When Its Just a Bump on the Head: Interpreting Skull Fractures in the Context of Child Maltreatment
5-month-old presents to ED after reported fall off bed. No other stigmata of abuse.
Accessible Version
I present this case as an illustrative example of the challenges that these cases pose and to present some of the literature that informs an approach to how to think about skull fractures. This is the 3D CT reconstruction of a 5-month- old presenting to the emergency department after a reported fall off of a bed. In this case, the child looks otherwise healthy and has no other stigmata of abuse including no bruises or subconjunctival hemorrhages.
Of course it will be helpful and important to know the circumstances surrounding the fall including, the developmental level of the child, height of the bed, surface of the floor and how the caregivers responded to the fall. But before any of this information is known, do we have a level of concern for abuse, and would you be inclined as a medical provider seeing this child to report to child protective services based solely on the age of the child and fracture type?
