title: The etiology and significance of fractures in infants and young children: a critical multidisciplinary review.
abstract: This paper addresses significant misconceptions regarding the etiology of fractures in infants and young children in cases of suspected child abuse. This consensus statement, supported by the Child Abuse Committee and endorsed by the Board of Directors of the Society for Pediatric Radiology, synthesizes the relevant scientific data distinguishing clinical, radiologic and laboratory findings of metabolic disease from findings in abusive injury. This paper discusses medically established epidemiology and etiologies of childhood fractures in infants and young children. The authors also review the body of evidence on the role of vitamin D in bone health and the relationship between vitamin D and fractures. Finally, the authors discuss how courts should properly assess, use, and limit medical evidence and medical opinion testimony in criminal and civil child abuse cases to accomplish optimal care and protection of the children in these cases.
authors.affiliation: Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA. Servaes@email.chop.edu.
authors.forename: Sabah
authors.initials: S
authors.lastname: Servaes
authors.affiliation: Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Brown
authors.affiliation: Department of Medical Imaging, Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
authors.forename: Arabinda K
authors.initials: AK
authors.lastname: Choudhary
authors.affiliation: Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Cindy W
authors.initials: CW
authors.lastname: Christian
authors.affiliation: Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Done
authors.affiliation: Department of Radiology, Children's Healthcare of Atlanta, Atlanta, GA, USA.
authors.forename: Laura L
authors.initials: LL
authors.lastname: Hayes
authors.affiliation: Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Levine
authors.affiliation: Florida International University College of Law, Miami, FL, USA.
authors.forename: Joëlle A
authors.initials: JA
authors.lastname: Moreno
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, NY, USA.
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Palusci
authors.affiliation: Department of Medical Imaging, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Shore
authors.affiliation: Department of Radiology, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Slovis
mesh_terms: D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D032921:Consensus; D005260:Female; D005554:Forensic Medicine; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors; D014808:Vitamin D Deficiency / Q000150:complications*
keywords: Child abuse; Children; Fractures; Infants; Metabolic bone disease; Non-accidental trauma; Radiography; Rickets; Vitamin D