CHILD PHYSICAL ABUSE

Broken bones happen to many children at some point during their growing years – and most of these are accidental.

Breaks that could be suspicious are any broken bones in infants. As many as two thirds of fractures in infants are non-accidental. Again this is because until they are mobile they are not usually capable of incurring accidental breaks.

There are some types of breaks in infants that are almost always a result of abuse – such as spiral fractures to the long bones especially the upper leg bone or upper arm bones. These are typically injuries caused by flinging a baby violently.

Infants with spiral fractures can often be left untreated for days and sometimes weeks. They will present as grizzly and difficult to hold and nurse – perhaps screaming during nappy changes – and having difficulty settling and sleeping. If you notice infants displaying this behaviour, particularly if you also notice bruising, and it can’t be explained, then you should note these concerns and report.

Remember with infants you owe an extremely high standard of duty of care. In many cases I investigated these spiral fractures happened in otherwise non-abusive households. They are typically injuries involving parents just “losing it” for a split second. Often parents didn’t even realise they’d caused an injury – or one parent wasn’t aware of the other parent causing the injury – and they were keen to have it attended to by a doctor once discovered. 

A common fracture seen in abuse is a fracture at the end of the long bones often associated with violent jerking or shaking of the child by the limb. Rib, shoulder and sternum fractures can also be suspicious and should be checked for credible explanation.

As with all other injuries, if fractures occur more often than normal or if there are multiple fractures in the one incident – then that raises a suspicion of abuse.