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Infants with Rib Fractures– Abuse or Not?

Rib fractures in infants does not always mean that the parents were abusive or committed a crime.

By Attorney Elisabeth K.H. Pasqualini, Child Abuse Defense Lawyer, Harrisburg, PA

Our firm has dealt with many cases where parents have been labeled as “abusive” by child protective services or children and youth services (“CYS”) in Pennsylvania or even criminally charged by the police. One thing is certain, the occurrence of rib fractures in infants does not always mean that the parents were abusive or criminally negligent, reckless or otherwise liable.

This is different than what the examining doctor for child protective services will advise the parents. They will examine the child for a chest cold, for instance, have a radiograph (x-rays) done to determine the significance of the cold– is it pneumonia, bronchitis, a cold or something else? But, in so doing, they will find the occurrence of several existing or healing rib fractures. Immediately, the anxiety that the parents had for their infant will now be constrained to themselves and whether they will be labeled as “abusive parents” on a CYS indicated or founded report. The parents will be questioned by the medical staff, a caseworker and even the police. What happened here? Did you squeeze the baby too hard? Did you compress the child’s thoracic cavity by sitting on him/her, squeezing him/her too hard? Make no doubt– no explanation will satisfy them. Further, they will undoubtedly come to the conclusion that this was abuse, you were the perpetrator (you were the only ones caring for the infant) and that the child(ren) should all be taken from you– even the ones that didn’t have signs of injury.

What’s the reality about healing rib fractures in infants?

  • They can be caused by a bone disease, often associated with low Vitamin D, which occurs at birth. A mother’s milk simply does not contain enough Vitamin D for the child. Further, supplements, such as Similac®, Enfamil®, Gerber Good Start®, and Earth’s Best® are not sufficient to provide sufficient Vitamin D. What types of bone diseases?
  1. Ehlers-Danlos syndrome type III/Hybermobility syndrome;
  2. Rickets; and
  3. Metabolic Bone Disease
  • Rib fractures do not typically occur in infants. Why not? An infant’s ribs are made of cartilage and they have not yet ossified or hardened into bone. Think about the amount of force needed to “break” a green twig. Now, apply that thinking to an infant’s ribs. You cannot do it, can you? Not without twisting the twig many times. Now, let’s apply that thought to actually breaking an infant’s ribs by compressing them. Would the baby still be alive? You’ve used enough force to essentially break or snap the unbreakable twig. But, the infant’s internal organs, such as heart, lungs, kidney, spleen, liver are all still functioning? Further, there’s no contusions, abrasions, scrapes, bruises on the external skin. Does this really make any sense? It doesn’t. Trauma experts report that multiple rib fractures due to trauma sufficient to fracture multiple ribs cause death or internal injuries over 90% of the time.
  • Bone deficiencies should not be tested for using x-rays. Any radiologist that’s worth their salt will tell you that they cannot test for a bone disease using x-rays. The only way to do it is with a bone biopsy or tissue sampling. Further, it’s relatively simple and painless to do. That’s the gold standard. Not an x-ray. In fact, radiologists missed rickets as a cause of rib fractures about 80% of the time.
  • The ribs are not displaced. What’s that mean? If one used the force necessary to break or fracture infantile ribs, wouldn’t it stand to reason that the ribs would become misaligned at the point where they were fractured? Ribs 3, 5, and 7, for instance wouldn’t be in a straight line anyone. But, the x-rays that were done still show that they are; how can that be? It’s because they were never fractured to begin with– rather, it’s a sign of a metabolic bone disease. A disease that had occurred at some point in the past and is now healing because the child’s Vitamin D levels are now sufficient to heal the bone. Doesn’t that make more sense? But, the “experts” are going to tell you “that cannot happen. My conclusion is right. This child has been abused.” Who pays them to say that? Certainly, not a defense lawyer.

If you’ve been accused of aggravated assault on an infant, endangering the welfare of a child, or any type of abuse of a child by CYS or the police– call an attorney. Do not let their experts, the caseworker or the police talk you into taking the fall for something you didn’t do.

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