The evaluation of a child for abuse must avoid both false positive and false negative diagnoses. A fracture can occur in a child for reasons other than physical abuse.


Conditions that can cause a fracture in a child:

(1) vaginal delivery (this should clear within a few weeks or months of birth)

(2) accidental trauma

(3) rickets

(4) copper deficiency

(5) congenital syphilis

(6) osteogenesis imperfecta (brittle bones)

(7) osteomyelitis

(8) bone tumor or cyst

(9) osteopenia of infancy

(10) infantile cortical hyperostosis (Caffey's disease)


A child with one of these findings could also be abused, but the diagnosis would need to be substantiated based on other findings.


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