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EDITORIALS: Naomi F Sugar Diagnosing child abuse BMJ 2008; 337: a1398 [Full text]

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"Diagnosis" of Child Abuse

Tari L. Cody   (15 October 2008)

Rib fractures

Michael D Innis   (16 October 2008)

"Diagnosis" of Child Abuse 15 October 2008
Tari L. Cody, Judge Ventura, CA 93009 Send response to journal: Re: "Diagnosis" of Child Abuse	I am curious whether medical professionals consider child abuse an appropriate "diagnosis." I have never seen a diagnosis of "intentional car accident" or "intentional gun shot." In situations where a patient is injured in a car accident, the physician may be able to diagnose a broken arm, and even explain what kind of force would be necessary to cause such a break, but never would a physician opine that the cause, reckless driving, is the same as a diagnosis. Gun shot wounds can be medically described in terms of what injuries are seen but a physician would never reach a diagnosis that the gun was intentionally fired. Correct? Child abuse is simply another way to state an intentionally caused injury to a child. Do physicians believe their medical expertise qualifies them to opine that the injuries a child has suffered were "intentional" or "non-accidental" as opposed to simply explaining the injuries and possible manner (e.g., compression, bending, twisting) in which the injuries could have occurred. Thank you. Competing interests: None declared
Rib fractures 16 October 2008
Michael D Innis, Medicolegal Consultant Home 4575 Send response to journal: Re: Rib fractures	Fractures in children are getting curiouser and curiouser. Now squeezing the chests of dead rabbits “has enabled clinicians to state with confidence that squeezing and bending an infant’s chest is the most likely mechanism for posterior rib fractures seen in child abuse” according to Naomi F Sugar (1) who endorses the “ rigorous attempt” of Kemp et al; to draw meaningful conclusions from a diverse and heterogeneous literature on patterns of skeletal fractures in child abuse (2) Before accusing a parent of causing a rib fracture by “squeezing and bending an infant’s chest” consideration should be given to the possibility that malabsorption of Vitamin K (3)caused a failure of mineralization osteocalcin and matrx Gla proteins in bones making them susceptible to spontaneous fracture (4,5). References 1.Naomi F Sugar BMJ 2008;337:a1398 2.Kemp AM, Dunstan F, Hamson S et al; Is this fracture due to child abuse? BMJ 2008;337 3. Kumar R, Marwaha N, Marwaha RK et al; Vitamin K deficiency in diarrhoea.Indian J Pediatr 2001;68:235 -8 4. Vermeer C, Knapen MHJ, Schurgers LJ. Vitamin K and metabolic bone disease.J Clin Pathol 1998;51:424-426 5. Innis MD. Vitamin K Deficiency Disease Jour Orthomol Med 2008;23:15-20 Competing interests: As prviously declared