geneticist to help ensure a correct diagnosis of unintentional injury, abuse, or disease process.

AAP also recommends that pediatricians:

  • Be aware of factors that may indicate abuse, such as when a child is nonambulatory or when fractures are not consistent with the history provided or for which no history of injury is given.
  • Closely evaluate all areas of the skin to look for other injuries or indications of a medical condition.
  • Order a skeletal survey for children up to 2 years of age – and up to 5 years in certain situations - to evaluate for subtle fractures that may be missed in a standard X-ray.
  • Report suspected abusive fractures to authorities when there is reasonable concern or suspicion for abuse. Reporting laws are subject to individual state statutes.
  • Be aware that bias is known to exist in child abuse diagnosis and reporting and attempt to limit its effects.

“If abuse is suspected, it is important to provide a thorough evaluation and then report the concern to authorities if there is a reasonable concern for abuse,” Dr. Haney said. “It can also be helpful to enlist other subspecialists in the evaluation. As a child abuse pediatrician, I often will determine that the injury is not the result of abuse and instead consistent with an accident or medical condition.”

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

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