Fractures in infants: one in four is non‐accidental

Abstract

AbstractThe study examines the cause of fractures in infants under a year of age presenting to an Accident and Emergency (A&E) department in order to ascertain the proportion of non‐accidental (NA) to accidental fractures. It also considers whether there were any child protection concerns in either group in the 4–5 years following the fracture. The study involved a retrospective review of notes of infants presenting with fractures over a 2‐year period. Health visitors (HV) completed a questionnaire regarding the well‐being of these children 4–5 years after the fracture occurred. The study identified 28 infants with fractures, seven NA and 21 accidental. Of the seven NA cases, five were diagnosed on presentation but two only on subsequent referral (2 days and 5 weeks later). On second presentation, one of these had more severe injuries. Six of the seven with NA fractures were male, five were less than 4 months of age and in four a skeletal survey revealed other fractures. Information from the HV questionnaire revealed that one of those considered to have had an accidental fracture in infancy was later put on the Social Services child protection register. It was concluded that fractures in infants under a year of age have a high risk of being NA and distinguishing these cases from accidental fractures can be difficult. The younger the infant, the greater the risk of a fracture being NA. A missed diagnosis may result in a child sustaining more severe injuries. A&E departments should have clear guidelines on the assessment of infants with fractures. Liaison with HVs and general practitioners is important to ensure primary care advice on accident prevention and to allow for surveillance regarding possible neglectful care. Copyright © 2003 John Wiley & Sons, Ltd.