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PEDIATRICS Vol. 112 No. 1 July 2003, pp. 185-188

EXPERIENCE AND REASON

Fractures in Biliary Atresia Misinterpreted as Child Abuse

Patricia A. DeRusso, MD, Melissa R. Spevak, MD and Kathleen B. Schwarz, MD

Department of Pediatrics
Division of Pediatric Gastroenterology and Nutrition
Johns Hopkins School of Medicine
Baltimore, MD 21287
Division of Pediatric Imaging
Russell H. Morgan Department of Radiology and Radiological Science
Johns Hopkins Hospital
Johns Hopkins University
Baltimore, MD 21287
Department of Pediatrics
Division of Pediatric Gastroenterology and Nutrition
Johns Hopkins School of Medicine
Baltimore, MD 21287

Bone fractures in children without a history of injury are highly suspicious for child abuse. Biliary atresia is a disorder associated with metabolic bone disease, and there are numerous reports of osteopenia, rickets, and/or fractures in this population. We report 3 cases of children with biliary atresia who had bony fractures as well as osteopenia whose caretakers were investigated for child abuse. Pediatricians should be aware of an increased incidence of fractures and overall prevalence of bone disease in this population.

Key Words: biliary atresia • osteopenia • fractures • abuse

Abbreviations: ED, emergency department • CPS, Child Protective Services

Received for publication Nov 15, 2002; Revised Feb 6, 2003;
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