Category: Visual Diagnosis
7d old child presents with difficulty feeding,vomiting one time, and now with intermittent apneic episodes. What's the diagnosis? (Careful....this one is tricky!)
Answer: Workup should include an ALTE and sepsis evaluation PLUS evaluation for non-accidental trauma
Non-accidental trauma (NAT)
NAT is most prevalent in children 0-3 months of age.
Classic metaphyseal lesions, rib fractures, and fractures in various stages of healing are most commonly described in children.
How do we know this is not just birth trauma from a shoulder dystocia, large for gestational age, or difficult vaginal delivery?
Subperiosteal new bone formation appears as a:
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Walters MM, Forbes PW, Buonomo C, and Kleinman PK. Healing Patterns of Clavicular Birth Injuries as a guide to fracture dating in cases of possible infant abuse. Pediatric Radiology. October 2014; 44: 1224-1229