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    Infant’s seizures and skull fracture could point to child abuse

     

    Differential diagnosis of skull fractures

    The differential diagnosis for linear skull fractures in children includes trauma, whether accidental or nonaccidental; genetic and/or endocrinologic diseases; and accessory cranial sutures (Table).

    Trauma

    Skull fractures typically result from traumatic events, regardless of whether the mechanism of injury was accidental or nonaccidental. Fractures most commonly affect the parietal bone, followed by the occipital, frontal, and temporal bones. Linear fractures are most common, followed by depressed and basilar fractures.

    In infants and toddlers, fractures may be the sentinel injury in a child abuse case. Each year, more than 650,000 children are substantiated as victims of maltreatment; therefore, it is important for the practitioner to be aware of the possibility of nonaccidental trauma when performing a history and physical exam.1 Multiple fractures in various stages of healing, delay in obtaining medical care, and other injuries of the skin, organs, or other systems are injuries that suggest abusive trauma.

    More: Trauma-informed care helps children in foster care

    Linear skull fractures can be caused by a short fall from several feet onto a hard surface. The majority of linear skull fractures are not inflicted. However, complex or bilateral skull fractures are more suggestive of nonaccidental trauma.2

    NEXT: Discussion

    Zoabe Hafeez, MD
    Dr Hafeez is assistant professor of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston ...
    Mykael Garcia, MD
    Dr Garcia is a pediatric chief resident at St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania.
    Maria D McColgan, MD, MSEd, FAAP
    Dr McColgan is associate professor of Pediatrics at Rowan University School of Osteopathic Medicine, Stratford, New Jersey, and Drexel ...

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