If your child has suffered a fracture you will understandably be distressed, upset and concerned. It is important that medical attention is sought if you have concerns that your child may have suffered a fracture. Medical professionals will then be able to appropriately treat any injury. A fracture in itself does not automatically mean that this will be assumed to be non-accidental and children do sadly suffer injuries in the course of everyday life. 

Medical professionals may however become concerned that a fracture could have been caused non-accidentally for a number of reasons. These can include:

• Fractures in am immobile child;
• Fractures of differing ages, particularly where earlier fractures have not been presented for medical attention;
• Metaphyseal corner fractures- medical professionals opine that such fractures may be caused by a “to and fro” manipulation such as shaking, or a twist or pull action;
• Skull fractures- such fractures are likely to have resulted from impact or trauma to the head. Professionals would need to explore whether such trauma occurred as a result of an accident or not; 
• Rib fractures which can be considered to be suggestive of a child being grabbed by the chest or squeezed with force, particularly when present in an infant. The degree of force required to cause such a fracture is not known but is likely to require considerable force over and above normal handling or rough play;
• Spiral fractures- such fractures would not typically result from a fall and are medically considered to be more likely to have resulted from a twisting force. 

Sometimes, there can be medical explanations regarding why a child may suffer fractures or be more susceptible to breaking their bones. 

• Metaphyseal corner fractures in new-borns could be associated with birth trauma such as during a breach presentation;
• Skull fractures can in a small number of cases be caused during birth. It is important to raise with professionals and your solicitor the nature of your delivery, including whether forceps were used, or if there were any concerns raised during the birth; 
• Vitamin D Deficiency
• Ostogenesis imperfecta (brittle bone disease)- this is often hereditary with a family history likely to be present, and is a condition where low bone density is identified make the bones weaker and more prone to fracturing. Skeletal surveys should be carried out to consider whether this condition is present. 

Additionally, even in the absence of a medical explanation for an injury, experts should be instructed to assess whether an explanation provided by the parent of carer could account for the injury occurring accidentally.

Where a fracture has occurred, medical professionals should carry out a number of investigations including imaging requirements. This should include initial x-rays and skeletal surveys and follow up imaging to be completed at 11-14 days. The doctors may also consider using a CT scan or MRI imaging although this is less common due to the associated risks. 

Within care proceedings, we would consider instructing an independent expert to assess the injuries. See our guidance on “Experts” (hyperlink to expert section) for further details.