title: Periosteal thickening as a manifestation of trauma in infancy.
abstract: This paper reports the findings in a study of the incidence of periosteal elevation in children and its possible relationship to child abuse. Two separate sets of radiographs of the skeleton of children were taken for a variety of diagnostic purposes. The suspected abuse set consisted of 59 radiographs taken for suspected child abuse. The mean age for all patients examined was 1.22 years whereas, the mean age for patients with cortical thickening was 0.5 years, suggesting that cortical thickening occurs in a relatively young population. Cortical thickening was assessed by reason for examination. A significant difference (p = .05) was detected with 6/8 (75%) of the patients with cortical thickening from the suspected child abuse groups and only 2/8 (25%) of the patients from the seizure-diagnostic category. The two infants who were noted to have periosteal elevation but were not suspected of abuse had experienced unusual circumstances, one was wearing an abduction splint and the other was a severely hypotonic premature. It is our impression that periosteal thickening is not a normal finding in infants and does not represent a consequence of normal infant care practices. In each case in which cortical thickening was detected, there was evidence to suggest that the child had experienced abnormal or rough handling. As a result of these findings, we believe that cortical thickening of the long bones detected on radiograph is an indication of child abuse.
mesh_terms: D000293:Adolescent; D001497:Battered Child Syndrome; D001842:Bone and Bones / Q000000981:diagnostic imaging; D002648:Child; D002649:Child Abuse; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000473:pathology; D006801:Humans; D006984:Hypertrophy; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010521:Periosteum / Q000473:pathology*; D011859:Radiography