Guidelines for looking at children’s injuries

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Doctors are taking a closer look at children’s injuries to identify which ones come from accidents and which ones are from abuse.

The great majority of fractures in children are due to accidents. But some injuries are inflicted, and pediatricians need to be alert to the possibility that a child may have been abused. Failure to identify that may place the child at risk for further abuse, with tragic consequences.

The American Academy of Pediatrics has just published guidelines for evaluating fractures in children. Some features that make it more likely that an injury was deliberate: if a child who is not yet walking has a leg or arm fracture, that may be inflicted. Fractures of the ribs and breastbone are also suspect. If a child has more than one fracture, or fractures and bruises of different ages, or if the story doesn’t match the injuries, those should all alert the pediatrician to the possibility of abuse.

That must be pursued cautiously, because incorrect diagnosis of abuse can have serious consequences for the family.

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