Fractures believed to be child abuse may be metabolic bone disease
Pediatric Academic Societies’ Annual Meeting 2011
New data suggest that metabolic bone disease, not child abuse, may be the cause of multiple unexplained fractures in some infants.
“Classic metaphyseal lesions, posterior rib fractures and fractures in different stages of healing are thought to be pathognomonic for child abuse,” researchers wrote. “However, we believe these findings can also be seen in metabolic bone disease of infancy.”
To investigate this theory, a radiologist reviewed X-rays of 63 infants with multiple unexplained fractures for features of metabolic bone disease; their fractures were originally considered child abuse. The researchers also searched the patients’ medical charts for the following factors that predispose children to metabolic bone disease: vitamin D deficiency in pregnancy and infancy; decreased fetal bone loading, including intrauterine confinement, malpresentation and maternal use of drugs that cause fetal immobilization; gestational diabetes; and use of drugs that decrease calcium absorption, such as acid-lowering drugs.
Results revealed that, on average, infants presented with fractures at 12.5 weeks of age, with each infant experiencing an average of nine fractures. The researchers identified 171 classical metaphyseal lesions in 42 infants and multiple rib fractures (≥4) in 29 infants. Although the researchers suspected epiphyseal separations in 6% of classical metaphyseal lesions, the majority were clinically silent and healed without callus or periosteal reaction.
X-ray images revealed that features of metabolic bone disease were present in all infants, the researchers said. Seventy-three percent of the pregnancies had evidence of fetal immobilization. Data showed that 52% of the infants tested and 87% of their mothers had abnormally low 25-hydroxyvitamin D levels. Thirteen percent of mothers also had gestational diabetes. The researchers noted that acid-lowering drugs were used by 14% of mothers during pregnancy and in 18% of the infants. Decreased fetal bone loading also occurred during 43% of pregnancies.
These results suggest that physicians should consider metabolic bone disease when encountering infants with multiple fractures, according to the researchers.
“Careful review of the X-rays with attention to the predisposing factors that can impair fetal and infant bone mineralization is critical to avoid an erroneous diagnosis of child abuse,” they wrote. “We do not believe that most [classical metaphyseal lesions] are fractures, but rather are regions of non-mineralized osteoid in healing [metabolic bone disease in infancy].”
For more information:
- Miller ME. Poster 1403.31. Poster session: Endocrinology & diabetes. Presented at: Pediatric Academic Societies 2011; April 30-May 3, 2011; Denver.
Source:
http://www.endocrinetoday.com/view.aspx?rid=83202
My Family are currently in the process of fighting to get our daughter/sister back from DOCS. We first took our daughter to see a paed. after 3 visits to local GP with her presenting with a bleeding mouth. Once at the hospital was told we had to stay in overnight and then they would give her a full skeletal xray which was standard practise. They found multiple fractures, ribs,fingers,thumbs, wrist and head. This was an absolute shock to us as there were no bruising, swelling and her crying which was not obessive or out of control was put down to wind or she was not getting enough breast as I was dual feeding,
She is being tested for OI and we are waiting forthe results, but from this article could this have been a factor? She didnt move at all in the womb, I use to wait anxiously to hear her heart beat, I smoked cigarettes during pregnancy. All this info but how can you prove definitely that you didnt hurt your child?
When fractures are found and there is no bruising, swelling or pain it is an alert that it may be some underlying condition. Yes. OI is a possibility. Osteopenia of prematurity is also a possibility. Small birth weight babies, twins, etc are at risk for bone disease. You should ensure that this too is tested for. If needed you can write medmisonline@gmail.com for a referral to a pediatric radiologist who may be able to assist you.
I have a similar scenario as Debbie. One of my twin grand-daughters choked while feeding and taken to the hospital. They did an x-ray (she did aspirate) and found to have multiple rib fractures. They did x-rays on the other twin and found rib fractures as well. Both twins were taken from us. We were given limited information from the hospital related to which tests they are doing. There was no bruising, swelling or pain. They had a well patient visit two weeks prior. MRI was normal and there were no retinal hemorrhages. During pregnancy my daughter was on bed rest for 30 days in the hospital, had Cholestasis of pregnancy and decreased cord blood flow. I’m waiting for the medical records so I can review.
Your baby may be present with some sign of Rickets. just write me at nl7667@yahoo.com we can talk more
Can you please tell me if you think I am right to see a clinical genetitict? When my son was 1 month old we took him to hospital with a swollen leg, following an xray we were told he had a fracture to the femur. then following a skeletal xray we were also told that he had 3 rib fractures and metaphyseal fractures to his fibula & tibia. still after 21 months we do not know how this as happened apart from the possibility of during normal handling whilst changing the nappy & winding (these are the only areas effected). We have been blamed for this and our son taken from our care. I can not accept this as neither of us harmed our son. There are numerous symptoms to bone disease in our son & family – our son as light blue sclera, had umbilical & inguinal hernia, slight dysmorphic features, degree of hyprtolorism, epicanthic folds, I have osteopenia, grey sclera, vit d of 35, my mother fractured her arm in 3 places after a small fall 60 years ago, she has also put out joints, there is a family history of artheritis & my sister has rhuematoid artheritis (diagnosed when 10 years old), my grandfather had osteoporosis with a crumbing spine and the list goes on……. I would be grateful of any advise you could give!!
Many Thanks
Most definitely you should see a geneticist! The other factors that can cause this is if your child was premature. Rickets and osteopenia of prematurity could be answers.
Please help. We are going through a similar situation. At four weeks old our son seemed to be alot more cranky and did not seem like he was sleeping or eating properly. He started to become very wheezy and seemed to have alot of phlegm in his throat. After the first few hours of noticing this, we brought him to our local hospital. We took him to his family doctor and took him to the hospital three times that week. At one point some milk had spilled and i was nervous that he may have aspirated it. When we went to the hopsital they did two chest xrays and said that he had not aspirated and that he was a perfectly healthy baby. They said that in regards to his throat it was normal for baby to have phlegm and that it would go away eventually. Well on the last day that we brought him to the hospital before he was apprehended, the doctor said that he noticed a rib fracture. But that everything else was perfect. Two hours later police were at our door because we were under investigation of child abuse. Eventually when he was brought to another hospital they said our son had 14 rib fractures and there ‘appeared to be knee fractures as well’ also they said that our son had been phlegmy due to a hole that had perferated in his throat. Now they think that either I or my husband had to have shoved a pen down his throat and that he had been abused. I have arthritits and it runs through both sides of the family. he had jaundice as a newborn i have severe teeth problems. He had a hernia on his belly button and he had a dimple on the base of his back. PLEASE help. We did not hurt our baby. Are there any medical things we can research to provide to our lawyers? And why wont they do the genetics testing that we authorized for. Its been four months.