Psychomotor retardation, hypotonia, hypopigmentation, pallor, and a sideroblastic anemia are some of the characteristic findings of copper deficiency in infants. In addition, human milk and formula contain sufficient copper to prevent deficiency. 89 This deficiency is not likely to be observed in full-term children younger than 6 months of age or preterm infants younger than 2.5 months of age, because fetal copper stores are sufficient for this length of time. 88 Copper insufficiency may be observed in children with severe nutritional disorders, for example, liver failure or short gut syndrome. Preterm infants are born with lower stores of copper than term infants, because copper is accumulated at a faster rate during the last trimester. Copper deficiency is a rare condition that may be complicated by bone fractures. Child’s Age and DevelopmentĬopper plays a role in cartilage formation. The presence of multiple fractures, fractures of different ages or stages of healing, delay in obtaining medical treatment, and the presence of other injuries suspicious for abuse (eg, coexisting injuries to the skin, internal organs, or central nervous system) should alert the physician to possible child abuse. Certain details that can help the physician determine whether a fracture was caused by abuse rather than unintentional injury include the history, the child’s age and developmental stage, the type and location of the fracture, the age of the fracture, and an understanding of the mechanism that causes the particular type of fracture. 10, 11 Specifically, it is important to recognize that any fracture, even fractures that are commonly noninflicted injuries, can be caused by child abuse.
Although some fracture types are highly suggestive of physical abuse, no pattern can exclude child abuse. 9 Although unintentional fractures are much more common than fractures caused by child abuse, the physician needs to remain aware of the possibility of inflicted injury. 6, – 8 In infants and toddlers, physical abuse is the cause of 12% to 20% of fractures. Differential Diagnosis of Fracturesįractures are a common childhood injury and account for between 8% and 12% of all pediatric injuries. To identify child abuse as the cause of fractures, the physician must take into consideration the history, the age of the child, the location and type of fracture, the mechanism that causes the particular type of fracture, and the presence of other injuries while also considering other possible causes. 2 However, incorrectly diagnosing physical abuse in a child with noninflicted fractures has serious consequences for the child and family. 3 In addition, fractures may be missed because radiography is performed before changes are obvious or the radiographic images are misread or misinterpreted. 3 In children younger than 3 years, as many as 20% of fractures caused by abuse may be misdiagnosed initially as noninflicted or as attributable to other causes. 5 As a result, when fractures are initially evaluated, a diagnosis of child abuse may be missed. 2, – 4 Physical abuse may not be considered in the physician’s differential diagnosis of childhood injury because the caregiver may have intentionally altered the history to conceal the abuse. 1 Failure to identify an injury caused by child abuse and to intervene appropriately may place a child at risk for further abuse, with potentially permanent consequences for the child. 10.1542/peds.2013-3793įractures are the second most common injury caused by child physical abuse bruises are the most common injury. Esposito Evaluating Children With Fractures for Child Physical Abuse. Mehollin-Ray, Maria-Gisela Mercado-Deane, Sarah Sarvis Milla, Irene N. Lukefahr, Robert D Sege, Christopher I.
Hennrikus, and the AMERICAN ACADEMY OF PEDIATRICS COMMITTEE ON CHILD ABUSE AND NEGLECT, SECTION ON RADIOLOGY, SECTION ON ENDOCRINOLOGY, SECTION ON ORTHOPAEDICS, the SOCIETY FOR PEDIATRIC RADIOLOGY, Cindy W.
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