When Is a Fracture Suspicious for Child Abuse?

• No history of injury
• History of injury not plausible—mechanism described not consistent with the type of fracture, the energy load needed to cause the fracture, or the severity of the injury
• Inconsistent histories or changing histories provided by caregiver
• Fracture in a nonambulatory child
• Fracture of high specificity for child abuse (eg, rib fractures)
• Multiple fractures
• Fractures of different ages
• Other injuries suspicious for child abuse
• Delay in seeking care for an injury