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

Key Points

CHAMP Education for Child Abuse Medical Providers

Skull fractures in children can occur from rather innocuous events.

Not ALL skull fractures are concerning for abuse.

The complexity of the skull fracture does not greatly increase the concern for abuse.

It is necessary to look at the whole picture to determine level of concern for abuse.

Involvement of a child abuse physician can help in the decision making around cases of skull fractures in children.

Reporting to child protective services is not benign.

Accessible Version

What I hope I have relayed to you today is that our understanding of skull fractures and abuse has grown over the years and that we can have a more educated response to skull fractures in infants. We know that not all skull fractures are concerning for abuse and that the complexity of the fracture does not greatly increase the concern for abuse. When evaluating a child with a skull fracture, it is essential to look at the whole picture with the help of possibly a social worker and child abuse physician to determine level of concern for abuse. And of course, we need to remember that making a report to CPS is not benign, and anytime we can be more specific in our concerns and reports to CPS, the less potential harm we may be causing.