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PediagogyAuthor: Lidia Park and Tammy Yau
Pedagogy is the art and science of teaching. In this same regard, Pediagogy was created with the goal of teaching on-the-go medical students, residents, and any other interested learners about bread-and-butter pediatrics. Pediagogy is an evidence-based podcast, reviewed by expert specialists, and made by UC Davis Childrens Hospital doctors. Lets learn about kids! Language: en Genres: Courses, Education, Health & Fitness, Medicine Contact email: Get it Feed URL: Get it iTunes ID: Get it |
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Non-Accidental Fractures
Tuesday, 1 September, 2026
Today we discuss pediatric fractures in the emergency department. We focus on how to identify fractures that may be indicative of child abuse versus those caused by accidental trauma or other medical conditions.This episode was written by UCD pediatric resident Mariama Lei Poquiz, with content support from pediatric emergency medicine and child abuse specialist Julia Magaña and additional help and guidance from pediatric hospitalist Lidia Park. Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at pediagogypod@gmail.comKey points:· Pediatric fractures may be the cause of accidental, medical, or non-accidental causes. Evaluation of pediatric fractures caused by non-accidental trauma can be done by taking a thorough history, a meticulous physical exam, and clinical judgement supplemented by imaging and laboratory data. · While there are no pathognomonic fractures indicative of child abuse, there are high risk features that increase the suspicion for child abuse. Additionally, there are fractures with higher specificity for child abuse than others. These high specificity fractures include those in the ribs, pelvis, scapula, sternum, classic metaphyseal lesions, and long bones in non-ambulatory children. · Toddler’s fractures are accidental fractures that may mimic child abuse. · The radiographic skeletal survey is the standard screening tool for evaluating children under 2 years old who are suspected of being abused. It is important to also do a follow up skeletal survey approximately 2 weeks after the initial one if the first skeletal survey was positive, equivocal, or negative, but with persistent clinical suspicion. These specific findings can be found in the American College of Radiology guidelines. Other work-up can include head imaging and laboratory studies. Sources: Auerbach, M., Coombs, C., Lindberg, D., Magaña, J., Ornstein, A., Sharma, S., & Tiyyagura, G. (2023, October). Bottom Line Recommendations: Child Abuse. Emergency Medical Services for Children Innovation and Improvement Center and Translating Emergency Medicine for Kids. Cindy W. Christian, COMMITTEE ON CHILD ABUSE AND NEGLECT, James E. Crawford-Jakubiak, Emalee G. Flaherty, John M. Leventhal, James L. Lukefahr, Robert D. Sege, Harriet MacMillan, Catherine M. Nolan, Linda Anne Valley, Tammy Piazza Hurley; The Evaluation of Suspected Child Physical Abuse. Pediatrics May 2015; 135 (5): e1337–e1354. 10.1542/peds.2015-0356 Cohen H, Miller S, Levin T, et al. ACR–SPR Practice Parameter for the Performance and Interpretation of Skeletal Surveys in Children. Amended 2023 (Resolution 2c, 2d) Sait S, Havariyoun G, Newman H, Das S, Haque S. Effective radiation dose of skeletal surveys performed for suspected physical abuse. Pediatr Radiol. 2023 Jan;53(1):69-77. doi: 10.1007/s00247-022-05477-6. Epub 2022 Aug 17. PMID: 35974201. Suzanne Haney, Susan Scherl, Linda DiMeglio, Jeannette Perez-Rossello, Sabah Servaes, Nadia Merchant, and the COUNCIL ON CHILD ABUSE AND NEGLECT, SECTION ON ORTHOPAEDICS, SECTION ON RADIOLOGY, and SECTION ON ENDOCRINOLOGY, and the SOCIETY FOR PEDIATRIC RADIOLOGY; Evaluating Young Children With Fractures for Child Abuse: Clinical Report. Pediatrics February 2025; 155 (2): e2024070074. 10.1542/peds.2024-070074 Tibial shaft fractures - pediatric. Orthobullets. Accessed June 12, 2026. https://www.orthobullets.com/pediatrics/4026/tibial-shaft-fractures--pediatric. Toddler fracture | Radiology Reference Article. Radiopaedia. Accessed June 12, 2026. https://radiopaedia.org/articles/toddler-fracture?lang=us. Translating Emergency Knowledge for Kids. (2021, March). Bottom Line Recommendations Pediatric Fractures.
