The American Academy of Pediatrics (AAP) has issued updated guidelines to assist medical professionals in diagnosing fractures in children and determining when these injuries might indicate child abuse. Published on January 21 in Pediatrics, the report emphasizes an evidence-based approach to evaluating pediatric fractures, particularly in cases that raise suspicions of abuse.

The guidelines, led by Dr. Suzanne Haney of the University of Nebraska Medical Center, incorporate recent advances in understanding fracture mechanisms, specificity, and medical conditions that predispose children to fractures. These insights are crucial for distinguishing between accidental injuries and potential abuse.

Fractures in nonambulatory children, injuries that don’t align with the provided history, or those lacking any history of trauma are flagged as particularly concerning. Some fracture types also carry high or moderate specificity for abuse, prompting closer examination.

When abuse is suspected, clinicians are advised to perform a thorough physical examination, carefully inspecting all areas of the child’s skin for additional injuries. Gathering a detailed medical and family history is critical to assess for prior injuries or conditions that might make the child more susceptible to fractures. The report also recommends follow-up imaging and laboratory tests to evaluate bone health and support diagnostic conclusions.

The report highlights the challenges of bias in diagnosing and reporting child abuse, urging healthcare providers to be mindful of its influence and to strive for objectivity. Suspected abusive fractures should be reported to child protective services based on reasonable suspicion, adhering to state laws and protocols.

“Optimal assessment of the child with fractures and suspected child abuse requires careful review of the clinical history, a thorough physical examination, rigorous imaging evaluation, and correlation with bone health laboratory studies,” the report states.

One of the report’s authors disclosed affiliations with pharmaceutical companies, including BioMarin, Pfizer, Catalyst, and Alexion.

These guidelines underscore the importance of a comprehensive, evidence-driven approach in identifying and addressing potential child abuse, ensuring that vulnerable children receive the protection and care they need.