When Its Just a Bump on the Head: Interpreting Skull Fractures in the Context of Child Maltreatment

Delay in Care


CHAMP Education for Child Abuse Medical Providers

Delayed care seeking is common for minor, but not major, accidental infant and toddler skull fractures. Most followed delayed onset of signs and symptoms. Delayed care seeking alone should not imply child abuse.

REFERENCES:

  • Metz et al 2021

Accessible Version

Delay in care is also often looked at as a red flag for abuse and in certain instances it is; such as in cases of abusive head trauma where the child is symptomatic and care has ben delayed. But given the nature of skull fractures, specifically that the fractures are usually stable and splinted by the surrounding tissue and that the child may have a lot of hair that obscures the soft tissue swelling, delay in care in cases of isolated skull fractures is not necessarily as concerning. That said, if the child is found to have a complex fracture with massive soft tissue swelling and noted to have concussive symptoms for a day or two before presenting to care, that would be much more concerning for either abuse and/or neglect. Short of that, I think that we can’t use delay in care as much in cases where there is an isolated skull fracture to determine level of concern for abuse.